Comparative Analysis of Bariatric Surgery Outcomes and Preoperative Body Composition in Obese Patients with Binge-Eating Disorders versus Simple Obesity Patients: A Retrospective Study

Comparative Analysis of Bariatric Surgery Outcomes and Preoperative Body Composition in Obese Patients with Binge-Eating Disorders versus Simple Obesity Patients: A Retrospective Study | 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 Comparative Analysis of Bariatric Surgery Outcomes and Preoperative Body Composition in Obese Patients with Binge-Eating Disorders versus Simple Obesity Patients: A Retrospective Study Xinping Wang, Dafang Zhan, Jie Zhang, Han Wang, Xiaoqin Pei, Miao Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7463390/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objective To investigate the impact of binge eating disorder (BED) on metabolic parameters and body composition in obese individuals, examine the pathogenic connection between obesity and BED, and assess its possible influence on the results of weight loss surgery. Methods This retrospective analysis included 302 obese patients derived from the Western China Bariatric Surgery Cohort. The participants were divided into the BED group and the non-BED (NBED) group on the basis of the Binge Eating Scale (BES) questionnaire and DSM-V diagnostic criteria. Basal metabolic parameters were assessed via an InBody 770 body composition analyzer, and rigorous follow-up tracking of postoperative weight variations was performed. Results The proportion of females was significantly greater (57.6% vs. 70.2%), and the BED group presented a greater body fat percentage (44.8% vs. 45.9%) and thigh fat mass (6.1 kg vs. 6.5 kg) (all P < 0.05) but a lower muscle-to-fat ratio (men 0.81 vs. 0.84; women 0.60 vs 0.64) and basal metabolic rate per unit body weight (men 15.6 kcal vs 15.9 kcal; women 15.1 kcal vs 15.5 kcal). There was no statistically significant difference in weight loss between the two groups at 1 year and 2 years post-operatively (P > 0.05). Conclusion This study revealed that obese patients with BED exhibit a unique metabolic phenotype characterized by a female predominance, regional fat accumulation (especially in the thigh area), and decreased energy metabolism efficiency. Lipotoxicity-mediated insulin resistance and chronic low-grade inflammatory states exacerbate metabolic disorders, and weight loss surgery has comparable short-term weight loss efficacy in obese BED patients and nonobese non-BED patients. Binge Eating Disorder Obesity Body Composition Bariatric Surgery Introduction Binge eating disorder (BED), officially included as an independent disease entity in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) in 2013, has now become the fastest-growing subtype of eating disorders worldwide. Its core clinical feature is recurrent episodes of uncontrolled eating behavior, which is significantly associated with obesity. Currently, the treatment of BED emphasizes the integrated application of psychological, pharmacological, and behavioral interventions, with a focus on individualized and long-term management(Crone et al. 2023). The prevalence of binge eating disorders in adults is 1.1–2.3%(Ágh et al. 2016), whereas in the obese population, the prevalence can significantly increase to 9–29%(McCuen-Wurst, Ruggieri, and Allison 2018). The comorbidity rate between binge eating disorder and obesity is high, and the two conditions influence each other. The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends psychological evaluation for candidates for metabolic and bariatric surgery (MBS) prior to surgery, aiming to optimize surgical outcomes through the screening of uncontrolled mental disorders and the implementation of behavioral interventions (such as the correction of binge eating behaviors)(Volkow et al. 2013). Compared with those with simple obesity, patients with obesity combined with binge eating disorder exhibit more significant metabolic abnormalities, including a greater proportion of visceral fat, more pronounced insulin resistance, and chronic low-grade inflammation(Olguin et al. 2017). Although the standard CBT course lasts for 3 to 6 months and can achieve symptom relief(Grilo and Juarascio 2023), this time window may pose multiple clinical risks for patients with comorbidities requiring urgent surgical intervention, thereby affecting overall efficacy. Existing studies indicate that the pathological mechanisms of obesity combined with binge eating disorder involve various aspects of biology(Bourdy and Befort 2023), psychology(Dingemans, Danner, and Parks 2017), and sociology(Bray et al. 2022). However, research on its body composition characteristics (such as fat distribution and visceral fat levels) and metabolic correlations remains limited. The use of body composition analysis provides not only precise assessments of metabolic characteristics and deepens the understanding of the pathological traits of this patient group but also crucial support for personalized clinical interventions. Methods This retrospective analysis included 302 obese patients derived from the Western China Bariatric Surgery Cohort.They were diagnosed by psychiatrists on the basis of the diagnostic criteria for BED in the DSM-V, and the judgment of whether the obese patients met the criteria for BED was simultaneously assessed via the Binge Eating Scale (BES) questionnaire. On the basis of the BES questionnaire score, patients with a BES total score of ≥18 points were further verified via the DSM-V diagnostic criteria and divided into the BED group and the NBED group. The inclusion criteria for the BED group were as follows: (A) obese patients with a BMI >28 kg/m²; (B) meeting the DSM-V diagnostic criteria for binge eating disorder, as evaluated by a specialist psychiatrist; (C) no prior use of any psychiatric medication or medication use of less than three days with a dosage below the standard therapeutic dose; and (D) aged 18–60 years. (E) willing to participate in this study and signed a written informed consent form. The inclusion criteria for the NBED group were as follows: (A) obese patients with a BMI >28 kg/m²; (B) no family history of mental disorders within two generations per the DSM-V criteria; and (C) willing to participate in this study and signed a written informed consent form. The exclusion criteria were patients with a history of severe physical and neurological diseases; a current or past history of other mental disorders; a history of traumatic brain injury with a loss of consciousness exceeding 10 minutes; a history of dependence on psychoactive substances such as alcohol (excluding nicotine, caffeine, and social drinking); individuals with intellectual disabilities; pregnant or breastfeeding women, ethnic minorities, disabled individuals, and critically ill patients; and a history of diseases affecting hormonal function. 2.1 Body composition In this study, body composition measurements were conducted by two researchers who had undergone rigorous professional training via a direct, segmental, multifrequency bioelectrical impedance analyzer (InBody770), which strictly followed the operational instructions of the device. Before the measurement, the participants were required to adhere strictly to the preparation procedures: abstain from consuming solid food and liquids for at least 2 hours and empty their bladders and bowels before the measurement to minimize the influence of physiological factors on the results. The participants were instructed to wear lightweight clothing and remove all metal accessories to prevent interference from metal with the bioelectrical impedance measurement. During the measurement, the participants had to maintain a specific standard posture: arms straight and naturally spread out, with the torso forming an approximately 15° angle with the vertical direction, standing throughout the process to ensure body stability and consistency of posture, thereby ensuring the accuracy of the measurement data. The specific indicators measured included several key parameters reflecting body composition: body mass index (BMI), neck circumference, abdominal circumference, hip circumference, waist‒hip ratio, upper arm circumference, thigh circumference, total body water (TBW), protein, minerals, body fat mass (BFM), skeletal lean mass (SLM), fat-free mass (FFM), skeletal muscle mass (SMM), percentage of body fat (PBF), basal metabolic rate (BMR), visceral fat area (VFA), bone mineral content (BMC), the ratio of muscle mass to fat mass (MFR), and BMR/weight (BMR/W). Among them, MFR was calculated on the basis of the ratio of skeletal muscle mass (SMM) to body fat mass (BFM), and BMR/W was calculated as the ratio of the basal metabolic rate (BMR) to body weight. These two indicators were calculated by researchers on the basis of the measurement data, whereas the values of the other indicators were automatically provided by the device's electronic system, ensuring objectivity and standardization in the data acquisition process. 2.2 Postoperative Follow-up This study conducted a two-year follow-up for patients included in the study who underwent bariatric surgery. Weight data were collected at two time points, one year post-surgery (±1 week) and two years post-surgery (±1 week), through telephone calls, text messages, and outpatient consultations. 