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Implications of emotional eating beliefs and reactance to dietary advice

Bariatric surgery may result in significant weight loss, however with large individual differences [1, 2]. In patients eligible for bariatric surgery (BS), dysfunctional eating (DE) has been found among 10–25% of obese patients considered for or completing bariatric surgery [3, 4], and DE has been reported both prior [3–6] to and after BS [7–10]. DE can be operationalized as exerting rigid control, or loss of control over eating, or eating for emotional reasons rather than hunger or appetite. DE, in particular emotionally regulated eating, may be negatively reinforced if used to alleviate negative mood or feelings of stress [11].

DE is associated with overconsumption of energy dense food [12–15], which may impair sustained weight loss postsurgically [7, 11, 16–18]. Conversely, psychological treatments which target DE may increase the possibility of sustained weight loss following BS.

In addition to DE, patients with morbid obesity may suffer from symptoms of anxiety and depression. The prevalence of any mood disorder is about 16% and 24%, respectively [19]. Theoretically, improving affective symptoms might improve control over eating as there are fewer negative affects that one needs food to regulate. Moreover, alleviations in depression may facilitate experiences of self-efficacy and hence the motivation to implement the necessary behavioral changes in terms of adhering to dietary recommendations [20]. Both disorders may be effectively treated by cognitive behavioral therapy