Personality Traits Predict Weight Loss Following Endoscopic Sleeve Gastroplasty: A Cohort Study with External Validation

Personality Traits Predict Weight Loss Following Endoscopic Sleeve Gastroplasty: A Cohort Study with External Validation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Personality Traits Predict Weight Loss Following Endoscopic Sleeve Gastroplasty: A Cohort Study with External Validation Benjamin I. Richter, Sameer Rao, Lucie Pham, Emmanuel Attah, Ana Hamann, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8129681/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Mar, 2026 Read the published version in Obesity Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract This is being submitted as a brief report and thus no abstract is included. Figures Figure 1 Figure 2 Introduction Obesity affects over one billion people worldwide, representing a growing public health crisis [1]. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, safe, and effective treatment option for obesity, but outcomes vary, prompting efforts to identify phenotypes that predict weight loss [2–4]. Personality traits may influence outcomes following bariatric interventions [5, 6]. The Five-Factor Model—encompassing emotional stability, agreeableness, extraversion, conscientiousness, and openness—is a personality framework that can be evaluated using a brief, validated survey at the point of care. We hypothesized that personality traits are associated with weight loss following ESG and sought to validate these findings across demographically distinct cohorts. Methods Study population and follow-up Primary Cohort This cohort included patients who underwent ESG from August 2013 to August 2019 at a tertiary academic medical center in New York where most patients were self-pay. All procedures were performed in a single center by the same gastroenterologist (R.S.) under institutional review board approval (IRB Protocol 1510016654). A randomly selected patient subset completed the Ten-Item Personality Inventory (TIPI) to assess Big Five traits. Personality traits—enduring patterns of thought, emotion, and behavior—are described by the Big Five model: Openness, Conscientiousness, Extraversion, Agreeableness, and Emotional Stability. This framework is cross-culturally validated and incorporated into the DSM-5-TR [7]. The TIPI provides a brief, validated assessment with acceptable psychometric properties, offering structural validity while minimizing participant burden [8]. Inclusion criteria were BMI > 30 kg/m² and failure of prior noninvasive weight loss interventions. Patients with BMI > 40 kg/m² were eligible if they declined or were ineligible for bariatric surgery. Exclusion criteria included prior bariatric procedures, family history of gastric cancer, history of gastric neoplasia, significant psychiatric illness, coagulopathy, or comorbidities precluding deep sedation. Patients were evaluated by a multidisciplinary team and were not required to discontinue weight loss pharmacotherapy post-ESG. Anthropometric and laboratory data were collected at baseline and at 1-, 3-, 6-, and 12-months post procedure, with annual follow-up encouraged. All patients received standardized dietary and lifestyle counseling. External Validation Cohort This cohort included patients who underwent ESG between September 2021 and December 2024 at a tertiary academic and safety-net hospital in New Jersey serving predominantly uninsured and underinsured populations. All procedures were performed by a single gastroenterologist (K.H.) under IRB approval (Pro2024002500). Patients with ≥ 12 months of follow-up were included. All other methods mirrored the primary cohort. Procedure and Outcomes ESG techniques and postoperative dietary protocols followed published standardized methods [3]. Weight loss was measured as percent total body weight loss (%TBWL = [(Initial Weight – Post-op Weight) / Initial Weight] × 100). Personality traits were assessed using the TIPI, with each trait scored on a 1–7 Likert scale. The primary outcome was %TBWL at last available follow-up. Statistical analysis Descriptive statistics are reported as mean (standard deviation, SD) and median (interquartile range, IQR). Multilevel mixed-effects linear regression with a fixed effect for time and random intercepts for patients was used to analyze associations between personality traits and weight loss. All tests were two-tailed with α = 0.05. Results Primary Cohort Thirty-four patients (83% female, mean age 48 ± 13 