2.3 Data analysis All the data were analyzed via SPSS 27 (IBM, Armonk, NY) software. Normally distributed measurement data are expressed as the means ± standard deviations, and intergroup comparisons were performed via the independent samples t test. Nonnormally distributed measurement data are expressed as medians (interquartile ranges), and intergroup comparisons were performed via the Mann‒Whitney U test, a nonparametric method. A p value < 0.05 was considered statistically significant. Results 3.1 Metabolic-related indicators and hormone levels in patients There were no statistically significant differences in preoperative blood glucose or blood lipid indicators between the BED group and the NBED group (all P > 0.05) (Table 1 ). Among male patients, there was no significant difference in testosterone, progesterone, or estradiol levels between the BED group and the NBED group (all P > 0.05). In female patients, the median testosterone level in the BED group (1.5 nmol/L, Q1-Q3: 1.2–2.1) tended to decrease compared with that in the NBED group (1.8 nmol/L, 1.4–2.2), but this difference did not reach statistical significance (P = 0.141). Progesterone and estradiol levels also did not significantly differ between the two groups (all P > 0.05) (Table 2 ). Table 1 Blood glucose and lipid levels in participants with BED or NBED variable NBED BED value P n M (P 25 ,P 75 ) n M (P 25 ,P 75 ) Glucose 149 5.21 (4.67,6.07) 149 5.33 (4.78,6.35) 1.263 0.206 * Triglyceride 145 1.59 (1.21,2.44) 143 1.72 (1.14,2.56) 0.532 0.465 * Total Cholesterol 145 4.88 (4.20,5.59) 143 4.98 (4.39,5.55) 1.007 0.290 * The data are presented as the means ± standard deviations or medians (Q 1, Q 3 ). *Mann‒Whitney U test; # Independent t test. Table 2 Hormone levels in participants with BED or NBED variable Male Female n NBED n BED P n NBED n BED P Testosterone 63 9.2(7.2,14.4) 44 9.2(6.9,12.2) 0.293 * 81 1.8(1.4,2.2) 101 1.5(1.2,2.1) 0.141 * Progesterone 59 0.2 (0.1,0.2) 43 0.2(0.1,0.2) 0.167 * 78 0.2 (0.2,0.6) 98 0.2 (0.2,1.6) 0.762 * Estradiol 62 136 (108,171) 44 128 ± 47 0.320 * 78 196(142,407) 101 193(141,339) 0.774 * The data are presented as the means ± standard deviations or medians (Q 1, Q 3 ). *Mann‒Whitney U test; # Independent t test. 3.2 Basic characteristics and obesity-related indicators of patients A total of 302 obese patients were included in this study, with 151 in the BED group and 151 in the NBED group. The proportion of obese patients with BEDs was 50%. There were 64 males (42.4%) and 87 females (57.6%) in the NBED group, whereas 45 males (29.8%) and 106 females (70.2%) were included in the BED group. The chi-square test revealed that the difference in sex distribution between the two groups was statistically significant (P < 0.05) (Table 3 ). Table 3 Basic information and obesity indicators in participants with BED or NBED variable NBED BED value P Gender Male 64(42.4%) 45(29.8%) Female 87(57.6%) 106(70.2%) 5.182 0.023 + Age(years) 32(27,39) 32, (25,32) -1.997 0.046 * Weight (kg) 100.5(89.1,117.0) 102.6(90.3,116.5) 0.544 0.587 * BMI (kg/m 2 ) 36.7(33.4,40.5) 37.8(34.4,41.0) 1.581 0.114 * Neck Circumference(cm) 42.7(40.4,45.2) 43.4(40.8,45.7) 1.164 0.245 * Chest Circumference (cm) 112.9(108.1,118.7) 114.4(107.5,120.0) 0.738 0.460 * Abdominal Circumference(cm) 116.7(109.8,128.6) 118.8(109.3,126.6) 0.086 0.932 * Hip Circumference(cm) 114.6(109.3,121.6) 116.5(110.6,122.2) 1.287 0.198 * Waist - Hip Ratio 1.02 ± 0.66 1.01 ± 0.68 1.629 0.104 # Arm Circumference (cm) 39.7(37.7,43.7) 40.9(37.9,43.6) 1.043 0.297 * Thigh Circumference(cm) 63.0 ± 4.8 63.8 ± 4.9 -1.465 0.144 # The data are presented as the means ± standard deviations, medians (Q 1, Q 3 ), and n(%). *Mann‒Whitney U test; # Independent t test; + Pearson χ² test. 3.3 Body composition Compared with the NBED group, the BED group presented greater PBF and thigh fat mass, whereas the MSR and basal metabolic rate per unit of body weight (BMR per unit of body weight) were lower in the BED group than in the NBED group. The differences were statistically significant (P < 0.05) (Table 4 ). Table 4 Body composition of participants with BED or NBED variable NBED BED value P Total Body Water 41.3(35.6,50.3) 39.3(36.3,46.3) -0.795 0.427 * protein 11.0(9.5,13.4) 10.6(9.8,12.5) -0.843 0.399 * Minerals 3.7 (3.6,4.42) 3.7(3.3,4.3) -0.784 0.433 * Body Fat Mass 44.7(37.8,53.7) 47.0 (39.9,53.9) 1.450 0.147 * Soft Lean Mass 52.9(45.7,64.5) 50.5(46.7,59.4) -0.832 0.405 * Fat Free Mass 55.9(48.5,68.2) 53.7(49.4,62.9) -0.844 0.399 * Skeletal Muscle Mass 31.1(26.9,38.4) 29.8(27.5,35.6) -0.843 0.399 * Percent Body Fat 44.8(40.3,48.8) 45.9(41.9,50.7) 2.065 0.039 * FFM of Arm 3.2 (2.7,4.1) 3.1(2.8,3.8) -0.927 0.354 * FFM of Trunk 25.9(23.0,31.0) 24.9(22.9,29.3) -0.968 0.333 * FFM of Leg 8.2 (7.3,10.3) 8.2(7.3,9.7) -0.644 0.520 * BFM of Arm 4.3(3,3,6.0) 4.8 (3.5,6.0) 1.406 * 0.160 * BFM of Trunk 22.4 ± 4.5 22.7 ± 3.7 -0.560 0.576 # BFM of Leg 6.1(5.1,7.3) 6.5(5.6,7.6) 2.095 0.036 * Basal Metabolic Rate 1,577(1418,1844) 1,530(1437,1728) -0.839 0.402 * Visceral Fat Area 214.3(183.2,244.0) 222.8(191.4,240.9) 0.807 0.420 * Bone Mineral Content 3.0 (2.7,3.7) 3.0 (2.7,3.5) -0.806 0.420 * Muscle-Fat ratio 0.69(0.58,0.82) 0.65(0.54,0.78) -2.115 0.034 * BMR per unit of body weight(BMR(kcal/day/kg)) 15.7 ± 1.6 15.3 ± 1.4 2.081 0.038 # Notes: Data are presented as the means ± standard deviations or medians (Q 1, Q 3 ). *Mann‒Whitney U test; # Independent t test. 3.4 Postoperative body weight In the first year after surgery, the difference in body weight between the two groups was not statistically significant (P > 0.05). In the second year after surgery, the NBED group maintained a median body weight of 70 kg (range 62.0–80.0 kg), whereas the body weight of the BED group slightly increased to 70.5 kg (range 62.0–83.5 kg). The difference in body weight between the two groups remained statistically insignificant (P > 0.05). In terms of absolute changes in body weight, the NBED group presented a change of 0.3 kg (range − 2.0–3.1 kg), whereas the BED group presented a change of 1.4 kg (range − 1.98–5.0 kg), with a difference of 1.183 (P = 0.237), which also did not reach statistical significance (Table 5 ). Table 5 Postoperative weight loss outcomes in participants with BED or NBED variable NBED BED P n M (P 25 ,P 75 ) n M (P 25 ,P 75 ) 1-Year Post-operative Weight(kg) 128 70.0(65.0,84.8) 126 70.0(62.0,80.0) 0.632 * ΔBMI at 1-Year Post-operative Follow-Up(kg/m 2 ) 128 10.4(8.6,13.7) 126 12.0 ± 4.43 0.069 * ΔWeight at 1-Year Post-operative Follow-Up(kg) 128 28.9(22.9,38.4) 126 32.5(24.1,40.6) 0.151 * %EWL at 1-Year Follow-Up 128 72.2(58.9,88.8) 126 73.4762.8,91.1) 0.568 * 2-Year Post-operative Weight(kg) 131 70.0(64.0,83.0) 117 70.5(62,83.5) 0.805 * ΔBMI at 2-Year Post-operative Follow-Up(kg/m 2 ) 131 10.0(7.8,13.3) 117 11.5 (8.0,13.8) 0.273 * ΔWeight at 2-Year Post-operative Follow-Up(kg) 131 27.6(21.7,37.4) 117 31.2(21.2,39.9) 0.396 * %EWL at 2-Year Follow-Up 131 71.8(56.8,88.0) 117 72.09(58.0,89.2) 0.964 * ΔWeight (Y2-Y1) 123 0.3(-2.0,3.1) 112 1.4(-1.98,5.0) 0.237 * Notes: Data are presented as the means ± standard deviations, medians (Q 1, Q 3 ). *Mann‒Whitney U test; # Independent t test.%EWL: percentage of excess weight loss = [(baseline weight - postoperative weight)/(baseline weight - ideal weight)] × 100%; ΔBMI = postop BMI - preop BMI; ΔWeight = postop weight - preop weight; Y1 = 1 year post-op; Y2 = 2 years post-op. Discussion This study aimed to compare body composition differences and postoperative weight loss outcomes between obese patients with BED and those without BED. The results revealed that the prevalence rate in the BED group was 50%, and the proportion of females in the BED group was significantly greater than that in the NBED group. Although there were no statistically significant differences between the two groups in baseline obesity indicators, such as metabolic markers, hormone levels, weight, and BMI, detailed body composition analysis indicated that the BED group presented a significantly greater body fat percentage and thigh fat accumulation (P < 0.05), accompanied by a simultaneous decrease in the MFR and BMR/W. Without preoperative psychological interventions, weight loss was not significantly different between the two groups at one year and two years post-surgery. The prevalence of binge eating disorder in the general population is approximately 1.1–2.3%(Ágh et al. 2016 ). This study revealed that the proportion of patients with BED among those undergoing bariatric surgery reached as high as 50%, which was significantly greater than that reported in the general population, further confirming the important association between obesity and binge eating disorders. This finding is consistent with those of previous studies and highlights the significantly increased incidence of BED in the obese population (7–17%)(Dawes et al. 2016 ). Obese individuals often face dual pressures from both physiological and psychological factors, and binge eating may be perceived as a strategy to cope with stress. Various psychological factors (e.g., the need for emotional regulation and stress management)(Gianini, White, and Masheb 2013), social and environmental factors(Barakat et al. 2023 ), and biological mechanisms (e.g., dopamine activity and addiction-related mechanisms)(Bourdy and Befort 2023; Parsons and Hurd 2015 ) may all play significant roles in this relationship. Furthermore, obesity itself may lead to increased food cravings and intake, whereas BEDs may further exacerbate the degree of obesity, forming a vicious cycle. This interaction not only affects patients' physical health but also may have negative impacts on their mental health. Therefore, deepening our understanding of the complex relationship between obesity and BED is crucial. This study revealed that the proportion of female patients in the BED group was significantly greater than that in the NBED group, suggesting a potential sex bias in the prevalence of binge eating disorder among obese females and its underlying influencing factors. Some studies have reported that the lifetime prevalence of binge eating disorder in females is approximately 1.9%(Kessler et al. 2013 ), which is approximately twice that reported in males. This result aligns with the findings of this study and the trend of a higher prevalence of binge eating disorder in female populations noted in the literature. This sex difference may be closely related to the multifaceted regulatory effects of estrogen on appetite and metabolism(Brutman, Sirohi, and Davis 2019). Additionally, women may be more vulnerable when facing social pressure, difficulties in emotional regulation, dissatisfaction with body image, and negative self-perceptions, making specific emotional traits and unique social factors important drivers of the high prevalence of binge eating disorders among females. The results of the body composition analysis revealed that the PBF and thigh fat mass in the BED group were significantly greater than those in the NBED group. Although the difference in PBF between the two groups was not statistically significant after stratification by sex, the BED group still presented higher levels of PBF, fat mass, and visceral fat area than the NBED group did (Supplementary Table 1), suggesting that BED patients may be more prone to storing fat in the abdominal and thigh regions. Ectopic deposition of thigh fat may reflect an "overflow effect" of energy surplus, which could be one of the causes of BED. Therefore, among obese patients (especially females), BED screening should be prioritized when thigh fat mass is high and the muscle-to-fat ratio is low. Early identification of binge eating behaviors can help facilitate targeted combined intervention strategies, such as metabolic regulation (e.g., muscle-building training) and psychological interventions (e.g., cognitive behavioral therapy). Moreover, the greater PBF, fat mass, and visceral fat area in the BED group suggest that binge eating behaviors might be closely associated with fat accumulation. Hence, it is necessary to further explore the molecular mechanisms of fat metabolism to reveal their potential roles and impacts on the BED phenotype. In adults, brown