The EBBS questionnaire (Eating Behavior after Bariatric Surgery) is a useful tool for identifying individuals at risk of long-term weight regain after bariatric surgery

The EBBS questionnaire (Eating Behavior after Bariatric Surgery) is a useful tool for identifying individuals at risk of long-term weight regain after bariatric surgery | 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 The EBBS questionnaire (Eating Behavior after Bariatric Surgery) is a useful tool for identifying individuals at risk of long-term weight regain after bariatric surgery Joana Nicolau, Pilar Sanchís, Guido Sfondrini, Luisa Ayala, Antelm Pujol, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5354771/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Apr, 2025 Read the published version in Obesity Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose : Bariatric surgery (BS) is an effective treatment for severe obesity, yet weight regain (WR) affects a significant proportion of patients in the long term. The lack of useful and standardized tools makes the follow-up of these patients more difficult. The Eating Behavior After Bariatric Surgery (EBBS) questionnaire was designed to assess adherence to post-surgical lifestyle recommendations, which may predict successful weight maintenance. This study aimed to adapt the EBBS for Spanish-speaking patients and evaluate its utility in assessing adherence to long-term lifestyle changes and its association with weight outcomes. Material and methods: A total of 100 patients who underwent a sleeve gastrectomy (mean follow-up: 90.4 ± 46 months) were included. The EBBS was administered to evaluate food, drink, behavior, and lifestyle domains. Results: Significant weight regain was observed in 70% of participants, and emotional eating (65%) and depression (53%) were common. The EBBS demonstrated good internal consistency (Cronbach’s alpha = 0.662). Higher total EBBS scores were significantly associated with greater excess weight loss (EWL), particularly for patients maintaining over 50% EWL (p = 0.04). Logistic regression revealed that EBBS scores >13.5 predicted EWL >50% (OR = 17.8, p = 0.010), underscoring the value of this tool in identifying patients at risk for WR. Conclusions: The Spanish version of the EBBS is a reliable tool for assessing post-BS eating behaviors and predicting long-term weight outcomes. Tailored interventions based on EBBS results may improve adherence to dietary and lifestyle recommendations, reducing the risk of WR. obesity bariatric surgery weight regain eating behavior EBBS lifestyle adherence weight loss maintenance long-term Figures Figure 1 Figure 2 Figure 3 Key points Weight regain affects a significant proportion of patients in the long term after bariatric surgery. Standardized tools are needed to prevent weight regain after bariatric surgery The EBBS (Eating Behavior after Bariatric Surgery questionnaire) may predict long-term weight outcomes. 1. INTRODUCTION Obesity has dramatically increased in the recent years reaching a pandemic status. In fact, in Spain the prevalence of obesity among adults is 23.8% with a negative impact on metabolic, mechanical, and psychological comorbidities as well as an increase in cardiovascular morbimortality and a reduction on quality of life [ 1 – 3 ]. Despite significant advances in antiobesity medications added to lifestyle changes when the latter are not enough to lose or maintain weight, bariatric surgery (BS) remains the most suitable option among Class III obesity and class II obesity with suboptimally controlled comorbidities. The mean weight loss after a successful BS is approximately 30–35% of the presurgery body weight. However, weight maintenance is as crucial as weight loss and, at least one-third of patients who undergo a BS procedure will regain more than 25% of total weight loss. A critical period for weight regain (WR) after BS is when weight loss has reached a plateau, tipically after 18–24 months. Preventing WR is essential, as it can lead to relapse metabolic, mechanical, and psychological comorbidities related to obesity [ 4 – 7 ]. However, the real prevalence of WR after BS is not well stablished due to the lack of a clear and universal definition [ 8 ]. Consequently, it is difficult to compare the results from different studies published so far. Besides, factors contributing to this WR are not completely understood. Therefore, a planned post-surgery lifestyle management protocol is essential to avoid WR [ 4 , 6 ]. However, up to date, and despite an ideal multidisciplinary approach, involving obesity specialists, dietitians, sport experts, psychologists, etc., the long-term evaluation