• affective temperaments
• bariatric surgery
• disordered eating behaviors
• emotional eating
• impulsivity
• obesity
• problematic eating behaviors

Background: Obesity represents one of the main public health challenges of the 21st century, with a prevalence of affected people that has steadily and dramatically increased worldwide over time. Within the context of obesity, disordered eating behaviors play a pivotal role, further complicating the clinical management of this condition and representing a maintaining factor of the disorder. Indeed, evidence from the literature highlights how emotional eating (EE) rates reach up to 65-75% of subjects in overweight or obese adult samples, and how as many as 54% of patients seeking bariatric surgery exhibit symptoms indicative of food dependence. This represents an obstacle for long-term outcome in people with severe obesity, such as weight loss maintenance after bariatric surgery.
Evidence from literature highlighted how pathological overeating may be a manifestation of a disrupted brain reward system, and this has been related to phenotypic expressions characterized by with high emotional dysregulation and impulsivity. The impulsiveness dimension observed in eating disorders and obesity has been accounted for by a deficient top–down cognitive inhibitory control over salience stimuli with a subsequent imbalance between impulsive and reflective systems.
The association between problematic eating behaviors and obesity has been investigated but limited studies have explored the role of affective temperaments as an innate and stable emotion-related traits influencing energy level, mood and responses to external stimuli.
Aim: Considering the above, the aim of this study is to investigate the relationship between emotional eating, impulsivity dimension, and affective temperaments in a sample of obese patients’ candidate for bariatric surgery.
Methods: A total sample of 304 obese outpatients were consecutively enrolled at the Psychiatry Clinic of the Department of Clinical and Experimental Medicine of the University of Pisa between September 2018 and June 2024, during the presurgical mental health evaluation routinely performed before the bariatric intervention in the framework of psychiatric, presurgical and medical assessment. Sociodemographic and clinical data were collected by psychiatrists during a single consultation. Assessments also included the following psychometric tests: the Structured Clinical Interview (SCID-5), the Emotional Eating Scale (EES), the Barratt Impulsivity Scale-Version 11 (BIS-11), and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto-questionnaire (TEMPS-A).
Results: In our sample, a significant correlation was observed between the EES total score and the BIS total score (p=0.003), as well as with the sub-dimensions of attentional impulsivity (p<0.001) and motor impulsivity (p=0.024). In addition, a significant correlation has been found between the total score of EES and the cyclothymic (p<0.001), depressive (p<0.001), irritable (p=0.013), and anxious (0.020) temperaments. When comparing obese patients with (EE) and without (No-EE) emotional eating, higher rates of both current (p=0.007) and lifetime (p=0.024) psychiatric comorbidities have been observed in the EE-group, namely for anxiety disorders (p=0.008) and eating disorders (p=0.014).
Limitations: The cross-sectional study design, the self-reported questionnaires, and the lack of inquire about GLP-1 agonists therapy.
Conclusions: Our study highlights a significant association of emotional eating in obese patients with the cyclothymic-irritable-anxious-depressive temperaments and impulsivity dimension. Thus, problematic eating behaviors and temperamental traits may have a bidirectional psychopathological influence in obese patients, and need to be carefully evaluated in subject seeking for bariatric surgery. Further study with longitudinal design including follow-up after surgery are needed to evaluate the long-term effects on outcome.