adipose tissue (BAT) is primarily concentrated in the neck, above the collarbone, along both sides of the spine, and near the adrenal glands. BAT mediates nonshivering thermogenesis through mitochondrial uncoupling protein 1 (UCP1), which consumes excess energy. However, BED patients may have low BAT activity, leading to an inability to efficiently expend the surplus energy generated by binge eating, which is then stored in the form of white adipose tissue (WAT), exacerbating fat accumulation(Wang et al. 2023 ). WAT is mainly divided into subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), which store energy through triglyceride accumulation(Heyde, Begemann, and Oster 2021). When the storage capacity of SAT reaches its limit, free fatty acids may accumulate in VAT and other ectopic locations, resulting in metabolic abnormalities(Tchkonia et al. 2013 ). Excessive expansion of WAT can also lead to hypoxia and macrophage infiltration, which releases proinflammatory factors such as TNF-α and IL-6, impairing adipocyte function, exacerbating central inflammation, interfering with insulin signaling, and inducing insulin and leptin resistance as well as fat metabolism disorders, thereby affecting appetite(Cassioli et al. 2020; Yang et al. 2024 ). Consequently, excessive fat accumulation not only leads to weight gain but also significantly impacts appetite regulation, further exerting profound effects on the development of obesity and related metabolic diseases. After gender stratification analysis, there were no statistically significant differences between the male and female groups in terms of SSM or FFM. However, the data indicated that the BED group presented a slightly lower muscle-to-fat ratio and BMR/W, which might be related to intramuscular fat infiltration. Although BED patients had FFM and SSM levels similar to those of obese individuals, their fat content was significantly greater (Supplementary Table 1). The deposition of fat within muscles could weaken the metabolic activity of muscle cells, thereby reducing the overall energy expenditure capacity of the muscle(Valkovič et al. 2016 ). A decrease in the basal metabolic rate could not only contribute to further weight gain but also exacerbate metabolic dysfunction. Furthermore, compared with subcutaneous fat, visceral fat is more likely to trigger chronic inflammation and endocrine abnormalities, subsequently affecting systemic metabolism(Yang et al. 2024 ). Consequently, obese patients with BED are more prone to developing metabolic syndrome, characterized by multiple metabolic abnormalities, such as hypertension, hyperglycemia, and hyperlipidemia. This study revealed that patients with obesity combined with BED and those with simple obesity had no significant difference in weight loss outcomes one and two years after bariatric surgery. One year after surgery, there were no significant differences (P > 0.05) in weight, BMI changes, weight reduction amount, or percentage of excess weight loss between the two groups; two years after surgery, these indicators remained consistent (P > 0.05). These findings suggest that bariatric surgery itself is effective for patients with obesity combined with BED, even without preoperative psychological interventions targeted at BED patients, demonstrating significant short-term weight improvement. This result aligns with those of several existing studies indicating that there is no significant difference in postoperative weight loss outcomes regardless of whether patients undergo preoperative CBT treatment(Paul et al. 2022 ). Although current guidelines recommend preoperative psychological interventions for bariatric surgery patients combined with BED to improve prognosis(Crone et al. 2023 ), this study suggests that for patients urgently requiring surgery to alleviate severe obesity and related metabolic complications, omitting preoperative psychological behavioral treatment may not significantly impact short-term weight loss outcomes. From a clinical practice perspective, a potential issue with preoperative psychological intervention is that it may prolong the waiting time for surgery. This delay could exacerbate health risks, particularly for high-risk obese patients with severe cardiopulmonary diseases or diabetes(Monsalve et al. 2023). Therefore, when weighing time costs against the benefits of intervention, clinical decisions should prioritize surgery for patients in urgent need rather than mandating the completion of psychological treatment first. Although two years after surgery, there were no significant differences in weight between the BED and NBED groups, the absolute weight change in the BED group was greater (1.4 kg versus 0.3 kg), suggesting a greater risk of weight regain. As the follow-up time increases, the risk of weight rebound for BED patients may further intensify. Previous studies have shown that the five-year post-operative weight regain risk for BED patients is 18% greater than that for non-BED patients(Kops et al. 2020), which might be associated with residual or recurrent binge eating behaviors(Aylward, Konsor, and Cox 2022). While bariatric surgery has favorable short-term outcomes for BED patients, inert metabolic activity in thigh fat may increase their risk of weight regain(Bharadwaj et al. 2015 ). Therefore, recording changes in diet and emotions in real time postsurgery, regularly monitoring body composition, reinforcing behavioral interventions(Cassin et al. 2020 ; Rudolph and Hilbert 2020), and strengthening leg resistance training to increase muscle mass are recommended, thereby maintaining long-term outcomes(Effting et al. 2022 ). This study reveals the unique pathological characteristics of body composition distribution and metabolic function in patients with obesity and BED by comparing the clinical features of BED patients and NBED patients. This study provides important evidence for the interaction mechanism between obesity and binge eating disorder, emphasizing the need to construct an intervention system from metabolic, psychological, and social dimensions to improve patient prognosis and break the vicious cycle of obesity and binge eating. Future research should focus on exploring the relationship between obesity and binge eating disorder and further investigate the connection between fat accumulation and binge eating disorder from the perspective of molecular mechanisms. Limitations However, this study has certain limitations. First, this study is retrospective in nature, making it impossible to clarify the causal relationship between BED and differences in body composition or metabolic disorders. Future research should employ prospective cohort studies to further validate these causal links. Second, the time frame for postoperative weight changes is relatively short, and follow-up analysis may be influenced by various external factors (such as lifestyle changes, exercise habits, dietary patterns, and psychological interventions). However, this study failed to collect comprehensive information on such variables, which might have resulted in bias in the evaluation of weight loss outcomes. Future research should employ RCTs to further explore the impact of preoperative cognitive behavioral therapy on weight loss outcomes in patients with binge eating disorders. Finally, potential mechanisms related to binge eating disorders, such as the interaction between fat distribution and muscle function, as well as the role of chronic inflammation in metabolic disorders, were not thoroughly analyzed in this study. These inferences require further validation through mechanistic studies. Future research should include larger sample sizes and encompass multicenter, multidimensional variables to construct a research framework for longitudinal observation and mechanistic exploration, aiming to comprehensively reveal the influencing factors of BED in weight loss and weight regain, thereby providing more reliable theoretical support for individualized treatment strategies. Conclusions and Clinical Significance This study revealed that obese patients with BED present a unique metabolic phenotype characterized by female predominance, regional fat accumulation (especially in the thigh area), and reduced energy metabolism efficiency. These features may exacerbate metabolic disorders through insulin resistance mediated by lipotoxicity and chronic low-grade inflammatory states. Bariatric surgery offers comparable short-term weight loss efficacy for obese patients with BEDs. In clinical practice, body composition analysis should be integrated into BED evaluation systems, and comprehensive intervention plans combining metabolic regulation and psychological support should be developed for patients. CBT can be used to disrupt the vicious cycle of binge eating and abnormal fat deposition, whereas resistance training can optimize body composition distribution, ultimately achieving both metabolic and psychological benefits. Declarations Ethics approval and consent to participate ：This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of [Longitudinal Study of Bariatric Surgery in Western China] (Ethics Approval Number: [ChiCTR2300073353]). Consent for publication： Not applicable Availability of data and materials： The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: This work was supported by the Science and Technology Department of Sichuan Province (2023YFS0115) and the Third People’s Hospital of Chengdu Scientific Research Project (2023PI26). Authors' contributions: Yuanchuan Zhang: Conceptualization (lead); supervision; writing, review and editing (support). Xinping Wang: writing – original draft (lead); formal analysis (equal) Dafang Zhan: investigation (lead); Han Wang: investigation (support). Jie Zhang: writing, review and editing (lead). Xiaoqin Pei: Conceptualization (support); Methodology (lead). Miao Chen: Formal Analysis (equal) Acknowledgements: This work was supported by grants from the Science and Technology Department of Sichuan Province (No. 2023YFS0115) and the Scientific Research Project of the Third People’s Hospital of Chengdu (No. 2023PI26). We extend our sincere appreciation to all the participants and researchers involved in this study. Specifically, we would like to acknowledge Yuanchuan Zhang for overall conceptualization and supervision; Xinping Wang for leading the original draft preparation and formal analysis; Dafang Zhan for conducting the investigation, with support from Han Wang; Jie Zhang for manuscript review and editing; Xiaoqin Pei for conceptual advice and methodology development; and Miao Chen for contributing equally to formal analysis. We are also grateful to the Western China Bariatric Surgery Patient Cohort for providing the biological samples and data critical to this study. We thank all the cohort participants and administrative staff for their invaluable resources and support. References Ágh, Tamás, Gábor Kovács, Dylan Supina, Manjiri Pawaskar, Barry K. Herman, Zoltán Vokó, and David V. 