Weight and shape overvaluation and its relation to anxiety, depression, and maladaptive eating symptoms for patients up to 4 years after bariatric surgery

Background: Weight and shape overvaluation (WSO; undue influence of weight and shape on self-evaluation) is common among individuals undergoing bariatric surgery. Little is known about how WSO relates to poorer outcomes for patients remote from surgery.

Objectives: To examine associations between WSO with anxiety and depression symptoms and various maladaptive eating behaviors in patients up to 4 years post-bariatric surgery.

Setting: Henry Ford Health, United States.

Methods: Patients who underwent surgery between 2018 and 2021 were invited to complete the study between 2021 and 2022. Participants (N = 765) completed anxiety and depression symptom and eating behavior measures.

Results: Participants endorsed moderate WSO (M = 3.62, standard deviation = 1.87), which was positively related to anxiety (r = .37) and depression (r = .20) symptoms; eating in response to anger/frustration (r = .26), anxiety (r = .28), and depression (r = .31); and addictive eating behaviors (r = .26); and was significantly associated with the presence of loss-of-control (odds ratio [OR] = 1.39), binge (OR = 1.39), and graze (OR = 1.24) eating. WSO also was related to more frequent grazing (r = .23) but not loss-of-control or binge eating frequency for participants who endorsed behavior presence.

Conclusions: Findings underscore that links between WSO, psychiatric distress, and maladaptive eating behaviors persist up to 4 years after bariatric surgery. These domains should be assessed at bariatric follow-ups, and assessment of WSO may help providers identify patients at risk for poorer outcomes. Findings should be used to inform temporal modeling of how WSO may predispose patients to poorer bariatric outcomes.