of the BS patient has traditionally been subjective and without validated tools. In this sense, Spaggiari G et al., designed and validated a self-administered questionnaire (Eating Behavior after Bariatric Surgery or EBBS) to quantify the patients’ adherence to dietary and lifestyle advice for a long term success after BS. This questionnaire included domains related to food, drinks, behaviors, and lifestyle after BS. The EBBS questionnaire showed a good internal validity. Furthermore, some domains were positively related with the percentage of weight loss maintained. The study was conducted in Italy, a Mediterranean country with common behaviors and culture with Spain [ 9 ]. This study aimed to adapt the EBBS questionnaire for Spanish-speaking patients and evaluate its utility as a tool to assess adherence to long-term lifestyle management following BS. Additionally, we examined whether the results obtained from the EBBS were related to WR or weight maintenance in these patients. 2. MATERIAL AND METHODS 2.1. Subjects Patients with a minimum follow-up of 36 months after undergoing a sleeve gastrectomy (performed between 2012 and 2018) were consecutively invited to participate in this study and a total of 100 subjects were included. Inclusion criteria included patients aged 18 years or older who underwent sleeve gastrectomy between 2012 and 2018. Exclusion criteria followed our BS protocol. The study was approved by the CEI-IB, the hospital ethics committee. Written informed consent was obtained from all patients prior to study participation. The minimum sample size required for this study was determined through a power analysis using a 95% confidence interval and 80% statistical power. Assuming a moderate effect size (Cohen's d = 0.5), the initial sample size was calculated at 90 patients. To account for a 10% expected dropout rate, this sample size was adjusted to 100 patients. 2.2. Eating Behavior after Bariatric Surgery Questionnaire (EBBS) : This questionnaire was designed to evaluate the patient’s adherence to dietary and lifestyle recommended habits after a bariatric surgery procedure. The questionnaire consists of 11 items divided into four functional domains: domain A (food) assess the number of meals per day, whether there is a regular consumption of sweets, etc.; domain B (drinks) refers to the assessment of regular intake of alcohol, sparkling drinks, etc.; domain C (behaviors) evaluates satiety after eating, intake speed, etc.; and domain S (lifestyle) assess how often the subject weighs himself, the frequency of physical activity, etc. Each answer is given a score from 0 to 2. The higher the final score, the better the subjects’ adherence to the recommended habits post bariatric surgery. The Italian version of the survey showed a good internal validity (Cronhbach’s alpha 0.743, Hotelling’s T-square test p < 0.001). Moreover, a direct significant correlation was found between both question 6 (domain B, “How many times a week do you drink sparkling beverages?”) (Rho 0.327, p = 0.037) and question 10 (domain S, “how much time do you spend on physical activity?”) (Rho 0.311, p = 0.048) and the weight loss maintenance. Furthermore, only the S domain was directly related with the percentage of weight loss maintained (Rho 0.305, p = 0.048) [ 9 , 10 ]. A Spanish version of this questionnaire was designed by literally translating the questions from the original test. 2.3. Sociodemographic and clinical parameters Gender, age, height, weight, BMI, educational level, partnership status and employment situation were recorded from electronic medical records. We obtained initial weight and BMI from computerized medical history. Significant weight regain was defined as an increase of more than 10% of the minimum weight loss achieved. 2.4. Statistical Analysis Continuous variables were presented as mean ± standard deviation (SD) or median with interquartile range (IQR), depending on their distribution, while categorical variables were expressed as frequencies and percentages. Normality of the data was assessed using the Shapiro-Wilk test. For normally distributed variables, comparisons between groups were performed using Student’s t-test, whereas non-parametric variables were compared using the Mann-Whitney U test. Associations between categorical variables were evaluated using Chi-square or Fisher's exact test, as appropriate. Pearson or Spearman correlation coefficients were used to assess relationships between continuous variables, depending on the distribution. The significance level was set at p < 0.05. Receiver Operating Characteristic (ROC) analysis was conducted to determine the optimal