Researchers wanted to know if people who still had emotional or eating problems before weight loss surgery would have worse results. They studied 114 people who had weight loss surgery—57 with ongoing mental health or nutrition concerns and 57 without them. After two years, both groups lost about the same amount of weight (around 70% of their excess weight). This suggests that having some emotional struggles before surgery doesn’t automatically mean the surgery won’t work well. The findings are encouraging for people worried that their mental health might prevent them from succeeding with weight loss surgery.

The Quick Take

  • What they studied: Whether people who still had emotional or eating difficulties before weight loss surgery would lose less weight than people without these issues
  • Who participated: 114 adults getting weight loss surgery between 2017 and 2020. Half had ongoing mental health or nutrition concerns despite preparation, and half didn’t. The groups were matched by age, gender, and type of surgery planned.
  • Key finding: After two years, people with emotional or eating concerns lost about 70% of their excess weight, which was nearly identical to the 71% lost by people without these concerns. The difference was too small to matter statistically.
  • What it means for you: If you’re considering weight loss surgery but worry that your emotional eating or mental health struggles will doom your results, this research suggests you shouldn’t automatically assume failure. However, this doesn’t mean mental health support isn’t important—it just means these challenges don’t automatically prevent good outcomes.

The Research Details

This was a controlled observational study, which means researchers watched what happened to two similar groups of people without randomly assigning them to different treatments. Between 2017 and 2020, they identified 57 people who had ongoing psychological or nutritional problems even after completing preparation for weight loss surgery. They then found 57 comparison patients who didn’t have these remaining issues, matching them carefully on factors like age, sex, and the type of surgery they were getting. Importantly, the patients didn’t know they were being studied, which helps prevent them from changing their behavior because they’re being watched.

Researchers measured weight at the time of surgery and then at 1, 6, 12, and 24 months afterward. They calculated the percentage of excess weight loss (how much of the extra weight people needed to lose was actually lost) and used statistical methods to compare the two groups over time. They also looked at whether people kept their follow-up appointments, their quality of life, and whether conditions like diabetes and high blood pressure improved.

This research approach is important because it answers a real-world question: in actual practice, do people with remaining emotional or eating problems do worse after surgery? By matching the groups carefully and not telling people they were being studied, the researchers reduced the chance that their results were skewed by other factors or by people changing their behavior.

The study has some strengths: it followed people for two full years, matched groups carefully to reduce bias, and didn’t tell participants about the study goal (reducing bias). However, the sample size is relatively small (114 people total), which means the results might not apply to everyone. The study was also done at specific hospitals in a specific time period, so results might differ in other settings. The researchers are continuing to follow these patients for five years, which will provide more information.

What the Results Show

The main finding was that people with remaining psychological or nutritional difficulties lost almost exactly as much weight as those without these difficulties. The group with concerns lost an average of 70.2% of their excess weight, while the comparison group lost 71.4%—a difference so small it could easily be due to chance. When researchers used statistical methods to account for other factors that might affect weight loss, the two groups still showed no meaningful difference in how their weight loss changed over the two-year period.

Beyond weight loss, the researchers looked at several other important outcomes. People in both groups were equally likely to attend their follow-up appointments with doctors. Their quality of life improved similarly in both groups at one year and two years after surgery. For people who had diabetes before surgery, both groups showed similar improvements. The same was true for people with high blood pressure—both groups improved at similar rates.

The study found no significant differences between groups in adherence to follow-up care, quality of life improvements, or management of related health conditions like diabetes and hypertension. This suggests that psychological and nutritional difficulties don’t affect the overall success of surgery in multiple ways—they don’t just affect weight loss, but also don’t seem to affect how well people stick with their medical care or how much their health improves.

Previous research has sometimes suggested that psychological problems might interfere with weight loss surgery success, but results have been mixed. This study adds to growing evidence that having some emotional or eating concerns before surgery doesn’t automatically predict poor outcomes. However, this doesn’t mean psychology isn’t important—it may mean that the preparation process helps people manage these issues well enough that they don’t derail surgery results.

The study is relatively small with only 114 people, so the results might not apply to everyone. It only followed people for two years, and the researchers are still collecting five-year data that might show different patterns. The study was done in specific hospitals during a specific time period, so results might differ in other places or times. The study also didn’t measure exactly how much psychological support each person received, so we don’t know if better support might help even more. Finally, the study only looked at people who completed their preoperative preparation—people who dropped out before surgery weren’t included.

The Bottom Line

If you’re considering weight loss surgery and have concerns about emotional eating or mental health issues, this research suggests you shouldn’t automatically assume you’ll fail. However, this doesn’t mean you should skip psychological support—it means that with proper preparation and support, these challenges don’t have to prevent good results. Work with your surgical team to address any concerns before surgery. (Confidence level: Moderate—based on a two-year study of 114 people)

This research is most relevant for people considering weight loss surgery who worry about emotional eating, anxiety, depression, or other psychological concerns. It’s also important for doctors and surgeons who counsel patients before surgery. People with severe untreated mental health conditions should still seek appropriate support, as this study looked at people who received preparation and care. This doesn’t apply to people not considering surgery.

Weight loss typically happens gradually over the first year after surgery, with most people reaching their maximum weight loss by 18-24 months. This study measured results at two years, so that’s the timeframe for the results shown here. Longer-term results (five years and beyond) are still being collected.

Want to Apply This Research?

  • If using a weight loss surgery tracking app, monitor percentage of excess weight loss monthly rather than just total pounds lost. This gives a clearer picture of progress toward the surgery’s goal. Also track attendance at follow-up appointments and any psychological support sessions to ensure consistent engagement with your care team.
  • Use the app to set reminders for follow-up appointments and to log any emotional eating triggers or mood changes. This helps you stay engaged with your care team and provides data to discuss with your doctors. If you notice patterns of emotional eating, use the app to note what emotions trigger it, then share this with your support team.
  • Beyond the two-year mark, continue tracking weight loss progress, follow-up appointment attendance, and any ongoing psychological support. The research suggests that people with initial concerns can succeed long-term, but consistent engagement with your medical team appears important. Use the app to maintain accountability and identify any emerging patterns that might need attention.

This research suggests that having psychological or nutritional concerns before weight loss surgery doesn’t automatically predict poor outcomes, but it doesn’t replace personalized medical advice. Weight loss surgery is a serious procedure with risks and benefits that vary by individual. Anyone considering bariatric surgery should discuss their specific situation, including any mental health concerns, with their surgical team and mental health professionals. This study followed people for two years only—longer-term outcomes may differ. Always consult with qualified healthcare providers before making decisions about surgery.