Impact of preoperative food addiction on weight loss and weight regain three years after bariatric surgery

Abstract

Background: Food addiction (FA) is prevalent among individuals with severe obesity and has been associated with poorer weight loss (WL) outcomes after dietary interventions. However, its long-term impact after bariatric surgery (BS) remains unclear. Objective: This study aimed to evaluate the effect of preoperative FA on WL and weight regain (WR) three years after different BS techniques. Methods: An ambispective study was conducted in 165 patients undergoing BS (41.1% sleeve gastrectomy [SG], 13.3% Roux-en-Y gastric bypass [RYGB], and 45.6% hypoabsorptive procedures [HA]). FA was assessed preoperatively using the Yale Food Addiction Scale 2.0. WL outcomes were evaluated at 1 and 3 years postoperatively. Mixed-effects models were used to assess longitudinal changes, adjusted for baseline weight, sex, type 2 diabetes (T2D), and height. Results: FA was present in 17.6% of patients. At 3 years, total WL was lower in FA patients compared to those without FA (-27.1% vs. -31.0%; p = 0.023), driven by greater WR from nadir (+8.3% vs. +1.7%; p = 0.03). The effect was particularly pronounced after RYGB and HA, but not after SG. Nevertheless, a substantial proportion of FA patients (58%) were no longer classified as having obesity at 3 years. The presence of FA was not associated with insufficient WL or lower T2D remission rates. Mixed models confirmed a significant interaction between FA and time, indicating a trend toward reduced WL over time in FA patients. Conclusions: Preoperative FA was not associated with a reduced likelihood of achieving satisfactory WL following BS. Our data does not support the use of preoperative FA as a decisive factor in guiding the choice of BS type. Although FA was associated with increased WR over time, clinically meaningful WL was achieved in most patients. Long-term multidisciplinary follow-up remains essential in this subgroup.