Skip to main content
Log in

Preoperative body-related emotional distress and culture as predictors of outcomes of bariatric surgery

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Findings concerning the impact of bariatric surgical intervention on both psychological variables and weight loss are often controversial and misconstrued the world over. The aim of this study was to classify bariatric surgery patients according to patterns of preoperative measures that may predict postoperative psychological and physiological outcomes and to compare these patterns between two distinct cultures.

Methods

Of 169 consecutive bariatric surgery candidates from Israel and 81 candidates from the United States, 73 and 35 patients, respectively consented to be included in a follow-up phase. Body image dissatisfaction, emotional eating behaviors, risk of suicide, depressive symptoms, anxious symptoms, and percent excess weight loss were measured. K-means clustering procedure was used to classify bariatric surgery patients according to their preoperative body-related emotional distress, which was composed of body image dissatisfaction and emotional eating. The joint effect of culture and body-related emotional distress cluster on psychological distress was tested.

Results

The cluster analysis revealed two preoperative body-related emotional distress patterns: high body-related emotional distress and low body-related emotional distress. Following surgery, US patients showed a higher risk of suicide and lower excess weight loss than Israeli patients within only the high body-related emotional distress cluster (a significant interaction effect).

Conclusion

Preoperative assessment of body-related emotional distress patterns among bariatric surgery candidates may enable professionals to identify potential postoperative risks of suicide, anxiety, and decreased weight loss. The relationship between the body-related emotional distress cluster and outcome measures is culture dependent.

Level III

Case–control analytic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets generated and analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Notes

  1. The original English version of these questionnaires were translated into Hebrew in previous studies (for details see [22]).

  2. The original English version of these questionnaires were translated into Hebrew in previous studies (for details see [22]).

  3. The original English version of these questionnaires were translated into Hebrew in previous studies (for details see [22]).

  4. We used the validated Hebrew versions of both PHQ-9 [43] and GAD-7 [44].

References

  1. Golzarand M, Toolabi K, Farid R (2017) The bariatric surgery and weight losing: a meta-analysis in the long-and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc 31:4331–4345. https://doi.org/10.1007/s00464-017-5505-1

    Article  PubMed  Google Scholar 

  2. Jumbe S, Bartlett C, Jumbe SL, Meyrick J (2016) The effectiveness of bariatric surgery on long term psychosocial quality of life—a systematic review. Obes Res Clin Pract 10(3):225–242. https://doi.org/10.1016/j.orcp.2015.11.009

    Article  PubMed  Google Scholar 

  3. de Zwaan M, Enderle J, Wagner S et al (2011) Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord 133(1–2):61–68. https://doi.org/10.1016/j.jad.2011.03.025

    Article  PubMed  Google Scholar 

  4. Gordon K, King W, White G et al (2016) A prospective, longitudinal examination of suicidal ideation among bariatric surgery patients. Surg Obes Relat Dis 12(7):44–45. https://doi.org/10.1016/j.soard.2016.08.441

    Article  Google Scholar 

  5. Geller S, Dahan S, Levy S, Goldzweig G, Hamdan S, Abu-Abeid S (2020) Body image and emotional eating as predictors of psychological distress following bariatric surgery. Obes Surg 30(4):1417–1423. https://doi.org/10.1007/s11695-019-04309-1

    Article  PubMed  Google Scholar 

  6. Castaneda D, Popov VB, Wander P, Thompson CC (2019) Risk of suicide and self-harm is increased after bariatric surgery—a systematic review and meta-analysis. Obes Surg 29(1):322–333. https://doi.org/10.1007/s11695-018-3493-4

    Article  PubMed  Google Scholar 

  7. Dawes AJ, Maggard-Gibbons M, Maher AR et al (2016) Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA 315(2):150–163. https://doi.org/10.1001/jama.2015.18118

    Article  CAS  PubMed  Google Scholar 

  8. Sarwer DB, Allison KC, Wadden TA et al (2019) (2019) Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Rel Dis 15(4):650–655. https://doi.org/10.1016/j.soard.2019.01.029