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Correia Horvath, Fabiana Silva Costa, and Rogério Friedman. 2020. “Binge Eating Scores Pre-Bariatric Surgery and Subsequent Weight Loss: A Prospective, 5 Years Follow-up Study.” Clinical Nutrition ESPEN 38:146–52. doi:10.1016/j.clnesp.2020.05.013. McCuen-Wurst, Courtney, Madelyn Ruggieri, and Kelly C. Allison. 2018. “Disordered Eating and Obesity: Associations between Binge Eating-Disorder, Night-Eating Syndrome, and Weight-Related Co-Morbidities.” Annals of the New York Academy of Sciences 1411(1):96–105. doi:10.1111/nyas.13467. Monsalve, Francisco A., Fernando Delgado-López, Barbra Fernández-Tapia, and Daniel R. González. 2023. “Adipose Tissue, Non-Communicable Diseases, and Physical Exercise: An Imperfect Triangle.” International Journal of Molecular Sciences 24(24):17168. doi:10.3390/ijms242417168. Olguin, Pablo, Manuel Fuentes, Guillermo Gabler, Anna I. Guerdjikova, Paul E. Keck, and Susan L. McElroy. 2017. “Medical Comorbidity of Binge Eating Disorder.” Eating and Weight Disorders: EWD 22(1):13–26. doi:10.1007/s40519-016-0313-5. Parsons, Loren H., and Yasmin L. Hurd. 2015. “Endocannabinoid Signaling in Reward and Addiction.” Nature Reviews. Neuroscience 16(10):579–94. doi:10.1038/nrn4004. Paul, Linda, Colin van der Heiden, Daphne van Hoeken, Mathijs Deen, Ashley Vlijm, René Klaassen, L. Ulas Biter, and Hans W. Hoek. 2022. “Three- and Five-Year Follow-up Results of a Randomized Controlled Trial on the Effects of Cognitive Behavioral Therapy before Bariatric Surgery.” The International Journal of Eating Disorders 55(12):1824–37. doi:10.1002/eat.23825. Rudolph, Almut, and Anja Hilbert. 2020. “Cognitive‒Behavioral Therapy for Postbariatric Surgery Patients With Mental Disorders: A Pilot Study.” Frontiers in Psychiatry 11:14. doi:10.3389/fpsyt.2020.00014. Tchkonia, Tamara, Thomas Thomou, Yi Zhu, Iordanes Karagiannides, Charalabos Pothoulakis, Michael D. Jensen, and James L. Kirkland. 2013. “Mechanisms and Metabolic Implications of Regional Differences among Fat Depots.” Cell Metabolism 17(5):644–56. doi:10.1016/j.cmet.2013.03.008. Valkovič, Ladislav, Marek Chmelík, Barbara Ukropcová, Thomas Heckmann, Wolfgang Bogner, Ivan Frollo, Harald Tschan, Michael Krebs, Norbert Bachl, Jozef Ukropec, Siegfried Trattnig, and Martin Krššák. 2016. “Skeletal Muscle Alkaline Pi Pool Is Decreased in Overweight-to-Obese Sedentary Subjects and Relates to Mitochondrial Capacity and Phosphodiester Content.” Scientific Reports 6(1):20087. doi:10.1038/srep20087. Volkow, N. D., G. J. Wang, D. Tomasi, and R. D. Baler. 2013. “Obesity and Addiction: Neurobiological Overlaps.” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 14(1):2–18. doi:10.1111/j.1467-789X.2012.01031.x. 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Supplementary Files SupplementaryTable.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Oct, 2025 Reviews received at journal 02 Oct, 2025 Reviews received at journal 15 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers invited by journal 08 Sep, 2025 Editor assigned by journal 01 Sep, 2025 Submission checks completed at journal 01 Sep, 2025 First submitted to journal 28 Aug, 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. 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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-7463390","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":512166611,"identity":"549b09fb-4f8c-481d-a4a4-dd3bcc55ebe9","order_by":0,"name":"Xinping Wang","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinping","middleName":"","lastName":"Wang","suffix":""},{"id":512166612,"identity":"6dd28f04-0733-4f66-bc24-9fe62b569d77","order_by":1,"name":"Dafang Zhan","email":"","orcid":"","institution":"The Third People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Dafang","middleName":"","lastName":"Zhan","suffix":""},{"id":512166613,"identity":"f2fc6fb7-fdd7-493c-80f9-eea0cf06895d","order_by":2,"name":"Jie Zhang","email":"","orcid":"","institution":"The Third People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Zhang","suffix":""},{"id":512166614,"identity":"c01014b1-dcfa-4f80-9e7a-3faa35aed7fd","order_by":3,"name":"Han Wang","email":"","orcid":"","institution":"The Third People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Wang","suffix":""},{"id":512166615,"identity":"65f71a41-1f72-4a13-b140-e2b3df87133e","order_by":4,"name":"Xiaoqin Pei","email":"","orcid":"","institution":"The Third People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqin","middleName":"","lastName":"Pei","suffix":""},{"id":512166616,"identity":"e1101fa3-abc3-47b4-b782-70b37ef94de1","order_by":5,"name":"Miao Chen","email":"","orcid":"","institution":"The Third People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Miao","middleName":"","lastName":"Chen","suffix":""},{"id":512166617,"identity":"1a9fe4d5-2f9b-4035-91db-02787a6a7937","order_by":6,"name":"Yuanchuan Zh ang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDACCQglx8befIA0LcZ8PMcSSNOSKCfhY0CcDv7ZPYafC37ZJLBJ8Hy88YbBTk63gZAld84YS8/sS8tjk+7dbDmHIdnY7AABLQYSOQbSvD2Hi9lkzm6T5mE4kLiNCC3Gv3l7/ie2SeQ8I1qLmTTPjwMgLWzEaZG4kVZmzduQbMzGc8zYco4BEX7hn5G8+TbPHzs5+fbmhzfeVNjJEdQCBoxtUCt5iIwaIPgD00K0jlEwCkbBKBhJAAA/iD1XiLCL2gAAAABJRU5ErkJggg==","orcid":"","institution":"The Third People's Hospital of Chengdu","correspondingAuthor":true,"prefix":"","firstName":"Yuanchuan","middleName":"Zh","lastName":"ang","suffix":""}],"badges":[],"createdAt":"2025-08-26 13:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7463390/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7463390/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91216079,"identity":"d3a9c2a9-db76-4763-bff4-3ed37fdb3dd7","added_by":"auto","created_at":"2025-09-12 19:41:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":862043,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7463390/v1/a2c1094c-6885-4d0b-b72e-69363e4ae88d.pdf"},{"id":91215155,"identity":"0c0e4d83-bbd4-4c83-bdd6-a239ef41cab8","added_by":"auto","created_at":"2025-09-12 19:17:15","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":22439,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-7463390/v1/5fd8519e949f89248a7beae1.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of Bariatric Surgery Outcomes and Preoperative Body Composition in Obese Patients with Binge-Eating Disorders versus Simple Obesity Patients: A Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBinge eating disorder (BED), officially included as an independent disease entity in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) in 2013, has now become the fastest-growing subtype of eating disorders worldwide. Its core clinical feature is recurrent episodes of uncontrolled eating behavior, which is significantly associated with obesity. Currently, the treatment of BED emphasizes the integrated application of psychological, pharmacological, and behavioral interventions, with a focus on individualized and long-term management(Crone et al. 2023).\u003c/p\u003e\n\u003cp\u003eThe prevalence of binge eating disorders in adults is 1.1–2.3%(Ágh et al. 2016), whereas in the obese population, the prevalence can significantly increase to 9–29%(McCuen-Wurst, Ruggieri, and Allison 2018). The comorbidity rate between binge eating disorder and obesity is high, and the two conditions influence each other. The American Society for Metabolic and Bariatric Surgery (ASMBS) recommends psychological evaluation for candidates for metabolic and bariatric surgery (MBS) prior to surgery, aiming to optimize surgical outcomes through the screening of uncontrolled mental disorders and the implementation of behavioral interventions (such as the correction of binge eating behaviors)(Volkow et al. 2013).\u0026nbsp;Compared with those with simple obesity, patients with obesity combined with binge eating disorder exhibit more significant metabolic abnormalities, including a greater proportion of visceral fat, more pronounced insulin resistance, and chronic low-grade inflammation(Olguin et al. 2017). Although the standard CBT course lasts for 3 to 6 months and can achieve symptom relief(Grilo and Juarascio 2023), this time window may pose multiple clinical risks for patients with comorbidities requiring urgent surgical intervention, thereby affecting overall efficacy.\u003c/p\u003e\n\u003cp\u003eExisting studies indicate that the pathological mechanisms of obesity combined with binge eating disorder involve various aspects of biology(Bourdy and Befort 2023), psychology(Dingemans, Danner, and Parks 2017), and sociology(Bray et al. 2022). However, research on its body composition characteristics (such as fat distribution and visceral fat levels) and metabolic correlations remains limited. The use of body composition analysis provides not only precise assessments of metabolic characteristics and deepens the understanding of the pathological traits of this patient group but also crucial support for personalized clinical interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective analysis included 302 obese patients derived from the Western China Bariatric Surgery Cohort.They were diagnosed by psychiatrists on the\u0026nbsp;basis of the diagnostic criteria for BED in the DSM-V, and the judgment of whether the obese patients met the criteria for BED was simultaneously assessed via the Binge Eating Scale (BES) questionnaire. On the basis of the BES questionnaire score, patients with a BES total score of \u0026ge;18 points were further verified via the DSM-V diagnostic criteria and divided into the BED group and the NBED group. The inclusion criteria for the BED group were as follows: (A) obese patients with a BMI \u0026gt;28 kg/m\u0026sup2;; (B) meeting the DSM-V diagnostic criteria for binge eating disorder, as evaluated by a specialist psychiatrist; (C) no prior use of any psychiatric medication or medication use of less than three days with a dosage below the standard therapeutic dose; and (D) aged 18\u0026ndash;60 years. (E) willing to participate in this study and signed a written informed consent form. The inclusion criteria for the NBED group were as follows: (A) obese patients with a BMI \u0026gt;28 kg/m\u0026sup2;; (B) no family history of mental disorders within two generations per the DSM-V criteria; and (C) willing to participate in this study and signed a written informed consent form.