years) completed the TIPI. Mean Baseline BMI was 36 ± 4 kg/m². Median follow-up duration was 24 months (IQR 12–24). Mean %TBWL was 15.7 ± 6.2% (Table 1 ). The highest mean personality score was for conscientiousness (5.5 ± 1.3); lowest for agreeableness (4.6 ± 1.3). Emotional stability demonstrated a significant positive association with %TBWL, with each one-point increase in emotional stability score corresponding to 1.9% greater TBWL (95% CI 0.2–3.5%, p = 0.026). This association remained statistically significant after adjusting for baseline BMI and follow-up compliance (β = 1.9, 95% CI 0.4–3.3%, p = 0.017). No other domains were associated with weight loss (Table 2 ). External Validation Cohort Twenty-three patients (74% female; mean age 47 ± 14 years) completed the TIPI. Baseline BMI was 44 ± 4 kg/m², with median follow-up of 17 months (IQR 14–22). Mean %TBWL was 12.6 ± 12.2% (Table 1 ). The highest mean personality score was for agreeableness (6.0); lowest for extraversion (4.6). Emotional stability was again significantly associated with %TBWL, with each one-point increase corresponding to 3.4% greater TBWL (95% CI 0.1–6.5%, p = 0.042). No other domains were associated with weight loss (Table 2 ). Discussion Emotional stability was consistently the only personality domain predictive of post-ESG weight loss across two demographically and socioeconomically distinct cohorts, suggesting a robust and generalizable relationship. This trait—characterized by resilience to stress and effective emotional regulation—may enhance adherence to post-ESG behavioral changes, like sustained dietary modification, physical activity, and follow-up attendance. While results are mixed, several prior bariatric surgery studies have linked lower emotional stability to poorer postoperative outcomes, although heterogeneity across studies and limited sample sizes may obscure this relationship [5, 6, 9] Given its rapid administration via the Ten-Item Personality Inventory (TIPI), emotional stability assessment can be seamlessly integrated into pre-procedural evaluations to support personalized, risk-stratified care. Patients with lower emotional stability scores may benefit from enhanced behavioral support, including psychological counseling, closer post-procedural follow-up, or pharmacological augmentation. Limitations of our study include modest sample sizes, predominantly female composition, and potential selection bias from optional survey completion. Prospective studies are needed to clarify mechanisms linking emotional stability to weight outcomes. Despite these limitations, this study provides the first validated evidence that emotional stability, measurable via a brief survey, predicts ESG weight loss across diverse populations. Incorporating personality assessment into routine evaluation may enable early identification of patients who could benefit from personalized psychological support, improving long-term outcomes. Declarations Author Contribution B.I.R.: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work; and the drafting of the work. S.R.: drafting parts of the work; revising the work critical for important intellectual content. L.P: drafting parts of the work; revising the work critical for important intellectual content. E.A.: drafting parts of the work; revising the work critical for important intellectual content. A.H.: revising the work critical for important intellectual content. K.L.: revising the work critical for important intellectual content. K.H.: supervision of the work; revising the work critical for important intellectual content. R.Z.S.: supervision of the work; revising the work critical for important intellectual content. All authors have read and agreed to the published version of the manuscript. Data Availability All data supporting the findings of this study are available within the paper and its Supplementary Information. References Collaboration NCDRF: Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults . Lancet 2024, 403 (10431):1027-1050. Singh S, Hourneaux de Moura DT, Khan A, Bilal M, Ryan MB, Thompson CC: Safety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: a systematic review and meta-analysis . Surg Obes Relat Dis 2020, 16 (2):340-351. Sharaiha RZ, Hajifathalian K, Kumar R, Saunders K, Mehta A, Ang B, Skaf D, Shah S, Herr A, Igel L et al : Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity . Clin Gastroenterol Hepatol 2021, 19 (5):1051-1057 e1052. Matteo MV, Bove V, Ciasca G, Carlino G, Di Santo R, Vinti