    Article  Google Scholar 

  9. Cheroutre C, Guerrien A, Rousseau A (2020) Contributing of cognitive-behavioral therapy in the context of bariatric surgery: a review of the literature. Obes Surg 30:3154–3166. https://doi.org/10.1007/s11695-020-04627-9

    Article  PubMed  Google Scholar 

  10. Peat CM, Peyerl NL, Muehlenkamp JJ (2008) Body image and eating disorders in older adults: a review. J Gen Psychol 135:343–348

    Article  PubMed  Google Scholar 

  11. Sarwer DB, Bishop-Gilyard CT, Carvajal R (2014) Quality of life. In: Still CD, Sarwer DB, Blankenship J (eds) The ASMBS textbook of bariatric surgery, vol 2. Integrated health. Springer, New York, pp 19–24

    Google Scholar 

  12. Bertoletti J, Galvis Aparicio MJ, Bordignon S, Trentini CM (2019) Body image and bariatric surgery: a systematic review of literature. Bariatr Surg Pract Patient Care 14:81–82. https://doi.org/10.1089/bari.2018.0036

    Article  Google Scholar 

  13. Marks DF (2015) Homeostatic theory of obesity. Health Psychol Open 29:1–30. https://doi.org/10.1177/2055102915590692

    Article  Google Scholar 

  14. Libeton M, Dixon JB, Laurie C, O’Brien PE (2004) Patient motivation for bariatric surgery: characteristics and impact on outcomes. Obes Surg 14:392–398. https://doi.org/10.1381/096089204322917936

    Article  PubMed  Google Scholar 

  15. Ortega J, Fernandez-Canet R, Álvarez-Valdeita S, Cassinello N, Baguena-Puigcerver MJ (2012) Predictors of psychological symptoms in morbidly obese patients after gastric bypass surgery. Surg Obes Rel Dis 8(6):770–776. https://doi.org/10.1016/j.soard.2011.03.015

    Article  Google Scholar 

  16. Muehlenkamp JJ (2012) Body regard in nonsuicidal self-injury: theoretical explanations and treatment directions. J Cog Psychother 26(4):331–347. https://doi.org/10.1891/0889-8391.26.4.331

    Article  Google Scholar 

  17. McGilley BH (2004) Feminist perspectives on self-harm behaviors and eating disorders. In: Levitt J, Sansone R, Cohn L (eds) Self-harm behavior and eating disorders: dynamics, assessment and treatment. Brunner-Routledge, New York, pp 75–92

    Google Scholar 

  18. Guerdjikova AI, West-Smith L, McElroy SL, Sonnanstine T, Stanford K, Keck PE (2007) Emotional eating and emotional eating alternatives in subjects undergoing bariatric surgery. Obes Surg 17:1091–1096. https://doi.org/10.1007/s11695-007-9184-1

    Article  PubMed  Google Scholar 

  19. Walfish S (2004) Self-assessed emotional factors contributing to increased weight gain in pre-surgical bariatric patients. Obes Surg 14:1402–1405. https://doi.org/10.1381/0960892042583897

    Article  PubMed  Google Scholar 

  20. van Strien T, Cebolla A, Etchemendy E et al (2013) Emotional eating and food intake after sadness and joy. Appetite 66:20–25. https://doi.org/10.1016/j.appet.2013.02.016

    Article  PubMed  Google Scholar 

  21. Appelhans BM, Whited MC, Schneider KL, Oleski J, Pagoto SL (2011) Response style and vulnerability to anger-induced eating in obese adults. Eat Behav 12(1):9–14. https://doi.org/10.1016/j.eatbeh.2010.08.009

    Article  PubMed  Google Scholar 

  22. Geller S, Levy S, Goldzweig G et al (2019) Psychological distress among bariatric surgery candidates: the roles of body image and emotional eating. Clin Obes 9(2):e12298. https://doi.org/10.1111/cob.12298