\u0026nbsp;The exclusion\u0026nbsp;criteria\u0026nbsp;were patients\u0026nbsp;with a history of severe physical and neurological diseases; a current or past history of other mental disorders; a history of traumatic brain injury with a loss of consciousness exceeding 10 minutes; a history of dependence on psychoactive substances\u0026nbsp;such as\u0026nbsp;alcohol (excluding nicotine, caffeine, and social drinking); individuals with intellectual disabilities; pregnant or breastfeeding women, ethnic minorities, disabled individuals, and critically ill patients; and a history of diseases affecting hormonal function.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.1 Body\u0026nbsp;\u003c/em\u003e\u003cem\u003ecomposition\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, body composition measurements were conducted by two researchers who had undergone rigorous professional training via a direct, segmental, multifrequency bioelectrical impedance analyzer (InBody770), which strictly followed the operational instructions of the device. Before the measurement, the participants were required to adhere strictly to the preparation procedures: abstain from consuming solid food and liquids for at least 2 hours and empty their bladders and bowels before the measurement to minimize the influence of physiological factors on the results. The participants were instructed to wear lightweight clothing and remove all metal accessories to prevent interference from metal with the bioelectrical impedance measurement. During the measurement, the participants had to maintain a specific standard posture: arms straight and naturally spread out, with the torso forming an approximately 15\u0026deg; angle with the vertical direction, standing throughout the process to ensure body stability and consistency of posture, thereby ensuring the accuracy of the measurement data.\u003cbr\u003e\u0026nbsp;The specific indicators measured included several key parameters reflecting body composition: body mass index (BMI), neck circumference, abdominal circumference, hip circumference, waist‒hip ratio, upper arm circumference, thigh circumference, total body water (TBW), protein, minerals, body fat mass (BFM), skeletal lean mass (SLM), fat-free mass (FFM), skeletal muscle mass (SMM), percentage of body fat (PBF), basal metabolic rate (BMR), visceral fat area (VFA), bone mineral content (BMC), the ratio of muscle mass to fat mass (MFR), and BMR/weight (BMR/W). Among them, MFR was calculated on the basis of the ratio of skeletal muscle mass (SMM) to body fat mass (BFM), and BMR/W was calculated as the ratio of the basal metabolic rate (BMR) to body weight. These two indicators were calculated by researchers on the basis of the measurement data, whereas the values of the other indicators were automatically provided by the device\u0026apos;s electronic system, ensuring objectivity and standardization in the data acquisition process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2 Postoperative Follow-up\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study conducted a two-year follow-up for patients included in the study who underwent bariatric surgery. Weight data were collected at two time points, one year post-surgery (\u0026plusmn;1 week) and two years post-surgery (\u0026plusmn;1 week), through telephone calls, text messages, and outpatient consultations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3 Data\u0026nbsp;\u003c/em\u003e\u003cem\u003eanalysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll the data were analyzed via SPSS 27 (IBM, Armonk, NY) software. Normally distributed measurement data are expressed as the means \u0026plusmn; standard deviations, and intergroup comparisons were performed via the independent samples t test. Nonnormally distributed measurement data are expressed as medians (interquartile ranges), and intergroup comparisons were performed via the Mann‒Whitney U test, a nonparametric method. A p value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Metabolic-related indicators and hormone levels in patients\u003c/h2\u003e\u003cp\u003eThere were no statistically significant differences in preoperative blood glucose or blood lipid indicators between the BED group and the NBED group (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among male patients, there was no significant difference in testosterone, progesterone, or estradiol levels between the BED group and the NBED group (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In female patients, the median testosterone level in the BED group (1.5 nmol/L, Q1-Q3: 1.2\u0026ndash;2.1) tended to decrease compared with that in the NBED group (1.8 nmol/L, 1.4\u0026ndash;2.2), but this difference did not reach statistical significance (P\u0026thinsp;=\u0026thinsp;0.141). Progesterone and estradiol levels also did not significantly differ between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\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\u003eBlood glucose and lipid levels in participants with BED or NBED\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003evalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en M (P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en M (P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlucose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e149 5.21 (4.67,6.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e149 5.33 (4.78,6.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.206\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriglyceride\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e145 1.59 (1.21,2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e143 1.72 (1.14,2.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.465\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Cholesterol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e145 4.88 (4.20,5.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e143 4.98 (4.39,5.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.290\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians (Q\u003csub\u003e1,\u003c/sub\u003e Q\u003csub\u003e3\u003c/sub\u003e). *Mann‒Whitney U test; \u003csup\u003e#\u003c/sup\u003eIndependent t test.\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\u003eHormone levels in participants with BED or NBED\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en NBED n BED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en NBED n BED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTestosterone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 9.2(7.2,14.4) 44 9.2(6.9,12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.293\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81 1.8(1.4,2.2) 101 1.5(1.2,2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.141\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProgesterone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 0.2 (0.1,0.2) 43 0.2(0.1,0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.167\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 0.2 (0.2,0.6) 98 0.2 (0.2,1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.762\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEstradiol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 136 (108,171) 44 128\u0026thinsp;\u0026plusmn;\u0026thinsp;47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.320\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78 196(142,407) 101 193(141,339)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.774\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians (Q\u003csub\u003e1,\u003c/sub\u003e Q\u003csub\u003e3\u003c/sub\u003e). *Mann‒Whitney U test; \u003csup\u003e#\u003c/sup\u003eIndependent t test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Basic characteristics and obesity-related indicators of patients\u003c/h2\u003e\u003cp\u003eA total of 302 obese patients were included in this study, with 151 in the BED group and 151 in the NBED group. The proportion of obese patients with BEDs was 50%. There were 64 males (42.4%) and 87 females (57.6%) in the NBED group, whereas 45 males (29.8%) and 106 females (70.2%) were included in the BED group. The chi-square test revealed that the difference in sex distribution between the two groups was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBasic information and obesity indicators in participants with BED or NBED\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003evalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64(42.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(29.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87(57.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106(70.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.023\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(27,39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32, (25,32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.046\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100.5(89.1,117.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102.6(90.3,116.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.587\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.7(33.4,40.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.8(34.4,41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.114\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeck Circumference(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42.7(40.4,45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.4(40.8,45.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.245\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChest Circumference\u0026nbsp;(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e112.9(108.1,118.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114.4(107.5,120.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.460\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal Circumference(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116.7(109.8,128.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118.8(109.3,126.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.932\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHip Circumference(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114.6(109.3,121.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116.5(110.6,122.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.198\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWaist - Hip Ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.629\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.104\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArm Circumference (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.7(37.7,43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.9(37.9,43.