L, Polidori G, Pontecorvi V, Papi M, Spada C et al : Success Predictors of Endoscopic Sleeve Gastroplasty . Obes Surg 2024, 34 (5):1496-1504. van Hout GC, Verschure SK, van Heck GL: Psychosocial predictors of success following bariatric surgery . Obes Surg 2005, 15 (4):552-560. Hjelmesaeth J, Rosenvinge JH, Gade H, Friborg O: Effects of Cognitive Behavioral Therapy on Eating Behaviors, Affective Symptoms, and Weight Loss After Bariatric Surgery: a Randomized Clinical Trial . Obes Surg 2019, 29 (1):61-69. Widiger TA MG: The Alternative Model of Personality Disorders (AMPD) from the Perspective of the Five-Factor Model. Psychopathology 2020 Jun 11, 53(3-4):149-156 . Thorrisen MM, Sadeghi T: The Ten-Item Personality Inventory (TIPI): a scoping review of versions, translations and psychometric properties . Front Psychol 2023, 14 :1202953. Montorio I, Izal M, Bellot A, Rodriguez J, de Iceta M: Personality Profiles Associated with Long-Term Success in Bariatric Surgery: 24-Month Follow-Up . Behav Sci (Basel) 2023, 13 (10). Tables Table 1 Baseline Characteristics of Study Cohorts Characteristic Primary Cohort (n = 34) External Validation Cohort (n = 23) Age, years (mean ± SD) 48 ± 13 47 ± 14 Female sex, n (%) 28 (83%) 17 (74%) Baseline BMI, kg/m² (mean ± SD) 36 ± 4 44 ± 4 Follow-up duration, months (median [IQR]) 24 [IQR: 12–24] 17 [IQR 14–22] Mean personality trait scores (TIPI) Extraversion 4.9 ± 1.7 4.6 ± 1.4 Agreeableness 4.6 ± 1.3 6.0 ± 1.0 Conscientiousness 5.5 ± 1.3 5.6 ± 1.5 Emotional stability 5.1 ± 1.3 5.1 ± 1.6 Openness 4.7 ± 1.1 5.5 ± 1.7 Abbreviations: BMI, body mass index; TIPI, Ten-Item Personality Inventory; IQR, interquartile range; SD, standard deviation. Table 2 Weight Loss and Personality Trait Outcomes Outcome Measure Primary Cohort (n = 34) External Validation Cohort (n = 23) % Total body weight loss (%TBWL, mean ± SD) 15.7 ± 6.2 12.6 ± 12.2 Association of Personality Trait (TIPI) with %TBWL (β, 95% CI, p-value) extraversion 0.25 (-1.07- 1.56), p = 0.70 3.65 (–0.06 to 7.37), p = 0.054 agreeableness 1.25 (-0.47–2.99), p = 0.15 1.67 (–3.83 to 7.16), p = 0.535 Conscioensciousness 0.19 (-1.56–1.94), p = 0.83 2.12 (–1.38 to 5.63), p = 0.221 emotional stability 1.85 (0.23–3.47) , p = 0.03 3.35 (0.12 to 6.59), p = 0.043 openness 0.58 (-1.48–2.64), p = 0.57 –0.42 (–3.69 to 2.86), p = 0.793 Abbreviations: TIPI, Ten-Item Personality Inventory; β, regression coefficient; CI, confidence interval; %TBWL, percent total body weight loss. Bold indicates statistical significance (p < 0.05). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Mar, 2026 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 16 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviews received at journal 04 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 02 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviewers invited by journal 01 Dec, 2025 Editor assigned by journal 28 Nov, 2025 Submission checks completed at journal 20 Nov, 2025 First submitted to journal 16 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8129681","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":553604622,"identity":"d1a488c3-bb7e-4d93-836d-e825f9c50b50","order_by":0,"name":"Benjamin I. Richter","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACA2YGxocfKhiYUYV58GthNpY4A9OSQIwWBgY2Cd42GJcYLebsvA8kJOfdYdftP8D2mfdHrZx5/wHGB2/bcGuxbGY3MCjc9ozZ7EYC82yehOPGMkCG4Vw8WgwOszEkSG47DNTCwMzMk3AscYYEA5s0LwEtB3jnALWcPwDWUj+D/wD7bwJaGBt4G4BaDiSAtNQkSDAksDHj02LZzMbMLHEM5LDEZsY5aQcMZ0gkNkvOOYdbizn/MfafH2oOJ5udP3yY4Y1NnbwE/+GDH96U4dYCA8kMDIwNQPowA5RBGNhB6TqiVI+CUTAKRsHIAgBdeEoIEhzKPgAAAABJRU5ErkJggg==","orcid":"","institution":"Rutgers, The State University of New Jersey","correspondingAuthor":true,"prefix":"","firstName":"Benjamin","middleName":"I.","lastName":"Richter","suffix":""},{"id":553604623,"identity":"c84fa337-21c9-4fde-9211-e30716a95edf","order_by":1,"name":"Sameer Rao","email":"","orcid":"","institution":"Rutgers, The State University of New Jersey","correspondingAuthor":false,"prefix":"","firstName":"Sameer","middleName":"","lastName":"Rao","suffix":""},{"id":553604624,"identity":"3cf6c9db-48dc-4bc7-a11a-f18bd8a50c2d","order_by":2,"name":"Lucie Pham","email":"","orcid":"","institution":"Rutgers, The State University of New Jersey","correspondingAuthor":false,"prefix":"","firstName":"Lucie","middleName":"","lastName":"Pham","suffix":""},{"id":553604625,"identity":"41978ec5-a1dd-451f-ba67-89f772add547","order_by":3,"name":"Emmanuel Attah","email":"","orcid":"","institution":"NewYork–Presbyterian