    Article  PubMed  Google Scholar 

  23. Canetti L, Bachar E, Bonne O (2016) Deterioration of mental health in bariatric surgery after 10 years despite successful weight loss. Eur J Clin Nutr 70:17–22. https://doi.org/10.1038/ejcn.2015.112

    Article  CAS  PubMed  Google Scholar 

  24. Bianciardi E, Di Lorenzo G, Niolu C et al (2019) Body image dissatisfaction in individuals with obesity seeking bariatric surgery: exploring the burden of new mediating factors. Riv Psichiatr 54(1):8–17. https://doi.org/10.1708/3104.30935

    Article  PubMed  Google Scholar 

  25. Luomala H, Sirieix L, Tahir R (2009) Exploring emotional-eating patterns in different cultures: toward a conceptual framework model. J Int Consum Mark 21:231–245. https://doi.org/10.1080/08961530802202818

    Article  Google Scholar 

  26. Council SK, Placek C (2014) Cultural change and explicit anti-fat attitudes in a developing nation: a case study in rural Dominica. Soc Med 9:11–21

    Google Scholar 

  27. Puraikalan Y (2018) Obesity: perceptions of body image and obesity among cross culture: a review. Obes Res Open J 5:e1–e2. https://doi.org/10.17140/OROJ-5-133

    Article  Google Scholar 

  28. Geller S, Levy S, Hyman O, Jenkins PL, Abu-Abeid S, Goldzweig G (2020) Body image, emotional eating and psychological distress among bariatric surgery candidates in Israel and the United States. Nutrients 12(2):490. https://doi.org/10.3390/nu12020490

    Article  PubMed Central  Google Scholar 

  29. Latzer Y, Witztum E, Stein D (2008) Eating disorders and disordered eating in Israel: an updated review. Eur Eat Disord Rev 16:361–374. https://doi.org/10.1002/erv.875

    Article  PubMed  Google Scholar 

  30. Safir MP, Flaisher-Kellner S, Rosenmann A (2005) When gender differences surpass cultural differences in personal satisfaction with body shape in Israeli college students. Sex Roles 52:369–378. https://doi.org/10.1007/s11199-005-2679-0

    Article  Google Scholar 

  31. Latzer Y, Orna T, Gefen S (2007) Level of religiosity and disordered eating psychopathology among modern–orthodox Jewish adolescent girls in Israel. Int J Adolesc Med Health 19:511–522. https://doi.org/10.1515/IJAMH.2007.19.4.511

    Article  PubMed  Google Scholar 

  32. Shloim N, Rudolf MCJ, Feltbower RG, Blundell-Birtill P, Hetherington MM (2019) Israeli and British women’s wellbeing and eating behaviours in pregnancy and postpartum. J Reprod Infant Psychol 37:123–138. https://doi.org/10.1080/02646838.2018.1529408

    Article  CAS  PubMed  Google Scholar 

  33. Brewis AA, Wutich A, Falletta-Cowden A, Rodriguez-Soto I (2011) Body norms and fat stigma in global perspective. Curr Anthrop 52:269–276. https://doi.org/10.1086/659309

    Article  Google Scholar 

  34. Feinson MC, Meir A (2012) Disordered eating and religious observance: a focus on ultra-orthodox Jews in an adult community study. Int J Eat Disord 45:101–109. https://doi.org/10.1002/eat.20895

    Article  PubMed  Google Scholar 

  35. Hofstede G, Hofstede GJ, Minkov M (2010) Cultures and organizations: software of the mind, revised and expanded, 3rd edn. McGraw-Hill, New York

    Google Scholar 

  36. Levenstein H (2012) Fear of food: a history of why we worry about what we eat. University of Chicago Press, Chicago

    Book  Google Scholar 

  37. Evans C, Dolan B (1993) Body shape questionnaire: derivation of shortened “alternate forms.” Int J Eat Disord 13:315–321. https://doi.org/10.1002/1098-108x

    Article  CAS  PubMed  Google Scholar 

  38. Arnow B, Kenardy J, Agras WS (1995) The emotional eating scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord 18:79–90. https://doi.org/10.1002/1098-108x