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.297\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThigh Circumference(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.144\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, medians (Q\u003csub\u003e1,\u003c/sub\u003e Q\u003csub\u003e3\u003c/sub\u003e), and n(%). *Mann‒Whitney U test; \u003csup\u003e#\u003c/sup\u003eIndependent t test; \u003csup\u003e+\u003c/sup\u003ePearson χ\u0026sup2; test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e\u003cem\u003e3.3 Body\u003c/em\u003e composition\u003c/h2\u003e\u003cp\u003eCompared with the NBED group, the BED group presented greater PBF and thigh fat mass, whereas the MSR and basal metabolic rate per unit of body weight (BMR per unit of body weight) were lower in the BED group than in the NBED group. The differences were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBody composition of participants with BED or NBED\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003evalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal Body Water\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41.3(35.6,50.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.3(36.3,46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.427\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eprotein\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.0(9.5,13.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.6(9.8,12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.399\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinerals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.7 (3.6,4.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.7(3.3,4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.433\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Fat Mass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.7(37.8,53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.0 (39.9,53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoft Lean Mass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52.9(45.7,64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.5(46.7,59.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.832\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.405\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFat Free Mass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.9(48.5,68.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.7(49.4,62.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.844\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.399\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkeletal Muscle Mass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.1(26.9,38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.8(27.5,35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.399\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePercent Body Fat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.8(40.3,48.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.9(41.9,50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.039\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFM of Arm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.2 (2.7,4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1(2.8,3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.927\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.354\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFM of Trunk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.9(23.0,31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.9(22.9,29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.333\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFM of Leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.2 (7.3,10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.2(7.3,9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.520\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBFM of Arm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.3(3,3,6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.8 (3.5,6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.406\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.160\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBFM of Trunk\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.560\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.576\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBFM of Leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.1(5.1,7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.5(5.6,7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.036\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBasal Metabolic Rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,577(1418,1844)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,530(1437,1728)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.839\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.402\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisceral Fat Area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e214.3(183.2,244.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e222.8(191.4,240.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.420\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBone Mineral Content\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.0 (2.7,3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.0 (2.7,3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.806\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.420\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMuscle-Fat ratio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69(0.58,0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.65(0.54,0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.034\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMR per unit of body weight(BMR(kcal/day/kg))\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.038\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNotes: Data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians (Q\u003csub\u003e1,\u003c/sub\u003e Q\u003csub\u003e3\u003c/sub\u003e). *Mann‒Whitney U test; \u003csup\u003e#\u003c/sup\u003eIndependent t test.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e\u003cem\u003e3.4 Postoperative\u003c/em\u003e \u003cb\u003ebody weight\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eIn the first year after surgery, the difference in body weight between the two groups was not statistically significant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the second year after surgery, the NBED group maintained a median body weight of 70 kg (range 62.0\u0026ndash;80.0 kg), whereas the body weight of the BED group slightly increased to 70.5 kg (range 62.0\u0026ndash;83.5 kg). The difference in body weight between the two groups remained statistically insignificant (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In terms of absolute changes in body weight, the NBED group presented a change of 0.3 kg (range \u0026minus;\u0026thinsp;2.0\u0026ndash;3.1 kg), whereas the BED group presented a change of 1.4 kg (range \u0026minus;\u0026thinsp;1.98\u0026ndash;5.0 kg), with a difference of 1.183 (P\u0026thinsp;=\u0026thinsp;0.237), which also did not reach statistical significance (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative weight loss outcomes in participants with BED or NBED\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBED\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en M (P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003en M (P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-Year Post-operative Weight(kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 70.0(65.0,84.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e126 70.0(62.0,80.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.632\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eΔBMI at 1-Year Post-operative Follow-Up(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 10.4(8.6,13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e126 12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.069\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eΔWeight at 1-Year Post-operative Follow-Up(kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 28.9(22.9,38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e126 32.5(24.1,40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.151\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e%EWL at 1-Year Follow-Up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 72.2(58.9,88.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e126 73.4762.8,91.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.568\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2-Year Post-operative Weight(kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 70.0(64.0,83.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e117 70.5(62,83.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.805\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eΔBMI at 2-Year Post-operative Follow-Up(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 10.0(7.8,13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e117 11.5 (8.0,13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.273\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eΔWeight at 2-Year Post-operative Follow-Up(kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 27.6(21.7,37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e117 31.2(21.2,39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.396\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e%EWL at 2-Year Follow-Up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e131 71.8(56.8,88.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e117 72.09(58.0,89.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.964\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eΔWeight (Y2-Y1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e123 0.3(-2.0,3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e112 1.4(-1.98,5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.237\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNotes: Data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, medians (Q\u003csub\u003e1,\u003c/sub\u003e Q\u003csub\u003e3\u003c/sub\u003e). *Mann‒Whitney U test; \u003csup\u003e#\u003c/sup\u003eIndependent t test.%EWL: percentage of excess weight loss = [(baseline weight - postoperative weight)/(baseline weight - ideal weight)] \u0026times; 100%; ΔBMI\u0026thinsp;=\u0026thinsp;postop BMI - preop BMI; ΔWeight\u0026thinsp;=\u0026thinsp;postop weight - preop weight; Y1\u0026thinsp;=\u0026thinsp;1 year post-op; Y2\u0026thinsp;=\u0026thinsp;2 years post-op.