cutoff value for EBBS scores associated with excess weight loss (EWL) greater than 50%. Sensitivity and specificity values were reported to evaluate the discriminative power of the EBBS score. The area under the curve (AUC) was also calculated to assess the model’s overall accuracy. Binary logistic regression analysis was employed to determine the association between EBBS scores and successful weight loss outcomes (defined as EWL > 50%). Both crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Confounders such as age, gender, time since surgery, and pre-surgical BMI were adjusted in the multivariate model. A two-tailed p-value of less than 0.05 was considered statistically significant. All statistical analyses were performed using SPSS software (version 24.0; IBM, Armonk, NY, USA). 3. RESULTS 3.1. Descriptive analysis A total of 100 patients who completed the EBBS questionnaire were included as part of a standard follow-up visit after BS, during which anthropometric, metabolic, and psychological variables were assessed. Among the patients, 66% were female, and the mean age was 53.7 ± 11 years. The study visit took place on average 90.4 ± 46 months after BS, with a mean BMI of 32.9 ± 7.4 kg/m² at that time. The pre-surgical BMI was 45.1 ± 5.9 kg/m², while the nadir weight after surgery was 85.1 ± 19.2 kg. The percentage of excess weight loss (%EWL) was 35.8 ± 10.2%. Notably, up to 65% of patients reported emotional eating, and 53% had significant depressive symptoms at the time of evaluation. Furthermore, 70 patients experienced significant weight regain after the surgical procedure (see Table 1 ). Table 1 Clinical and sociodemographic characteristics of patients. Values are expressed as mean ± SD or frequency (percentage). n = 100 Age (years) 54 ± 11 Gender (female) 66 ( 66% ) Time from Bariatric surgery (motnhs) 90 ± 46 BIM pre-surgery (kg/cm2) 49 ± 5,9 BMI post-surgery (kg/cm2) 33 ± 7,4 Excess of Weight Loss (% EWL) 36 ± 10 Total Weight Loss (% TWL) 33 ± 12 Weight regain 70 ( 70% ) Diet adherence 40 ( 40% ) Exercise adherence 35 ( 35% ) Visit adherence 52 ( 52% ) Depression 53 ( 53% ) Emotional eating 65 ( 65% ) Figure 1 shows the percentage of participants by BMI categories before (pre-BMI) and after (post-BMI) BS. Before surgery, 98% of patients presented with class III obesity (BMI > 40 kg/m²). After surgery, the distribution shifted, with 10%, 29%, 13%, and 14% of patients classified as having normal weight, overweight, obesity class I, and obesity class II, respectively. 3.2. Eating Behavior after Bariatric Surgery Questionnaire (EBBS) The EBBS demonstrated good internal consistency (Cronbach’s alpha = 0.662; Hotelling's T-squared test, p < 0.001). The mean total EBBS score was 13.1 ± 2.4. Descriptive analyses for each domain of eating behavior are presented in Table 2 . The A-domain, which relates to food consumption behaviors, scored 4 ± 1.5, indicating relatively good compliance with dietary recommendations. The B-domain, which assesses drink consumption behaviors, scored 3.7 ± 1.3, suggesting modest but generally poor adherence to post-BS drinking guidelines. The C-domain, related to hunger and speed of eating, scored 3.3 ± 1.1, reflecting low compliance. Finally, the S-domain, which assesses lifestyle habits, scored 2.1 ± 1.3, indicating above-average adherence to physical activity and regular self-weighing. Table 2 Eating behavior after bariatric surgery (EBBS) score distribution among questions and domains. Values are expressed as mean ± SD and median (interquartile range). Mean ± SD Median ( Q1 - Q3 ) Questions 1. How many meals do you eat per day? 1,8 ± 0,5 2 ( 2 - 2 ) 2 How quickly do you consume the main meals? 0,8 ± 0,6 1 ( 1 - 1 ) 3 How much water do you drink during the meal? 1,2 ± 0,7 1 ( 1 - 2 ) 4 How many times a week do you eat sweets? 1,2 ± 0,8 1 ( 1 - 2 ) 5 How many times a week do you drink wine or alcohol? 1,3 ± 0,8 2 ( 2 - 2 ) 6 How many times a week do you drink sparkling beverages? 1,1 ± 0,9 1 ( 1 - 2 ) 7 How hungry do you feel before meals? 1,2 ± 0,6 1 ( 1 - 2 ) 8 How full do you feel after meals? 1,5 ± 0,5 1 ( 1 - 2 ) 9 How is the portion of vegetables you consume during the meal? 1,1 ± 0,7 1 ( 1 - 2 ) 10 How much time do you spend on physical activity? 0,8 ± 0,9 1 ( 1 - 2 ) 11 How often do you weigh yourself? 