November 06, 2019
3 min read

Weight gain fear tied to post-bariatric surgery overeating, depression

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LAS VEGAS — Patients who express greater fear of regaining weight after bariatric surgery may be more susceptible to overeating and depression, according to findings presented at ObesityWeek.

Jessica L. Lawson

“These results suggest that fear of weight gain may be important to assess in postop bariatric patients, and as it is a brief assessment, it offers a reasonable starting point that when answered in the affirmative can guide providers to further follow-up and treatment referrals if warranted,” Jessica L. Lawson, PhD, of the Yale School of Medicine, told Endocrine Today.

Lawson and colleagues assessed the fear of weight gain and the sensitivity to weight gain among 145 adults (mean age, 45.4 years; 83% women) approximately 6 months following sleeve gastrectomy. Participants had endorsed loss of control eating and were seeking treatment for their eating and weight concerns. The study examined potential associations with loss of control eating, depression and “eating disorder psychopathology,” including eating restraint, overvaluation of shape and weight, and dissatisfaction with shape and weight.

Defining fear

Lawson said that the fear of gaining weight is assessed via clinician-guided interview by asking patients how many days they have been afraid of regaining weight in the last 4 weeks, which corresponds to a rating scale from 0-6 with a rating of 4 or greater indicating clinical fear of weight gain.

Sensitivity to weight gain is a measure of how much weight gain would induce a marked distressing or upsetting reaction, according to Lawson, who recommended that providers work with patients to find the minimum amount of weight they would have to gain in a week to elicit such a response.

Both of these measures are potentially influenced by the reality that these patients are “coached from the beginning to focus on the number on the scale,” which can potentially influence positive or negative outcomes.

“I like to consider constructs like this on a continuum,” Lawson said during a presentation. “One of the questions posed in this research is to what extent, where on this continuum does the scale tip? When does fear of weight gain and sensitivity to weight gain stop being adaptive for a person — if it ever was in the first place — and move toward becoming more harmful or maladaptive?”

Potential links with loss of control eating

Lawson and colleagues found that there were correlations between fear of weight gain and sensitivity to weight gain and greater eating disorder psychopathology.

“This research, though correlational in nature, which precludes statements of causality, takes another step toward identifying important clinical correlates to assess among patients who have undergone bariatric surgery and may be struggling with eating concerns and offers a new direction for longitudinal research efforts,” Lawson told Endocrine Today.

Among the entire study cohort, 48.3% of patients met the clinical requirements for fear of weight gain. Lawson noted that loss of control eating events occurred substantially more often for these patients compared with those who did not meet the clinical criteria for fear of weight gain.

“Prior to this research it might have been expected that that patients who have undergone surgery would not be fearful of gaining weight, especially within 6 months postop because they are likely still in active weight-loss phase, or perhaps if they are fearful, that the fear is adaptive in maintaining weight-loss efforts,” Lawson said. “However, these results suggest a different story in that the clinical levels of fear of weight gain may be maladaptive, and so it is an important construct to attend to.”

Rates of loss of eating events were not affected to a significant degree by sensitivity to weight gain, which Lawson said was present to a clinical degree in 73.1% of the study population.

“While both phenomena are related to disordered-eating pathology, results suggest that sensitivity to weight gain is perhaps more normative and not as salient to assess clinically as fear of weight gain,” Lawson said. “Paradoxically, individuals who report fearing weight gain actually weigh more postoperatively and experience greater frequency of loss of control eating, among other disordered eating pathology, and more depressive symptoms.” – by Phil Neuffer


Lawson J, et al. T-OR-2033. Presented at: ObesityWeek 2019; Nov. 3-7, 2019; Las Vegas.

Disclosure: Lawson reports no relevant financial disclosures.