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to compare body composition differences and postoperative weight loss outcomes between obese patients with BED and those without BED. The results revealed that the prevalence rate in the BED group was 50%, and the proportion of females in the BED group was significantly greater than that in the NBED group. Although there were no statistically significant differences between the two groups in baseline obesity indicators, such as metabolic markers, hormone levels, weight, and BMI, detailed body composition analysis indicated that the BED group presented a significantly greater body fat percentage and thigh fat accumulation (P \u0026lt; 0.05), accompanied by a simultaneous decrease in the MFR and BMR/W. Without preoperative psychological interventions, weight loss was not significantly different between the two groups at one year and two years post-surgery.\u003c/p\u003e\u003cp\u003eThe prevalence of binge eating disorder in the general population is approximately 1.1–2.3%(Ágh et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This study revealed that the proportion of patients with BED among those undergoing bariatric surgery reached as high as 50%, which was significantly greater than that reported in the general population, further confirming the important association between obesity and binge eating disorders. This finding is consistent with those of previous studies and highlights the significantly increased incidence of BED in the obese population (7–17%)(Dawes et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Obese individuals often face dual pressures from both physiological and psychological factors, and binge eating may be perceived as a strategy to cope with stress. Various psychological factors (e.g., the need for emotional regulation and stress management)(Gianini, White, and Masheb 2013), social and environmental factors(Barakat et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and biological mechanisms (e.g., dopamine activity and addiction-related mechanisms)(Bourdy and Befort 2023; Parsons and Hurd \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) may all play significant roles in this relationship. Furthermore, obesity itself may lead to increased food cravings and intake, whereas BEDs may further exacerbate the degree of obesity, forming a vicious cycle. This interaction not only affects patients' physical health but also may have negative impacts on their mental health. Therefore, deepening our understanding of the complex relationship between obesity and BED is crucial.\u003c/p\u003e\u003cp\u003eThis study revealed that the proportion of female patients in the BED group was significantly greater than that in the NBED group, suggesting a potential sex bias in the prevalence of binge eating disorder among obese females and its underlying influencing factors. Some studies have reported that the lifetime prevalence of binge eating disorder in females is approximately 1.9%(Kessler et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), which is approximately twice that reported in males. This result aligns with the findings of this study and the trend of a higher prevalence of binge eating disorder in female populations noted in the literature. This sex difference may be closely related to the multifaceted regulatory effects of estrogen on appetite and metabolism(Brutman, Sirohi, and Davis 2019). Additionally, women may be more vulnerable when facing social pressure, difficulties in emotional regulation, dissatisfaction with body image, and negative self-perceptions, making specific emotional traits and unique social factors important drivers of the high prevalence of binge eating disorders among females.\u003c/p\u003e\u003cp\u003eThe results of the body composition analysis revealed that the PBF and thigh fat mass in the BED group were significantly greater than those in the NBED group. Although the difference in PBF between the two groups was not statistically significant after stratification by sex, the BED group still presented higher levels of PBF, fat mass, and visceral fat area than the NBED group \u003cb\u003edid\u003c/b\u003e (Supplementary Table\u0026nbsp;1), suggesting that BED patients may be more prone to storing fat in the abdominal and thigh regions. Ectopic deposition of thigh fat may reflect an \"overflow effect\" of energy surplus, which could be one of the causes of BED. Therefore, among obese patients (especially females), BED screening should be prioritized when thigh fat mass is high and the muscle-to-fat ratio is low. Early identification of binge eating behaviors can help facilitate targeted combined intervention strategies, such as metabolic regulation (e.g., muscle-building training) and psychological interventions (e.g., cognitive behavioral therapy). Moreover, the greater PBF, fat mass, and visceral fat area in the BED group suggest that binge eating behaviors might be closely associated with fat accumulation. Hence, it is necessary to further explore the molecular mechanisms of fat metabolism to reveal their potential roles and impacts on the BED phenotype. In adults, brown adipose tissue (BAT) is primarily concentrated in the neck, above the collarbone, along both sides of the spine, and near the adrenal glands. BAT mediates nonshivering thermogenesis through mitochondrial uncoupling protein 1 (UCP1), which consumes excess energy. However, BED patients may have low BAT activity, leading to an inability to efficiently expend the surplus energy generated by binge eating, which is then stored in the form of white adipose tissue (WAT), exacerbating fat accumulation(Wang et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). WAT is mainly divided into subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), which store energy through triglyceride accumulation(Heyde, Begemann, and Oster 2021). When the storage capacity of SAT reaches its limit, free fatty acids may accumulate in VAT and other ectopic locations, resulting in metabolic abnormalities(Tchkonia et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Excessive expansion of WAT can also lead to hypoxia and macrophage infiltration, which releases proinflammatory factors such as TNF-α and IL-6, impairing adipocyte function, exacerbating central inflammation, interfering with insulin signaling, and inducing insulin and leptin resistance as well as fat metabolism disorders, thereby affecting appetite(Cassioli et al. 2020; Yang et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Consequently, excessive fat accumulation not only leads to weight gain but also significantly impacts appetite regulation, further exerting profound effects on the development of obesity and related metabolic diseases.\u003c/p\u003e\u003cp\u003eAfter gender stratification analysis, there were no statistically significant differences between the male and female groups in terms of SSM or FFM. However, the data indicated that the BED group presented a slightly lower muscle-to-fat ratio and BMR/W, which might be related to intramuscular fat infiltration. Although BED patients had FFM and SSM levels similar to those of obese individuals, their fat content was significantly greater (Supplementary Table\u0026nbsp;1). The deposition of fat within muscles could weaken the metabolic activity of muscle cells, thereby reducing the overall energy expenditure capacity of the muscle(Valkovič et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). A decrease in the basal metabolic rate could not only contribute to further weight gain but also exacerbate metabolic dysfunction. Furthermore, compared with subcutaneous fat, visceral fat is more likely to trigger chronic inflammation and endocrine abnormalities, subsequently affecting systemic metabolism(Yang et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Consequently, obese patients with BED are more prone to developing metabolic syndrome, characterized by multiple metabolic abnormalities, such as hypertension, hyperglycemia, and hyperlipidemia.\u003c/p\u003e\u003cp\u003eThis study revealed that patients with obesity combined with BED and those with simple obesity had no significant difference in weight loss outcomes one and two years after bariatric surgery. One year after surgery, there were no significant differences (P \u0026gt; 0.05) in weight, BMI changes, weight reduction amount, or percentage of excess weight loss between the two groups; two years after surgery, these indicators remained consistent (P \u0026gt; 0.05). These findings suggest that bariatric surgery itself is effective for patients with obesity combined with BED, even without preoperative psychological interventions targeted at BED patients, demonstrating significant short-term weight improvement. This result aligns with those of several existing studies indicating that there is no significant difference in postoperative weight loss outcomes regardless of whether patients undergo preoperative CBT treatment(Paul et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Although current guidelines recommend preoperative psychological interventions for bariatric surgery patients combined with BED to improve prognosis(Crone et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), this study suggests that for patients urgently requiring surgery to alleviate severe obesity and related metabolic complications, omitting preoperative psychological behavioral treatment may not significantly impact short-term weight loss outcomes. From a clinical practice perspective, a potential issue with preoperative psychological intervention is that it may prolong the waiting time for surgery. This delay could exacerbate health risks, particularly for high-risk obese patients with severe cardiopulmonary diseases or diabetes(Monsalve et al. 2023). Therefore, when weighing time costs against the benefits of intervention, clinical decisions should prioritize surgery for patients in urgent need rather than mandating the completion of psychological treatment first. Although two years after surgery, there were no significant differences in weight between the BED and NBED groups, the absolute weight change in the BED group was greater (1.4 kg versus 0.3 kg), suggesting a greater risk of weight regain. As the follow-up time increases, the risk of weight rebound for BED patients may further intensify. Previous studies have shown that the five-year post-operative weight regain risk for BED patients is 18% greater than that for non-BED patients(Kops et al. 2020), which might be associated with residual or recurrent binge eating behaviors(Aylward, Konsor, and Cox 2022). While bariatric surgery has favorable short-term outcomes for BED patients, inert metabolic activity in thigh fat may increase their risk of weight regain(Bharadwaj et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Therefore, recording changes in diet and emotions in real time postsurgery, regularly monitoring body composition, reinforcing behavioral interventions(Cassin et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Rudolph and Hilbert 2020), and strengthening leg resistance training to increase muscle mass are recommended, thereby maintaining long-term outcomes(Effting et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study reveals the unique pathological characteristics of body composition distribution and metabolic function in patients with obesity and BED by comparing the clinical features of BED patients and NBED patients. This study provides important evidence for the interaction mechanism between obesity and binge eating disorder, emphasizing the need to construct an intervention system from metabolic, psychological, and social dimensions to improve patient prognosis and break the vicious cycle of obesity and binge eating. Future research should focus on exploring the relationship between obesity and binge eating disorder and further investigate the connection between fat accumulation and binge eating disorder from the perspective of molecular mechanisms.