1,1 ± 0,9 1 ( 1 - 2 ) Domains and total puntuation A-FOOD 4,1 ± 1,5 4 ( 3 - 5 ) B-DRINKS 3,7 ± 1,3 4 ( 3 - 5 ) C-BEHAVIORS 3,3 ± 1,1 3 ( 3 - 4 ) S-LIFESTYLE 2,2 ± 1,3 2 ( 1 - 3 ) EBBS TOTAL 13,1 ± 2,4 13 ( 12 - 14 ) Correlation analysis was conducted using bivariate Pearson's correlation to determine the relationships between post-BS eating behaviors and anthropometric outcomes. A positive correlation between total EBBS score and weight regain was observed (r = 0.28, p = 0.004). Additionally, a positive correlation was found between food consumption behavior (A-domain) and pre-surgical BMI (r = 0.2, p = 0.04), as well as %EWL (r = 0.19, p = 0.04). Adherence to drinking behaviors was also positively correlated with %EWL (r = 0.2, p = 0.04). Furthermore, behavior patterns assessed by the C-domain showed positive correlations with both current BMI (r = 0.2, p = 0.04) and pre-surgical BMI (r = 0.24, p = 0.01). Weight regain, on the other hand, was negatively associated with adherence to lifestyle behaviors after BS (S-domain) (r = -2.5, p = 0.01). These correlations are summarized in Table 3 . Table 3 Coefficient of correlation between EBBS questionnarie and demographic data. BMI - pre , BMI pre-surgery; BMI-post , BMI post-surgery; TWL , total weight loss; %TWL , percent total weight loss; %EWL , percent excess weight loss; **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level EBBS TOTAL A-FOOD B-DRINKS C-BEHAVIOR S-LIFESTYLE EDAD BMI-pre (kg/cm2) BMI-post (kg/cm2) %EPP %TPP EBBS TOTAL A-FOOD ,299 ** B-DRINKS ,426 ** -0,178 C-BEHAVIOR ,579 ** -0,027 0,012 S-LIFESTYLE ,433 ** -0,104 -0,079 0,124 Age (years) -0,023 0,071 -,214 * -0,065 0,022 BMI-pre (kg/cm2) 0,110 ,206 * -0,178 ,247 * -0,037 -0,109 BMI-post (kg/cm2) 0,008 -0,070 -0,180 ,207 * 0,054 0,038 ,535 ** %EWL -0,045 ,198 * -,202 * -0,051 -0,006 -0,132 ,372 ** -,208 * %TWL 0,052 ,245 * 0,081 -0,102 -0,105 -0,112 0,012 -,831 ** ,566 ** 3.3. Weight and psychological parameters and EBBS questionnaire Patients with significant depressive symptoms exhibited significantly lower total EBBS scores compared to patients without depression (12.4 ± 2.5 vs. 13.8 ± 2.2; p = 0.007). Moreover, a lower percentage of patients with depression engaged in more than 150 minutes of exercise per week compared to those without depression (17% vs. 55%; p < 0.0001). Adherence to follow-up visits was also lower among patients with depression (34% vs. 72%; p < 0.001). Emotional eating was associated with lower total EBBS scores (12.6 ± 2.2 vs. 13.8 ± 2.7; p = 0.006). However, no significant differences were found across the individual subdomains (A, B, C, or S). Additionally, patients who experienced significant weight regain had lower total EBBS scores (12.6 ± 2.3 vs. 14.2 ± 2.5; p = 0.001), though again, no differences were observed in the subdomains. 3.4. Excess of weight loss and EBBS Questionnaire Patients with an %EWL greater than 50% had higher total EBBS scores (14.4 ± 2.2 vs. 12.9 ± 2.4; p = 0.04). Figure 2 illustrates the total EBBS scores and domain-specific scores for patients who achieved over 50% EWL compared to those with less than 50% EWL. Patients with higher EWL showed significantly greater scores in overall EBBS and lifestyle domains (p < 0.05). The ROC analysis of EBBS scores for predicting EWL greater than 50% was also conducted (Fig. 3 ). The area under the curve (AUC) was 0.696 (95% CI: 0.534–0.858), indicating moderate discriminative ability. An optimal cutoff value of 13.5 for the EBBS score was identified, associated with EWL greater than 50%. This cutoff demonstrated reasonable sensitivity (87.5%) and specificity (54.9%) for predicting successful weight loss outcomes. Finally, binary logistic regression was also performed to study the association between EBBS and percentage of excess of weight loss upper 50%. The results presented in Table 4 indicate a significant association between higher EBBS scores (greater than 13.5, using the optimal cutoff value) and achieving excess weight loss (EWL) greater than 50%, compared to EWL below 50% (crude odds ratio [OR] = 14.5, 95% CI: 1.7–123.0, p = 0.014). After adjusting for confounding factors, including age, gender, time since bariatric surgery, and pre-surgery BMI, the adjusted OR increases to 17.8 (95% CI: 17.7–158.4, p = 0.010), indicating an even stronger association. These findings suggest that higher EBBS scores may be a predictor of successful weight loss outcomes post-bariatric surgery, emphasizing the importance of psychological and behavioral assessments in predicting long-term weight loss success. Table 4 Crude and adjusted Odds Ratio (O.R) of EBBS Questuinnarie upper than 13,5 (using optimal cut off value) associated to EWL upper than 50% (vs. EWL 13,5 14,5 ( 1,7 - 123,0 ) 0,014 17,8 ( 17,7 - 158,4 ) 0,010 * Adjusted for age (years), gender (male/female), time from bariatric surgery(months and BMI before surgery (kg/cm2). 