Hospital","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"","lastName":"Attah","suffix":""},{"id":553604626,"identity":"818edc96-6bfa-45a1-a905-786e5e494741","order_by":4,"name":"Ana Hamann","email":"","orcid":"","institution":"NewYork–Presbyterian Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"","lastName":"Hamann","suffix":""},{"id":553604627,"identity":"caa40a54-d817-4420-9ec5-fd0109278c5e","order_by":5,"name":"Kyle Liang","email":"","orcid":"","institution":"NewYork–Presbyterian Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kyle","middleName":"","lastName":"Liang","suffix":""},{"id":553604628,"identity":"bdac9e17-0615-4b8e-ac3e-0e777652f010","order_by":6,"name":"Kaveh Hajifathalian","email":"","orcid":"","institution":"Rutgers, The State University of New Jersey","correspondingAuthor":false,"prefix":"","firstName":"Kaveh","middleName":"","lastName":"Hajifathalian","suffix":""},{"id":553604629,"identity":"ea584daa-105e-4e87-adda-b12b654fa7ca","order_by":7,"name":"Reem Z. Sharaiha","email":"","orcid":"","institution":"NewYork–Presbyterian Hospital","correspondingAuthor":false,"prefix":"","firstName":"Reem","middleName":"Z.","lastName":"Sharaiha","suffix":""}],"badges":[],"createdAt":"2025-11-16 22:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8129681/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8129681/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-026-08504-9","type":"published","date":"2026-03-28T16:10:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97664875,"identity":"b3420577-a2a4-458c-b9a4-b5c43b306bcd","added_by":"auto","created_at":"2025-12-08 09:15:13","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":221651,"visible":true,"origin":"","legend":"","description":"","filename":"PersonalityTraitsandWeightLoss11.19.2025copy.docx","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/df7052e0c51a0f6338ac2561.docx"},{"id":97383453,"identity":"b5106bb4-8a88-4667-bb1a-3d1a590669da","added_by":"auto","created_at":"2025-12-03 18:56:36","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8169,"visible":true,"origin":"","legend":"","description":"","filename":"14af20ef7b9f4cef9cab9e1acba59503.json","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/ff9403d3ffed4a785503b9df.json"},{"id":97664781,"identity":"2f97243e-56d7-4d83-9d81-1c0f553f6131","added_by":"auto","created_at":"2025-12-08 09:14:16","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24061,"visible":true,"origin":"","legend":"","description":"","filename":"14af20ef7b9f4cef9cab9e1acba595031enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/1512fa0111d47a3e0b04d245.xml"},{"id":97664729,"identity":"9824761f-5fd8-4efd-a71f-1a5df23e35e2","added_by":"auto","created_at":"2025-12-08 09:13:33","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":23942,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/12bb84fd5e63e2c164278bd3.png"},{"id":97383454,"identity":"070897f8-593e-4b63-ba1e-9bee8d109df9","added_by":"auto","created_at":"2025-12-03 18:56:36","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22226,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/4cd6c33627ff152bcd659b64.png"},{"id":97383459,"identity":"1bc0377b-5398-4f72-8362-63a3784c736d","added_by":"auto","created_at":"2025-12-03 18:56:36","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22492,"visible":true,"origin":"","legend":"","description":"","filename":"14af20ef7b9f4cef9cab9e1acba595031structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/f6357a4e94aa0e0b0c2da195.xml"},{"id":97665479,"identity":"5fddaddb-66b6-4d08-b42a-0f9e7c3cbdf2","added_by":"auto","created_at":"2025-12-08 09:18:39","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29525,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/aa8f04bedac9b948dc7797a8.html"},{"id":97383452,"identity":"7506b975-0ce0-44e4-8c00-bedb32ee8fd5","added_by":"auto","created_at":"2025-12-03 18:56:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74417,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/9aeaa5d1f2cf5055a1bbefc4.jpeg"},{"id":97383458,"identity":"c89495b3-3b19-4697-bde5-d418b0900ff5","added_by":"auto","created_at":"2025-12-03 18:56:36","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85294,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/4bacf5416b9c1df50af0ac12.jpeg"},{"id":105754995,"identity":"f56bd49e-b385-4773-a15d-2b8ebd3ac4bd","added_by":"auto","created_at":"2026-03-30 16:23:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1088742,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8129681/v1/b016ed34-5796-41dc-896b-84c006ebfdcb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Personality Traits Predict Weight Loss Following Endoscopic Sleeve Gastroplasty: A Cohort Study with External Validation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity affects over one billion people worldwide, representing a growing public health crisis [1]. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, safe, and effective treatment option for obesity, but outcomes vary, prompting efforts to identify phenotypes that predict weight loss [2\u0026ndash;4].\u003c/p\u003e\u003cp\u003ePersonality traits may influence outcomes following bariatric interventions [5, 6]. The Five-Factor Model\u0026mdash;encompassing emotional stability, agreeableness, extraversion, conscientiousness, and openness\u0026mdash;is a personality framework that can be evaluated using a brief, validated survey at the point of care. We hypothesized that personality traits are associated with weight loss following ESG and sought to validate these findings across demographically distinct cohorts.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population and follow-up\u003c/h2\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003ePrimary Cohort\u003c/h2\u003e\u003cp\u003eThis cohort included patients who underwent ESG from August 2013 to August 2019 at a tertiary academic medical center in New York where most patients were self-pay. All procedures were performed in a single center by the same gastroenterologist (R.S.) under institutional review board approval (IRB Protocol 1510016654). A randomly selected patient subset completed the Ten-Item Personality Inventory (TIPI) to assess Big Five traits.\u003c/p\u003e\u003cp\u003ePersonality traits\u0026mdash;enduring patterns of thought, emotion, and behavior\u0026mdash;are described by the Big Five model: Openness, Conscientiousness, Extraversion, Agreeableness, and Emotional Stability. This framework is cross-culturally validated and incorporated into the DSM-5-TR [7]. The TIPI provides a brief, validated assessment with acceptable psychometric properties, offering structural validity while minimizing participant burden [8].\u003c/p\u003e\u003cp\u003eInclusion criteria were BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 kg/m\u0026sup2; and failure of prior noninvasive weight loss interventions. Patients with BMI\u0026thinsp;\u0026gt;\u0026thinsp;40 kg/m\u0026sup2; were eligible if they declined or were ineligible for bariatric surgery. Exclusion criteria included prior bariatric procedures, family history of gastric cancer, history of gastric neoplasia, significant psychiatric illness, coagulopathy, or comorbidities precluding deep sedation. Patients were evaluated by a multidisciplinary team and were not required to discontinue weight loss pharmacotherapy post-ESG.\u003c/p\u003e\u003cp\u003eAnthropometric and laboratory data were collected at baseline and at 1-, 3-, 6-, and 12-months post procedure, with annual follow-up encouraged. All patients received standardized dietary and lifestyle counseling.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eExternal Validation Cohort\u003c/h3\u003e\n\u003cp\u003eThis cohort included patients who underwent ESG between September 2021 and December 2024 at a tertiary academic and safety-net hospital in New Jersey serving predominantly uninsured and underinsured populations. All procedures were performed by a single gastroenterologist (K.H.) under IRB approval (Pro2024002500). Patients with \u0026ge;\u0026thinsp;12 months of follow-up were included. All other methods mirrored the primary cohort.\u003c/p\u003e\n\u003ch3\u003eProcedure and Outcomes\u003c/h3\u003e\n\u003cp\u003e ESG techniques and postoperative dietary protocols followed published standardized methods [3].\u003c/p\u003e\u003cp\u003eWeight loss was measured as percent total body weight loss (%TBWL = [(Initial Weight \u0026ndash; Post-op Weight) / Initial Weight] \u0026times; 100). Personality traits were assessed using the TIPI, with each trait scored on a 1\u0026ndash;7 Likert scale. The primary outcome was %TBWL at last available follow-up.