Metacognitive processes and affective symptoms associated with postoperative eating dysregulation following bariatric surgery

Background and Aims

Obesity is a complex, chronic, and relapsing disease requiring multifaceted management. While bariatric surgery represents one of the most effective interventions for sustained weight reduction, long-term outcomes may be complicated by the recurrence of maladaptive eating behaviors. Existing theoretical models do not fully account for postoperative eating dysregulation, leading to growing interest in the Self-Regulatory Executive Function model and metacognitive processes. This study aimed to examine pre-to-postoperative alterations in eating attitudes and behaviors following bariatric surgery, and to evaluate the relationships between postoperative eating dysregulation, metacognitive beliefs, cognitive-attentional processes, and affective symptoms, including anxiety and depression.

Methods

This cross-sectional study with retrospective preoperative data included 80 patients (88.8% female; mean age = 37.71 ± 9.38 years) who had undergone laparoscopic sleeve gastrectomy at a single clinical center. Participants were evaluated during postoperative follow-up (mean follow-up = 11.51 ± 6.58 months). Eating behaviors were assessed using the Three-Factor Eating Questionnaire-Revised 21, with preoperative baseline data extracted retrospectively. Postoperative psychological and metacognitive variables were measured using the Metacognitions Questionnaire-30, Cognitive Attentional Syndrome Scale-1, and Hospital Anxiety and Depression Scale. Data were analyzed using paired-samples t-tests and hierarchical multiple linear regression models.

Results

Paired t-tests revealed significant postoperative reductions in uncontrolled eating (52.73 ± 21.94 to 21.80 ± 19.92; p < 0.001) and emotional eating (54.51 ± 27.46 to 19.65 ± 25.31; p < 0.001), alongside a significant increase in cognitive restraint (47.01 ± 22.70 to 66.45 ± 18.57; p < 0.001). Despite achieving a mean total weight loss of 37.15 ± 14.02 kg, high self-reported surgical satisfaction (88.7%), and dietary adherence (8.03/10), 47.5% of the sample reported frequent grazing behaviors, while only 7.5% were receiving active psychopharmacological treatment. Hierarchical regression models accounted for 42.0%, 46.2%, and 52.6% of the variance in uncontrolled eating, cognitive restraint, and emotional eating, respectively. Elevated anxiety was the strongest positive predictor of postoperative emotional eating (beta = 0.423, p < 0.001), whereas cognitive self-consciousness uniquely predicted cognitive restraint (beta = 0.614, p < 0.001). Lower adherence to dietary guidelines significantly predicted both uncontrolled eating (beta = -0.285, p < 0.05) and emotional eating (beta = -0.318, p < 0.05).

Conclusions

Within the limits of a single-center design and modest sample size, these findings suggest that postoperative eating dysregulation may involve a multidimensional structure influenced by distinct affective and metacognitive mechanisms. Although indicators of surgical success were prominent, they coexisted with regulatory vulnerabilities, including frequent grazing behavior and low rates of active psychopharmacological treatment. Routine assessment of emotional and metacognitive processes should be considered in bariatric follow-up. Interventions targeting anxiety and specific metacognitive dysfunctions may provide a preliminary basis for more personalized, psychologically informed multidisciplinary care after bariatric surgery.

Keywords:bariatric surgery; metacognition; emotional eating; anxiety; dietary adherence; sleeve gastrectomy.

References

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