4. CONCLUSIONS This study provides valuable insights into the role of eating behaviors post-bariatric surgery, as assessed by the EBBS questionnaire, in predicting weight loss outcomes. Our findings suggest that higher EBBS scores are significantly associated with greater excess weight loss, highlighting the importance of adherence to recommended dietary behaviors after surgery for achieving favorable weight outcomes. The adjusted OR of 17.8 further underscores the strength of this association, even when accounting for critical confounders like age, gender, and pre-surgical BMI. A significant prevalence of emotional eating (65%) and depressive symptoms (53%) was observed among the patients. These factors were negatively correlated with EBBS scores, suggesting that they adversely affect the ability to adhere to recommended dietary and lifestyle modifications post-surgery. Specifically, patients with depression showed lower adherence to exercise and fewer follow-up visits, which may contribute to the high rate of weight regain observed in this cohort (70%). These results point to the necessity of incorporating targeted psychological interventions to address emotional eating and depressive symptoms, thereby improving adherence and surgical outcomes [ 4 , 6 , 7 ]. Additionally, patients with higher EWL had better overall EBBS scores, particularly in domains related to lifestyle and physical activity. This emphasizes the role of an active lifestyle, including physical activity and self-monitoring, in mitigating weight regain and promoting sustained weight loss. The negative association between weight regain and lifestyle adherence also highlights the need for consistent lifestyle interventions [ 4 , 6 , 8 , 11 ]. In this regard, our results align with the Italian study by Spaggiari et al. who found that patients who, according to the EBBS, reported consuming fewer carbonated beverages and those who engaged in regular physical activity—specifically 30 to 60 minutes at least 5 times a week—experienced less weight regain [ 9 ]. However, unlike our findings, Spaggiari et al. did not observe any correlation between the presence of psychological disorders and weight regain [ 9 ]. One of the main differences from our study is that they did not assess the presence of emotional eating in patients, focusing only on mood disorders, well-being, and body image perception. Furthermore, Alsehemi et al, validated an Arabic translation of the EBBS. They also found an association between weight-related outcomes and the EBBS scales. Moreover, participant compliance with food consumption behaviors did not correlate with weight loss maintenance. However, subjects were 22 times more likely to maintain weight loss when complying with drinking behaviors and 40 times more when they had a regular adherence to physical activity and lifestyle behaviors [ 10 ]. The similarity in results demonstrates the validity and consistency of this test in different populations for identifying patients at risk of long-term weight regain after bariatric surgery. Furthermore, the ROC analysis also indicated an optimal EBBS score cutoff of 13.5 for predicting successful weight loss outcomes (EWL > 50%). This threshold can serve as a useful tool for identifying patients at risk of suboptimal weight loss, allowing for tailored interventions to enhance adherence and improve outcomes. Significant long-term weight regain after BS is more common than desired, with up to one-third of patients experiencing a regain of more than 25% of the total weight lost. This is because 51 to 70% of patients report suboptimal adherence to food/lifestyle guidelines after BS. However, the causes of this weight regain are multifactorial, ranging from psychological factors to loss of adherence to healthy habits or failure to follow-up with the BS team. Therefore, it is essential to develop protocols or tools that can be applied in clinical practice to help identify, at an early stage, those patients who, due to their dietary patterns, lifestyle, or the presence of psychological issues, are at higher risk. This would allow for closer follow-up and individualized intervention [ 3 , 4 , 6 , 8 , 11 , 12 ]. The EBBS is a simple tool to detect patients who, in the long term after BS, exhibit lifestyle patterns that predispose them to regain weight [ 9 , 10 ]. Similarly, long-term follow-up of these patients is crucial to prevent weight regain. There are some limitations to this study that must be acknowledged. First, the cross-sectional design limits our ability to establish causation between eating behaviors and weight outcomes. Additionally, the use of self-reported data in the EBBS questionnaire may introduce bias, such as recall or social desirability bias. The sample size, although informative, may