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics are reported as mean (standard deviation, SD) and median (interquartile range, IQR). Multilevel mixed-effects linear regression with a fixed effect for time and random intercepts for patients was used to analyze associations between personality traits and weight loss. All tests were two-tailed with α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePrimary Cohort\u003c/h2\u003e\u003cp\u003eThirty-four patients (83% female, mean age 48\u0026thinsp;\u0026plusmn;\u0026thinsp;13 years) completed the TIPI. Mean Baseline BMI was 36\u0026thinsp;\u0026plusmn;\u0026thinsp;4 kg/m\u0026sup2;. Median follow-up duration was 24 months (IQR 12\u0026ndash;24). Mean %TBWL was 15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The highest mean personality score was for conscientiousness (5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3); lowest for agreeableness (4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3).\u003c/p\u003e\u003cp\u003eEmotional stability demonstrated a significant positive association with %TBWL, with each one-point increase in emotional stability score corresponding to 1.9% greater TBWL (95% CI 0.2\u0026ndash;3.5%, p\u0026thinsp;=\u0026thinsp;0.026). This association remained statistically significant after adjusting for baseline BMI and follow-up compliance (β\u0026thinsp;=\u0026thinsp;1.9, 95% CI 0.4\u0026ndash;3.3%, p\u0026thinsp;=\u0026thinsp;0.017). No other domains were associated with weight loss (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExternal Validation Cohort\u003c/h3\u003e\n\u003cp\u003eTwenty-three patients (74% female; mean age 47\u0026thinsp;\u0026plusmn;\u0026thinsp;14 years) completed the TIPI. Baseline BMI was 44\u0026thinsp;\u0026plusmn;\u0026thinsp;4 kg/m\u0026sup2;, with median follow-up of 17 months (IQR 14\u0026ndash;22). Mean %TBWL was 12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The highest mean personality score was for agreeableness (6.0); lowest for extraversion (4.6).\u003c/p\u003e\u003cp\u003eEmotional stability was again significantly associated with %TBWL, with each one-point increase corresponding to 3.4% greater TBWL (95% CI 0.1\u0026ndash;6.5%, p\u0026thinsp;=\u0026thinsp;0.042). No other domains were associated with weight loss (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEmotional stability was consistently the only personality domain predictive of post-ESG weight loss across two demographically and socioeconomically distinct cohorts, suggesting a robust and generalizable relationship. This trait\u0026mdash;characterized by resilience to stress and effective emotional regulation\u0026mdash;may enhance adherence to post-ESG behavioral changes, like sustained dietary modification, physical activity, and follow-up attendance. While results are mixed, several prior bariatric surgery studies have linked lower emotional stability to poorer postoperative outcomes, although heterogeneity across studies and limited sample sizes may obscure this relationship [5, 6, 9]\u003c/p\u003e\u003cp\u003eGiven its rapid administration via the Ten-Item Personality Inventory (TIPI), emotional stability assessment can be seamlessly integrated into pre-procedural evaluations to support personalized, risk-stratified care. Patients with lower emotional stability scores may benefit from enhanced behavioral support, including psychological counseling, closer post-procedural follow-up, or pharmacological augmentation.\u003c/p\u003e\u003cp\u003eLimitations of our study include modest sample sizes, predominantly female composition, and potential selection bias from optional survey completion. Prospective studies are needed to clarify mechanisms linking emotional stability to weight outcomes. Despite these limitations, this study provides the first validated evidence that emotional stability, measurable via a brief survey, predicts ESG weight loss across diverse populations. Incorporating personality assessment into routine evaluation may enable early identification of patients who could benefit from personalized psychological support, improving long-term outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eB.I.R.: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work; and the drafting of the work. S.R.: drafting parts of the work; revising the work critical for important intellectual content. L.P: drafting parts of the work; revising the work critical for important intellectual content. E.A.: drafting parts of the work; revising the work critical for important intellectual content. A.H.: revising the work critical for important intellectual content. K.L.: revising the work critical for important intellectual content. K.H.: supervision of the work; revising the work critical for important intellectual content. R.Z.S.: supervision of the work; revising the work critical for important intellectual content. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data supporting the findings of this study are available within the paper and its Supplementary Information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCollaboration NCDRF: \u003cstrong\u003eWorldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults\u003c/strong\u003e. \u003cem\u003eLancet\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e403\u003c/strong\u003e(10431):1027-1050.\u003c/li\u003e\n\u003cli\u003eSingh S, Hourneaux de Moura DT, Khan A, Bilal M, Ryan MB, Thompson CC: \u003cstrong\u003eSafety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eSurg Obes Relat Dis\u0026nbsp;\u003c/em\u003e2020, \u003cstrong\u003e16\u003c/strong\u003e(2):340-351.\u003c/li\u003e\n\u003cli\u003eSharaiha RZ, Hajifathalian K, Kumar R, Saunders K, Mehta A, Ang B, Skaf D, Shah S, Herr A, Igel L\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eFive-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity\u003c/strong\u003e. \u003cem\u003eClin Gastroenterol Hepatol\u0026nbsp;\u003c/em\u003e2021, \u003cstrong\u003e19\u003c/strong\u003e(5):1051-1057 e1052.\u003c/li\u003e\n\u003cli\u003eMatteo MV, Bove V, Ciasca G, Carlino G, Di Santo R, Vinti L, Polidori G, Pontecorvi V, Papi M, Spada C\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eSuccess Predictors of Endoscopic Sleeve Gastroplasty\u003c/strong\u003e. \u003cem\u003eObes Surg\u0026nbsp;\u003c/em\u003e2024, \u003cstrong\u003e34\u003c/strong\u003e(5):1496-1504.\u003c/li\u003e\n\u003cli\u003evan Hout GC, Verschure SK, van Heck GL: \u003cstrong\u003ePsychosocial predictors of success following bariatric surgery\u003c/strong\u003e. \u003cem\u003eObes Surg\u0026nbsp;\u003c/em\u003e2005, \u003cstrong\u003e15\u003c/strong\u003e(4):552-560.\u003c/li\u003e\n\u003cli\u003eHjelmesaeth J, Rosenvinge JH, Gade H, Friborg O: \u003cstrong\u003eEffects of Cognitive Behavioral Therapy on Eating Behaviors, Affective Symptoms, and Weight Loss After Bariatric Surgery: a Randomized Clinical Trial\u003c/strong\u003e. \u003cem\u003eObes Surg\u0026nbsp;\u003c/em\u003e2019, \u003cstrong\u003e29\u003c/strong\u003e(1):61-69.\u003c/li\u003e\n\u003cli\u003eWidiger TA MG: \u003cstrong\u003eThe Alternative Model of Personality Disorders (AMPD) from the Perspective of the Five-Factor Model.\u003c/strong\u003e\u003cem\u003ePsychopathology\u0026nbsp;\u003c/em\u003e2020 Jun 11, \u003cstrong\u003e53(3-4):149-156\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eThorrisen MM, Sadeghi T: \u003cstrong\u003eThe Ten-Item Personality Inventory (TIPI): a scoping review of versions, translations and psychometric properties\u003c/strong\u003e. \u003cem\u003eFront Psychol\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e14\u003c/strong\u003e:1202953.\u003c/li\u003e\n\u003cli\u003eMontorio I, Izal M, Bellot A, Rodriguez J, de Iceta M: \u003cstrong\u003ePersonality Profiles Associated with Long-Term Success in Bariatric Surgery: 24-Month Follow-Up\u003c/strong\u003e. \u003cem\u003eBehav Sci (Basel)\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e13\u003c/strong\u003e(10).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of Study Cohorts\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary Cohort (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExternal Validation Cohort (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (74%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline BMI, kg/m\u0026sup2; (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44\u0026thinsp;\u0026plusmn;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up duration, months (median [IQR])\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 [IQR: 12\u0026ndash;24]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 [IQR 14\u0026ndash;22]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean personality trait scores (TIPI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtraversion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAgreeableness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConscientiousness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional stability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOpenness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eAbbreviations: BMI, body mass index; TIPI, Ten-Item Personality Inventory; IQR, interquartile range; SD, standard deviation.