Abstract

Background: Bariatric surgery is the most effective long-term treatment for severe obesity; however, a subset of patients fails to achieve optimal weight loss. This study investigated the role of psychiatric disorders and transdiagnostic psychopathological traits in predicting weight loss outcomes two years after surgery. Methods: This prospective naturalistic study included 125 consecutive bariatric surgery candidates undergoing routine preoperative psychiatric assessment. Psychiatric comorbidities, emotional dysregulation and ADHD-related dimensions were assessed using structured clinical interviews and self-report questionnaires. Weight outcomes were evaluated at 24 months after bariatric surgery, with post-surgical inadequate weight loss defined as percentage of excess weight loss (%EWL) < 50%. Results: Of the 125 patients initially assessed, 89 underwent bariatric surgery and 48 completed the follow-up. At 24 months, 10 patients (20.8%) showed inadequate weight loss. Poorer weight outcomes were associated with older age, sleeve gastrectomy, and lifetime mood disorders, whereas no significant associations emerged with anxiety disorders or binge eating disorder. Patients with inadequate weight loss showed higher levels of emotional dysregulation, while no differences emerged for other ADHD-related dimensions. Emotional dysregulation remained significantly associated with poorer weight outcomes in multivariate analysis. Conclusions: Emotional dysregulation may represent a transdiagnostic factor influencing bariatric surgery outcomes, supporting the importance of integrating emotional and cognitive dimensions into preoperative assessment and postoperative care.

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