not be sufficient to detect smaller or more nuanced effects, and the wide confidence intervals observed indicate potential variability and imprecision in effect estimates. The homogeneity of the sample, which includes only patients who underwent sleeve gastrectomy, should be considered when applying the EBBS questionnaire to patients who have undergone other surgical procedures. Future research with larger and more diverse populations is necessary to confirm these findings. We are the first to adapt the EBBS questionnaire for Spanish-speaking patients. Our results suggest that it is a promising tool for predicting weight outcomes in a real word-scenario, with scores above 13.5 being associated with more favorable results. Future studies should aim to validate these findings in larger samples and explore interventions to improve psychological support and adherence to post-surgery recommendations, ultimately enhancing long-term weight management and patient outcomes. Declarations Author Contribution JN wrote the manuscript, researched data, and gave final approval of the version. PS made the statistics and reviewed the manuscript. LA collected the data and gave the final approval of the manuscript. AP, MIT and GS collected the data, conceived the graphical abstract and gave the final approval of the manuscript. LM contributed to the discussion, reviewed the manuscript, and gave final approval of the manuscript. FUNDING No funding was received for conducting this study. COMPLIANCE WITH ETICAL STANDARDS All studies involved in studies performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants included in the study understood the information related to the study, understood, and signed a written informed consent. All authors signed that there is no current or potential conflict of interest in relation to this article. DATA AVAILABILITY STATEMENT: Data analyzed during the current study are available from the corresponding author on reasonable request. References https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Ralston J, Brinsden H, Buse K, Candeias V, Caterson I, Hassell T, et al. Time for a new obesity narrative. Lancet. 2018;392:1384–6. Wharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192:E875–91. Istfan NW, Lipartia M, Anderson WA, Hess DT, Apovian CM. Approach to the Patient: Management of the Post–Bariatric Surgery Patient With Weight Regain. The Journal of Clinical Endocrinology & Metabolism. 2021;106:251–63. Kheniser K, Saxon DR, Kashyap SR. Long-Term Weight Loss Strategies for Obesity. J Clin Endocrinol Metab. 2021;106:1854–66. Athanasiadis DI, Martin A, Kapsampelis P, Monfared S, Stefanidis D. Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc. 2021;35:4069–84. Tolvanen L, Christenson A, Surkan PJ, Lagerros YT. Patients’ Experiences of Weight Regain After Bariatric Surgery. Obes Surg. 2022;32:1498–507. El Ansari W, Elhag W. Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review. Obes Surg. 2021;31:1755–66. Spaggiari G, Santi D, Budriesi G, Dondi P, Cavedoni S, Leonardi L, et al. Eating Behavior after Bariatric Sur Additional Declarations No competing interests reported. Supplementary Files Figure4graphicalabstract.jpg Cite Share Download PDF Status: Published Journal Publication published 03 Apr, 2025 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 11 Jan, 2025 Reviews received at journal 08 Jan, 2025 Reviewers agreed at journal 30 Dec, 2024 Reviews received at journal 03 Dec, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers invited by journal 07 Nov, 2024 Editor assigned by journal 02 Nov, 2024 Submission checks completed at journal 01 Nov, 2024 First submitted to journal 29 Oct, 2024 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. 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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-5354771","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":376508058,"identity":"ed0c9fed-38eb-492a-9ead-926691c21330","order_by":0,"name":"Joana Nicolau","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBACxgbGBgaGAgjnAEMFkGRmbiBCiwFMyxmQFkb8WiDAAGZAG8QYvIqZZzc3fvhgYJe4vf104sGf82qj+duBWn5UbMPtsDkHmyVnGCQnzjmTu+Ew77bjuTMOAx3bc+Y2bi0zEtuYeQyYE2cwALUwbjuW2wDUwszYRlBLfeIM/rcbDv6ccyx3PpFaDifOkMjdcIC3oQZkF0EtIL8cN54h8XbDYZ5jB3I3ArUcxOcXwxnpDz98qKiWncGfu/njj5q63HnnDx988KMCj5YGVP5hMHkAp3ogkEfj1+FTPApGwSgYBSMUAAC9umGeNuDAQwAAAABJRU5ErkJggg==","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":true,"prefix":"","firstName":"Joana","middleName":"","lastName":"Nicolau","suffix":""},{"id":376508059,"identity":"663b3566-e423-4beb-bc09-6f0f44ac6adc","order_by":1,"name":"Pilar