When bariatric surgery reduces food addiction: a prospective study

Xuyan Ban¹Chen Wang¹Lin Liu¹Chuan-Yu Yin^1,2Hui-Lin Zhang^1,2Ting Xu¹Hong-Wei Zhang¹Xiao-Dong Han¹Hui Zheng³Jian-Zhong Di^1*

• ¹Department of Metabolic & Bariatric Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
• ²College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, China
• ³National Institute on Drug Abuse (NIH), Bethesda, Maryland, United States

Background: Studies have shown that patients with obesity appear to be more susceptible to food addiction than the general population. Bariatric surgery stands as the most potent remedy for combating obesity, and it is believed to alleviate the manifestations of food addiction. However, the timing of bariatric surgery to improve food addiction has seldom been the focus of attention. Methods: In this research, 78 individuals who underwent bariatric surgery were tracked over a period of two years. The Yale Food Addiction Scale 2.0 (YFAS 2.0) was employed to assess changes in food addiction tendencies post-surgery. Mixed linear modeling and cluster analysis were applied to investigate the timing of influence of bariatric surgery on the evolution of sub domains of food addiction. Results: We found that: (1) Bariatric surgery significantly reduces food addiction scores; (2) Bariatric surgery rapidly reduces food addiction scores within first month of surgery and extends to 2 years after surgery; (3) Symptoms in the YFAS 2.0 could be divided into two domains (rapid decline / slow decline) based on their progression following surgery. Rapid decline domain experience rapid improvement shortly (usually 1st month) after the bariatric surgery and maintains a consistently low symptom level, while the slow decline domain improves slowly (usually 4th month) in the post-operative phase. Discussion:Bariatric surgery induced rapid and sustained remission of food addiction, significantly reducing total food addiction scores within 1 month postoperatively. The effects maintained through 24 months, potentially through neurophysiological and gut microbiota alterations. Despite rapid remission of most food addiction symptoms, social/interpersonal problems, hazardous use, and large amount/longer showed delayed improvement, suggesting distinct behavioral persistence mechanisms. Conclusion: Food addiction scores can rapidly decline postoperatively and remain consistently lower. However, bariatric surgery does not fully improve all addiction symptoms at the 1st month. This suggests the importance of establishing multidisciplinary clinics in bariatric metabolic surgery.