• bariatric surgery
• eating disorders
• obesity
• PTSD
• traumatic events

INTRODUCTION: Obesity is an ever-increasing serious disease and a major global health problem. Recent research has demonstrated a link between post-traumatic stress disorder (PTSD) and eating behaviour and obesity, highlighting that the comorbidity of obesity and PTSD is associated with a significant mental and physical health burden. However, despite their significant impact, PTSD symptoms are often underreported in the preoperative assessment of bariatric patients. It should also be born in mind that the current scientific literature indicates that people can show post-traumatic stress reactions that lead to suffering even without a formal diagnosis of PTSD. This argues in favour of a multidimensional approach that takes into account not only the full pathological expression of the disorder, but also minor traumas, subthreshold symptoms, atypical manifestations and personality traits, and that envisages that these factors can also occur in isolation over time and not just as part of a temporally circumscribed clinical syndrome, leading to the concept of the post-traumatic stress spectrum. Given this background, the aim of the study is to investigate the effects of lifetime trauma and post-traumatic stress spectrum in a sample of patients with obesity and candidates for bariatric surgery and to assess their clinical correlates and impact on altered eating behaviour.
MATERIALS AND METHODS: This observational study includes 282 patients with obesity who underwent psychiatric evaluation as part of the preoperative assessment for bariatric surgery at the Azienda Ospedaliero-Universitaria Pisana (AOUP). Socio-demographic and clinical characteristics were recorded using a special data sheet. The post-traumatic stress spectrum and eating behaviour were assessed using the following self-report questionnaires: TALS (Trauma and Loss Spectrum-Self Report), EES (Emotional Eating Scale), EDE-Q (Eating Disorder Examination Questionnaire), EDI (Eating Disorder Inventory), I-YFAS (Italian Yale Food Addiction Scale 2), I-NEQ (Italian Night Eating Questionnaire) and GRAZ (Grazing Questionnaire). Based on the TALS results, the participants were categorised into two groups: no PTSD and at least partial PTSD. A p-value <.05 was considered statistically significant.
RESULTS: The total sample consisted of 72% women, with a mean age of 47.34 years and a mean BMI of 43.23; 69% of participants had a BMI of over 40. A total of 48.2% of the sample reported at least partial PTSD and high mean scores in all domains of TALS. The group with at least partial PTSD showed significantly lower percentage of people in employment than the group noPTSD and a significantly higher percentage of people with a psychiatric diagnosis and on medication. The group with at least partial PTSD showed significantly higher scores than noPTSD group in the global score and in all subscales of the EES, EDE-Q (except Restraint), EDI (except Drive for Thinness and Maturity Fears) and GRAZ. It also has a higher mean score than the total score and the mood/sleep dimension of the NEQ. As for the I-YFAS, a higher percentage of subjects with at least partial PTSD is observed for all symptoms analysed (except Amount, Tolerance and Problems) and for Food Addiction.
CONCLUSIONS: The results of this study show a high prevalence of post-traumatic stress symptoms in candidates for bariatric surgery, particularly when compared to the general population, and suggest an association with altered eating behaviour that could influence the outcome of bariatric surgery. This suggests the need for further studies to develop personalised intervention strategies for bariatric patients.