Sanchís","email":"","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":false,"prefix":"","firstName":"Pilar","middleName":"","lastName":"Sanchís","suffix":""},{"id":376508060,"identity":"a20ab749-b263-4256-abbb-21a4becac1de","order_by":2,"name":"Guido Sfondrini","email":"","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":false,"prefix":"","firstName":"Guido","middleName":"","lastName":"Sfondrini","suffix":""},{"id":376508061,"identity":"8d179909-2565-42f7-897c-78e1e7ac3a20","order_by":3,"name":"Luisa Ayala","email":"","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":false,"prefix":"","firstName":"Luisa","middleName":"","lastName":"Ayala","suffix":""},{"id":376508062,"identity":"2fe96551-74dd-484d-acf9-95f28b7236a2","order_by":4,"name":"Antelm Pujol","email":"","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":false,"prefix":"","firstName":"Antelm","middleName":"","lastName":"Pujol","suffix":""},{"id":376508063,"identity":"ad8251da-6bd1-4e17-9a38-ae1ffcfc69ea","order_by":5,"name":"María Isabel Tamayo","email":"","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Isabel","lastName":"Tamayo","suffix":""},{"id":376508064,"identity":"a9716439-9a46-4ecc-989a-4994077dd578","order_by":6,"name":"Lluís Masmiquel","email":"","orcid":"","institution":"Hospital Son Llatzer","correspondingAuthor":false,"prefix":"","firstName":"Lluís","middleName":"","lastName":"Masmiquel","suffix":""}],"badges":[],"createdAt":"2024-10-29 13:38:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5354771/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5354771/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-025-07836-2","type":"published","date":"2025-04-03T15:57:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70284957,"identity":"8e0fc2f3-6c07-428b-85b7-698dba898361","added_by":"auto","created_at":"2024-12-01 16:09:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":57541,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of participants\u003cstrong\u003e \u003c/strong\u003eaccording BMI categories before (BMI pre) and after (BMI post) bariatric surgery.\u003c/p\u003e","description":"","filename":"Figure1EBBS.png","url":"https://assets-eu.researchsquare.com/files/rs-5354771/v1/7475225d6268350bb923df38.png"},{"id":70284958,"identity":"e7d670ba-80f8-415e-8e71-5068cdf686ac","added_by":"auto","created_at":"2024-12-01 16:09:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":362541,"visible":true,"origin":"","legend":"\u003cp\u003eValues of total scores for the EBBS Questionnaire and its domains among patients who experienced weight loss of over 50% after bariatric surgery compared to those with weight loss of less than 50%. Values are expressed as mean ± SE. *: p \u0026lt; 0.05 compared to the corresponding value in the EWL \u0026lt; 50% group.\u003c/p\u003e","description":"","filename":"Figure2EBBS.png","url":"https://assets-eu.researchsquare.com/files/rs-5354771/v1/c76e6ecac0bcd7c5f7b4569b.png"},{"id":70284960,"identity":"ae605759-587f-44e7-a454-666014976134","added_by":"auto","created_at":"2024-12-01 16:09:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":93313,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver-operating characteristic (ROC) analysis of EBBS punctuation and EWL upper to 50%. (A) ROC curve of EBBS punctuation (test variable) with respect to EWL upper to 50$% (state variable). (B) Sensitivity (Se) and specificity (Sp) of the test for different cutoff values of EBBS. The dashed vertical line indicates the value that concurrently optimizes Se and Sp (EBBs = 13.5; Se = 0,875, Sp = 0,549, Youden Index = 0.549.\u003c/p\u003e","description":"","filename":"Figure3EBBS.png","url":"https://assets-eu.researchsquare.com/files/rs-5354771/v1/7e02fcc8023dbfa1d354ff19.png"},{"id":80082339,"identity":"8a679a6c-33a7-47f2-99fa-9a14832b8c78","added_by":"auto","created_at":"2025-04-07 16:08:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1477403,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5354771/v1/172fe525-99bd-40d6-83a1-7b816e54a585.pdf"},{"id":70285248,"identity":"53e71fc4-7e02-4f2b-81d6-834693e8e373","added_by":"auto","created_at":"2024-12-01 16:17:27","extension":"jpg","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":44277,"visible":true,"origin":"","legend":"","description":"","filename":"Figure4graphicalabstract.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5354771/v1/b868478488f442e5212cf02f.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"The EBBS questionnaire (Eating Behavior after Bariatric Surgery) is a useful tool for identifying individuals at risk of long-term weight regain after bariatric surgery","fulltext":[{"header":"Key points","content":"\u003cp\u003eWeight regain affects a significant proportion of patients in the long term after bariatric surgery.