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWeight Loss and Personality Trait Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome Measure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary Cohort (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExternal Validation Cohort (n\u0026thinsp;=\u0026thinsp;23)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e% Total body weight loss (%TBWL, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssociation of Personality Trait (TIPI) with %TBWL (β, 95% CI, p-value)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eextraversion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25 (-1.07- 1.56), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.70\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.65 (\u0026ndash;0.06 to 7.37), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.054\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eagreeableness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.25 (-0.47\u0026ndash;2.99), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.15\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.67 (\u0026ndash;3.83 to 7.16), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.535\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConscioensciousness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.19 (-1.56\u0026ndash;1.94), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.83\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.12 (\u0026ndash;1.38 to 5.63), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.221\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eemotional stability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.85 (0.23\u0026ndash;3.47)\u003c/b\u003e, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.03\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e3.35 (0.12 to 6.59), p\u0026thinsp;=\u0026thinsp;0.043\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eopenness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.58 (-1.48\u0026ndash;2.64), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.57\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ndash;0.42 (\u0026ndash;3.69 to 2.86), \u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.793\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eAbbreviations: TIPI, Ten-Item Personality Inventory; β, regression coefficient; CI, confidence interval; %TBWL, percent total body weight loss.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eBold indicates statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8129681/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8129681/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"This is being submitted as a brief report and thus no abstract is included. ","manuscriptTitle":"Personality Traits Predict Weight Loss Following Endoscopic Sleeve Gastroplasty: A Cohort Study with External Validation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 18:56:32","doi":"10.21203/rs.3.rs-8129681/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-16T14:54:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T17:15:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-04T20:41:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28023044766419813054399917146199109553","date":"2025-12-03T21:56:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130431854746543252296253861640621217977","date":"2025-12-03T03:40:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233288601210580796004828195710868122639","date":"2025-12-01T17:46:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328856365591517786079993634706243080539","date":"2025-12-01T17:45:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-01T17:38:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-28T10:52:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-20T16:54:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2025-11-16T22:35:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"26595c8b-eeb2-4725-90a8-38232738d2e1","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:18:37+00:00","versionOfRecord":{"articleIdentity":"rs-8129681","link":"https://doi.org/10.1007/s11695-026-08504-9","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2026-03-28 16:10:53","publishedOnDateReadable":"March 28th, 2026"},"versionCreatedAt":"2025-12-03 18:56:32","video":"","vorDoi":"10.1007/s11695-026-08504-9","vorDoiUrl":"https://doi.org/10.1007/s11695-026-08504-9","workflowStages":[]},"version":"v1","identity":"rs-8129681","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8129681","identity":"rs-8129681","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}