    Article  CAS  PubMed  Google Scholar 

  39. Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX (2001) The suicidal behaviors questionnaire-revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 4:443–454. https://doi.org/10.1177/107319110100800409

    Article  Google Scholar 

  40. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief severity measure. J Gen Int Med 16:606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

    Article  CAS  Google Scholar 

  41. Spitzer RL, Kroenke K, Williams JB, Lowe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Int Med 166:1092–1097. https://doi.org/10.1001/archinte.166.10.1092

    Article  Google Scholar 

  42. Brethauer SA, Kim J, El Chaar M et al (2015) Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg 25:587–606. https://doi.org/10.1016/j.soard.2015.02.003

    Article  PubMed  Google Scholar 

  43. O’Brien KS, Latner JD, Puhl RM et al (2016) The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite 102:70–76. https://doi.org/10.1016/j.appet.2016.02.032

    Article  PubMed  Google Scholar 

  44. Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller KH (2010) Risk of suicide after long-term follow-up from bariatric surgery. Am J Med 123(11):1036–1042. https://doi.org/10.1016/j.amjmed.2010.06.016

    Article  PubMed  PubMed Central  Google Scholar 

  45. Heinberg LJ, Lavery ME (2014) Psychosocial issues after bariatric surgery. In: Still CD, Sarwer DB, Blankenship J (eds) The ASMBS textbook of bariatric surgery, vol 2. Integrated health. Springer, New York, pp 43–53

    Google Scholar 

  46. Kaplan U, Romano-Zelekha O, Goitein D et al (2020) Trends in bariatric surgery: a 5-year analysis of the Israel National Bariatric Surgery Registry. Obes Surg 30(5):1761–1767. https://doi.org/10.1007/s11695-020-04426-2

    Article  PubMed  Google Scholar 

  47. Shiri S, Gurevich T, Feintuch U, Beglaibter N (2007) Positive psychological impact of bariatric surgery. Obes Surg 17(5):663–668. https://doi.org/10.1007/s11695-007-9111-5

    Article  PubMed  Google Scholar 

  48. Perera S, Eisen RB, Dennis BB et al (2016) Body mass index is an important predictor for suicide: results from a systematic review and meta-analysis. Suicide Life Threat Behav 46(6):697–736. https://doi.org/10.1111/sltb.12244

    Article  PubMed  Google Scholar 

  49. Ahmed HO, Ezzat RF (2019) Quality of life of obese patients after treatment with the insertion of intra-gastric balloon versus Atkins diet in Sulaimani Governorate, Kurdistan Region Iraq. Ann Med Surg 37:42–46. https://doi.org/10.1016/j.amsu.2018.11.014

    Article  Google Scholar 

  50. Ahmed HO (2018) Pattern of changes in quality of life of obese patients after sleeve gastrectomy in Sulaimani province-Kurdistan-Iraq, based on 4 years experience in two bariatric centers. Ann Med Surg 26(1):9–14. https://doi.org/10.1016/j.amsu.2017.12.008

    Article  Google Scholar 

  51. Sakran N, Raziel A, Goitein O, Szold A, Goitein D (2016) Laparoscopic sleeve gastrectomy for morbid obesity in 3003 patients: results at a high-volume bariatric center. Obes Surg 26(9):2045–2050. https://doi.org/10.1007/s11695-016-2063-x

    Article  PubMed  Google Scholar 

  52. Sala M, Haller DL, Laferrère B, Homel P, McGinty JJ (2017) Predictors of attrition before and after bariatric surgery. Obes Surg 27(2):548–551. https://doi.org/10.1007/s11695-016-2510-8

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shulamit Geller.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Geller, S., Levy, S., Hyman, O. et al. Preoperative body-related emotional distress and culture as predictors of outcomes of bariatric surgery. Eat Weight Disord 26, 2361–2369 (2021). https://doi.org/10.1007/s40519-020-01085-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-020-01085-1

Keywords

Navigation