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The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery

Medical Hospital, Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany
Department of General, Visceral and Transplant Surgery, University of Tübingen, 72076 Tübingen, Germany
Author to whom correspondence should be addressed.
Nutrients 2016, 8(11), 721;
Received: 13 September 2016 / Revised: 3 November 2016 / Accepted: 9 November 2016 / Published: 14 November 2016
(This article belongs to the Special Issue Eating Disorders, Diet-Related Diseases, and Metabolic Health)
PDF [515 KB, uploaded 14 November 2016]


Bariatric surgery has serious implications on metabolic health. The reasons for a failure of bariatric surgery, i.e., limited weight loss, are multifactorial and include psychological factors. We established a theoretical model of how impulsivity is related to weight loss outcome. We propose that depressive symptoms act as a mediator between impulsivity and pathological eating behavior, and that pathological eating behavior has a direct impact on weight loss outcome. We calculated excessive weight loss (%EWL) and assessed self-reported impulsivity (using the Baratt Impulsiveness Scale (BIS-15) total score), depressive symptoms (the Patient Health Questionnaire (PHQ-9) score), and pathological eating behavior (the Eating Disorder Inventory 2 (EDI-2) total score) in 65 patients four years after laparoscopic sleeve gastrectomy. Regression and mediation analyses were computed to validate the theoretical model. The BIS-15, PHQ-9, and EDI-2 have medium to high correlations between each other, and EDI-2 correlated with %EWL. The mediation analysis yielded that the PHQ-9 represents a significant mediator between BIS-15 and EDI-2. The regression model between EDI-2 and %EWL was also significant. These results support our theoretical model, i.e., suggest that impulsivity has an indirect impact on weight loss outcome after bariatric surgery, mediated by depression and transferred through pathological eating behavior. Thus, the underlying psychological factors should be addressed in post-operative care to optimize weight loss outcome. View Full-Text
Keywords: weight loss; bariatric surgery; impulsivity; depression; eating behavior weight loss; bariatric surgery; impulsivity; depression; eating behavior

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Schag, K.; Mack, I.; Giel, K.E.; Ölschläger, S.; Skoda, E.-M.; Von Feilitzsch, M.; Zipfel, S.; Teufel, M. The Impact of Impulsivity on Weight Loss Four Years after Bariatric Surgery. Nutrients 2016, 8, 721.

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