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Weight Loss After Weight-Loss Surgery: The Mediating Role of Dichotomous Thinking

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Abstract

Purpose

Overly rigid forms of dietary restraint are associated with poorer weight loss outcomes. Dichotomous (“all or nothing”) thinking has been shown to mediate this relationship in non-clinical participants, but this finding has yet to be replicated in clinical samples of individuals who have had weight-loss surgery.

Materials and Methods

A cross-sectional design was used, adopting quantitative questionnaires with 129 individuals who had previously underwent bariatric surgery at least 12 months prior to participation. Bootstrapped mediation analysis was used to establish the mediating role of dichotomous thinking.

Results

Eating-specific dichotomous thinking was shown to fully mediate the relationship between dietary restraint and post-surgical weight loss. In contrast, no mediation effect was found for generalised dichotomous thinking.

Conclusion

Dichotomous thinking specifically about food/eating may play a central role in weight loss maintenance after weight-loss surgery. Pre-surgical assessment of dichotomous thinking, and provision of psychological therapy to think more flexibly about food, is suggested.

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Data Availability

The dataset analysed in the current study, along with code for the statistical analyses, are available from the Teesside University Research Data Repository (https://researchdata.tees.ac.uk), DOI: https://doi.org/10.17632/4cbnfccrsr.1.

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Funding

This study was a doctoral thesis project completed in partial fulfilment of the lead author’s (Dr Chloe Marshall, nee Hole) doctorate in Clinical Psychology and received no form of research grant.

Author information

Authors and Affiliations

  1. Centre for Applied Psychological Science, Department of Psychology, Teesside University, Middlesbrough, TS1 3BX, UK

    Chloe Marshall & Alan R. Bowman

  2. Tees, Esk and Wear Valleys NHS Foundation Trust, West Park Hospital, Darlington, DL2 2TS, UK

    Chloe Marshall

  3. Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland, Tyne & Wear, SR4 7TP, UK

    Robert Reay

Authors
  1. Chloe Marshall
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  2. Robert Reay
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  3. Alan R. Bowman
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Corresponding author

Correspondence to Alan R. Bowman.

Ethics declarations

Ethical Approval

The study was reviewed and approved by the Research Ethics Committee of the host organisation (Teesside University, reference no. 172/18) as well as the Health Research Authority (HRA, reference no. DL/19/ES/0076). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to Participate

Informed consent was obtained from all participants included in the study, who had the option of withdrawing their participation up to 4 weeks after completion.

Conflict of Interest

The authors declare no competing interests.

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Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study was completed in partial fulfilment of the first author’s doctorate in Clinical Psychology.

Key Points

• Dichotomous thinking mediates the link between restraint eating and weight loss in dieters.

• This study replicates these findings in individuals who have received weight-loss surgery.

• Assessing eating-specific dichotomous thinking pre surgery may optimise weight loss outcomes.

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Marshall, C., Reay, R. & Bowman, A.R. Weight Loss After Weight-Loss Surgery: The Mediating Role of Dichotomous Thinking. OBES SURG 34, 1523–1527 (2024). https://doi.org/10.1007/s11695-024-07122-7

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  • DOI: https://doi.org/10.1007/s11695-024-07122-7

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