Predictors of a Healthy Eating Disorder Examination-Questionnaire (EDE-Q) Score 1 Year After Bariatric Surgery
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Bariatric surgery (BS) has been shown to ameliorate health-related quality of life and eating disorder symptoms. However, the correlation of these changes with weight loss is not uniform, suggesting that additional factors have an impact on postoperative outcomes.
To assess the impact of BS on eating disorder symptoms at 1 year postoperatively and to generate predictive models for the achievement of optimal eating behavior.
Retrospective cohort study on a prospectively collected database of all consecutive patients who underwent primary BS in our academic center between January 2015 and March 2017. Eating Disorder Examination-Questionnaire (EDE-Q) was used to measure eating psychopathology. Logistic regression was used to estimate the odds ratio of achieving “healthy” EDE-Q at 1 year. Missing data was handled by multiple imputations for the regression model.
Two-hundred thirty-four patients were included. A complete-case analysis in 135 cases showed a “healthy” EDE-Q in 27.4% at baseline and in 83.7% at 1 year (difference = 56.3%, P = 0.018). Only the baseline EDE-Q “healthy” status influenced significantly the odds of achieving “healthy” EDE-Q at 1 year (OR 6.7, 95% CI 1.18–38.14, P = 0.04).
BS seems to promote successful treatment of self-reported eating disorder symptoms during the first postoperative year. The achievement of optimal results is independent of age, sex, weight loss, obesity-related comorbidity status, surgical technique, or 30-day surgical complications. Future studies, using validated questionnaires specifically designed to investigate eating behavior after BS and/or direct measurements of the eating behavior are needed to clarify the underlying neuropsychologic mechanisms that drive the observed postoperative changes.
KeywordsEating Disorder Examination Questionnaire Eating behavior Bariatric surgery Excess weight loss Predictors of outcome Roux-en-Y gastric bypass
We are grateful to Samuel Aemisegger, clinical male nurse, to Mira Giama, and to the resident doctors of the Department of Surgery, University Hospital Zurich, for their valuable help in the data collection process. We also acknowledge Lukas Frick, MD, for his input in data analysis with the R software and Amy Taheri, PhD candidate, for her help in proofreading.
The study was entirely funded by the assistant-professorship research grant awarded by the University of Zurich to Prof. Dr. med. Marco Bueter, PhD.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and cantonal research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Cantonal Ethics Committee of Zurich approved the study (nr: 2016-00022). For this type of study, formal consent is not required, as it was a retrospective study.
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