• bariatric surgery outcome
• emotional dysregulation
• executive dysfunction
• impulsivity
• mood disorders

The prevalence of obesity has increased globally over the past 50 years, reaching pandemic proportions. Obesity is a chronic, relapsing, and progressive disease with a multifactorial etiology. Psychiatric disorders are highly prevalent among obese patients and often play a crucial role in both the development and progression of this condition. Recent evidence highlights a significant correlation between obesity and different psychopathological dimensions, such as emotional dysregulation, impulsivity, and cognitive and executive dysfunction. Bariatric surgery has been recognized as the gold standard treatment for severe obesity, resulting in substantial and sustained weight loss. However, the variability in postsurgical outcomes has raised concerns regarding the impact of psychopathological factors on bariatric surgery outcomes. In particular, traits like emotional dysregulation and impulsivity, frequently seen in mood and eating disorders, may adversely affect post-surgery weight loss outcomes.
This study aims to assess whether the presence of psychiatric disorders or specific psychopathological traits in bariatric surgery candidates influence two-year postoperative outcomes in a naturalistic setting. Specifically, our hypothesis is that patients exhibiting marked traits of emotional dysregulation and impulsivity, commonly associated with mood and eating disorders, will achieve less weight loss than other patients after bariatric surgery.
A prospective and naturalistic study was conducted on 125 obese patients referred for bariatric surgery at the Obesity Centre of the U.O Endocrinology 1 of Pisa University Hospital between March 2019 and July 2022. Sociodemographic and clinical data were collected during presurgical evaluations, along with an assessment of current and/or lifetime psychiatric comorbidities using the Mini-International Neuropsychiatric Interview (MINI, version 7.0.2). Psychopathological dimensions were further examined through validated questionnaires (WRAADDS, RIPoSt-40). Patients who underwent surgery attended regular follow-up visits over two years. Weight loss was measured using the percentage of excess weight loss (%EWL), with inadequate weight loss defined as %EWL < 50%.
Among the 89 patients who underwent surgery, 48 completed the 2-year follow-up. The average BMI reduction after 2 years was 14.86 kg/m², corresponding to 73.2% of the initial excess BMI. Ten patients (20.8%) presented inadequate weight loss (%EWL < 50%). Suboptimal outcomes were associated with older age (53.60 years vs. 43.58 years; p=0.012), undergoing LSG (90.0% vs. 52.6%; p=0.032), and the presence of mood disorders (p=0.023). Emotional dysregulation, measured through WRAADDS and RIPoSt-40, emerged as a significant predictor of inadequate weight loss.
Psychiatric comorbidities, particularly mood disorders and emotional dysregulation, are key factors influencing the long-term weight loss outcomes in bariatric surgery. The correlation between psychopathology and bariatric surgery outcomes requires further investigation, as future studies could influence clinical interventions.