\u003c/p\u003e\u003cp\u003eLimitations\u003c/p\u003e\u003cp\u003eHowever, this study has certain limitations. First, this study is retrospective in nature, making it impossible to clarify the causal relationship between BED and differences in body composition or metabolic disorders. Future research should employ prospective cohort studies to further validate these causal links. Second, the time frame for postoperative weight changes is relatively short, and follow-up analysis may be influenced by various external factors (such as lifestyle changes, exercise habits, dietary patterns, and psychological interventions). However, this study failed to collect comprehensive information on such variables, which might have resulted in bias in the evaluation of weight loss outcomes. Future research should employ RCTs to further explore the impact of preoperative cognitive behavioral therapy on weight loss outcomes in patients with binge eating disorders. Finally, potential mechanisms related to binge eating disorders, such as the interaction between fat distribution and muscle function, as well as the role of chronic inflammation in metabolic disorders, were not thoroughly analyzed in this study. These inferences require further validation through mechanistic studies. Future research should include larger sample sizes and encompass multicenter, multidimensional variables to construct a research framework for longitudinal observation and mechanistic exploration, aiming to comprehensively reveal the influencing factors of BED in weight loss and weight regain, thereby providing more reliable theoretical support for individualized treatment strategies.\u003c/p\u003e"},{"header":"Conclusions and Clinical Significance","content":"\u003cp\u003eThis study revealed that obese patients with BED present a unique metabolic phenotype characterized by female predominance, regional fat accumulation (especially in the thigh area), and reduced energy metabolism efficiency. These features may exacerbate metabolic disorders through insulin resistance mediated by lipotoxicity and chronic low-grade inflammatory states. Bariatric surgery offers comparable short-term weight loss efficacy for obese patients with BEDs. In clinical practice, body composition analysis should be integrated into BED evaluation systems, and comprehensive intervention plans combining metabolic regulation and psychological support should be developed for patients. CBT can be used to disrupt the vicious cycle of binge eating and abnormal fat deposition, whereas resistance training can optimize body composition distribution, ultimately achieving both metabolic and psychological benefits.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e：This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of [Longitudinal Study of Bariatric Surgery in Western China] (Ethics Approval Number: [ChiCTR2300073353]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication：\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials：\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eThis work was supported by the Science and Technology Department of Sichuan Province (2023YFS0115) and the Third People\u0026rsquo;s Hospital of Chengdu Scientific Research Project (2023PI26).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions: \u003c/strong\u003eYuanchuan Zhang: Conceptualization (lead); supervision; writing, review and editing (support). Xinping Wang: writing \u0026ndash; original draft (lead); formal analysis (equal) Dafang Zhan: investigation (lead); Han Wang: investigation (support). Jie Zhang: writing, review and editing (lead). Xiaoqin Pei: Conceptualization (support); Methodology (lead). Miao Chen: Formal Analysis (equal)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from the Science and Technology Department of Sichuan Province (No. 2023YFS0115) and the Scientific Research Project of the Third People\u0026rsquo;s Hospital of Chengdu (No. 2023PI26).\u003c/p\u003e\n\u003cp\u003eWe extend our sincere appreciation to all the participants and researchers involved in this study. Specifically, we would like to acknowledge Yuanchuan Zhang for overall conceptualization and supervision; Xinping Wang for leading the original draft preparation and formal analysis; Dafang Zhan for conducting the investigation, with support from Han Wang; Jie Zhang for manuscript review and editing; Xiaoqin Pei for conceptual advice and methodology development; and Miao Chen for contributing equally to formal analysis.\u003c/p\u003e\n\u003cp\u003eWe are also grateful to the Western China Bariatric Surgery Patient Cohort for providing the biological samples and data critical to this study. We thank all the cohort participants and administrative staff for their invaluable resources and support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u0026Aacute;gh, Tam\u0026aacute;s, G\u0026aacute;bor Kov\u0026aacute;cs, Dylan Supina, Manjiri Pawaskar, Barry K. Herman, Zolt\u0026aacute;n Vok\u0026oacute;, and David V. 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Baler. 2013. \u0026ldquo;Obesity and Addiction: Neurobiological Overlaps.\u0026rdquo; \u003cem\u003eObesity Reviews: An Official Journal of the International Association for the Study of Obesity\u003c/em\u003e 14(1):2\u0026ndash;18. doi:10.1111/j.1467-789X.2012.01031.x.\u003c/li\u003e\n\u003cli\u003eWang, Sufen, Yifan Liu, Jiaqi Chen, Yuejing He, Wanrui Ma, Xinguang Liu, and Xuerong Sun. 2023. \u0026ldquo;Effects of Multi-Organ Crosstalk on the Physiology and Pathology of Adipose Tissue.\u0026rdquo; \u003cem\u003eFrontiers in Endocrinology\u003c/em\u003e 14. doi:10.3389/fendo.2023.1198984.\u003c/li\u003e\n\u003cli\u003eYang, Zi‐Han, Fang‐Zhou Chen, Yi‐Xiang Zhang, Min‐Yi Ou, Poh‐Ching Tan, Xue‐Wen Xu, Qing‐Feng Li, and Shuang‐Bai Zhou. 2024. \u0026ldquo;Therapeutic Targeting of White Adipose Tissue Metabolic Dysfunction in Obesity: Mechanisms and Opportunities.\u0026rdquo; \u003cem\u003eMedComm\u003c/em\u003e 5(6):e560. doi:10.1002/mco2.560.\u003c/li\u003e\n\u003c/ol\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":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Binge Eating Disorder, Obesity, Body Composition, Bariatric Surgery","lastPublishedDoi":"10.21203/rs.3.rs-7463390/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7463390/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo investigate the impact of binge eating disorder (BED) on metabolic parameters and body composition in obese individuals, examine the pathogenic connection between obesity and BED, and assess its possible influence on the results of weight loss surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective analysis included 302 obese patients derived from the Western China Bariatric Surgery Cohort. The participants were divided into the BED group and the non-BED (NBED) group on the basis of the Binge Eating Scale (BES) questionnaire and DSM-V diagnostic criteria. Basal metabolic parameters were assessed via an InBody 770 body composition analyzer, and rigorous follow-up tracking of postoperative weight variations was performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe proportion of females was significantly greater (57.6% vs. 70.2%), and the BED group presented a greater body fat percentage (44.8% vs. 45.9%) and thigh fat mass (6.1 kg vs. 6.5 kg) (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) but a lower muscle-to-fat ratio (men 0.81 vs. 0.84; women 0.60 vs 0.64) and basal metabolic rate per unit body weight (men 15.6 kcal vs 15.9 kcal; women 15.1 kcal vs 15.5 kcal). There was no statistically significant difference in weight loss between the two groups at 1 year and 2 years post-operatively (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study revealed that obese patients with BED exhibit a unique metabolic phenotype characterized by a female predominance, regional fat accumulation (especially in the thigh area), and decreased energy metabolism efficiency. Lipotoxicity-mediated insulin resistance and chronic low-grade inflammatory states exacerbate metabolic disorders, and weight loss surgery has comparable short-term weight loss efficacy in obese BED patients and nonobese non-BED patients.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of Bariatric Surgery Outcomes and Preoperative Body Composition in Obese Patients with Binge-Eating Disorders versus Simple Obesity Patients: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 19:17:10","doi":"10.21203/rs.3.rs-7463390/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-31T02:30:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T08:50:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-15T06:55:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308348129554776982892719246693434248246","date":"2025-09-09T00:00:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214085450686586423257086170420501664934","date":"2025-09-08T23:31:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-08T08:06:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-01T23:55:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-01T13:01:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Eating Disorders","date":"2025-08-28T16:26:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-eating-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"joed","sideBox":"Learn more about [Journal of Eating Disorders](http://jeatdisord.biomedcentral.com)","snPcode":"40337","submissionUrl":"https://submission.nature.com/new-submission/40337/3","title":"Journal of Eating Disorders","twitterHandle":"@JEatDisord","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"708e8ed2-5821-4bb6-98d9-5c8e71d3686f","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T08:55:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-12 19:17:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7463390","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7463390","identity":"rs-7463390","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}