Preoperative body-related emotional distress and culture as predictors of outcomes of bariatric surgery

Shulamit Geller*, Sigal Levy, Ofra Hyman, Paul L. Jenkins, Subhi Abu-Abeid, Gil Goldzweig

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: Findings concerning the impact of bariatric surgical intervention on both psychological variables and weight loss are often controversial and misconstrued the world over. The aim of this study was to classify bariatric surgery patients according to patterns of preoperative measures that may predict postoperative psychological and physiological outcomes and to compare these patterns between two distinct cultures. Methods: Of 169 consecutive bariatric surgery candidates from Israel and 81 candidates from the United States, 73 and 35 patients, respectively consented to be included in a follow-up phase. Body image dissatisfaction, emotional eating behaviors, risk of suicide, depressive symptoms, anxious symptoms, and percent excess weight loss were measured. K-means clustering procedure was used to classify bariatric surgery patients according to their preoperative body-related emotional distress, which was composed of body image dissatisfaction and emotional eating. The joint effect of culture and body-related emotional distress cluster on psychological distress was tested. Results: The cluster analysis revealed two preoperative body-related emotional distress patterns: high body-related emotional distress and low body-related emotional distress. Following surgery, US patients showed a higher risk of suicide and lower excess weight loss than Israeli patients within only the high body-related emotional distress cluster (a significant interaction effect). Conclusion: Preoperative assessment of body-related emotional distress patterns among bariatric surgery candidates may enable professionals to identify potential postoperative risks of suicide, anxiety, and decreased weight loss. The relationship between the body-related emotional distress cluster and outcome measures is culture dependent. Level III: Case–control analytic study.

Original languageEnglish
Pages (from-to)2361-2369
Number of pages9
JournalEating and Weight Disorders
Issue number7
StatePublished - Oct 2021


  • Bariatric surgery
  • Body image dissatisfaction
  • Cross-cultural differences
  • Emotion dysregulation
  • Emotional eating
  • Psychological distress


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