\u003c/p\u003e\n\u003cp\u003eStandardized tools are needed to prevent weight regain after bariatric surgery\u003c/p\u003e\n\u003cp\u003eThe EBBS (Eating Behavior after Bariatric Surgery questionnaire) may predict long-term weight outcomes.\u003c/p\u003e"},{"header":"1. INTRODUCTION","content":"\u003cp\u003eObesity has dramatically increased in the recent years reaching a pandemic status. In fact, in Spain the prevalence of obesity among adults is 23.8% with a negative impact on metabolic, mechanical, and psychological comorbidities as well as an increase in cardiovascular morbimortality and a reduction on quality of life [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite significant advances in antiobesity medications added to lifestyle changes when the latter are not enough to lose or maintain weight, bariatric surgery (BS) remains the most suitable option among Class III obesity and class II obesity with suboptimally controlled comorbidities. The mean weight loss after a successful BS is approximately 30\u0026ndash;35% of the presurgery body weight. However, weight maintenance is as crucial as weight loss and, at least one-third of patients who undergo a BS procedure will regain more than 25% of total weight loss. A critical period for weight regain (WR) after BS is when weight loss has reached a plateau, tipically after 18\u0026ndash;24 months. Preventing WR is essential, as it can lead to relapse metabolic, mechanical, and psychological comorbidities related to obesity [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the real prevalence of WR after BS is not well stablished due to the lack of a clear and universal definition [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Consequently, it is difficult to compare the results from different studies published so far. Besides, factors contributing to this WR are not completely understood. Therefore, a planned post-surgery lifestyle management protocol is essential to avoid WR [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, up to date, and despite an ideal multidisciplinary approach, involving obesity specialists, dietitians, sport experts, psychologists, etc., the long-term evaluation of the BS patient has traditionally been subjective and without validated tools. In this sense, Spaggiari G et al., designed and validated a self-administered questionnaire (Eating Behavior after Bariatric Surgery or EBBS) to quantify the patients\u0026rsquo; adherence to dietary and lifestyle advice for a long term success after BS. This questionnaire included domains related to food, drinks, behaviors, and lifestyle after BS. The EBBS questionnaire showed a good internal validity. Furthermore, some domains were positively related with the percentage of weight loss maintained. The study was conducted in Italy, a Mediterranean country with common behaviors and culture with Spain [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to adapt the EBBS questionnaire for Spanish-speaking patients and evaluate its utility as a tool to assess adherence to long-term lifestyle management following BS. Additionally, we examined whether the results obtained from the EBBS were related to WR or weight maintenance in these patients.\u003c/p\u003e"},{"header":"2. MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Subjects\u003c/h2\u003e \u003cp\u003ePatients with a minimum follow-up of 36 months after undergoing a sleeve gastrectomy (performed between 2012 and 2018) were consecutively invited to participate in this study and a total of 100 subjects were included. Inclusion criteria included patients aged 18 years or older who underwent sleeve gastrectomy between 2012 and 2018. Exclusion criteria followed our BS protocol. The study was approved by the CEI-IB, the hospital ethics committee. Written informed consent was obtained from all patients prior to study participation.\u003c/p\u003e \u003cp\u003eThe minimum sample size required for this study was determined through a power analysis using a 95% confidence interval and 80% statistical power. Assuming a moderate effect size (Cohen's \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5), the initial sample size was calculated at 90 patients. To account for a 10% expected dropout rate, this sample size was adjusted to 100 patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. \u003cb\u003eEating Behavior after Bariatric Surgery Questionnaire (EBBS)\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003eThis questionnaire was designed to evaluate the patient\u0026rsquo;s adherence to dietary and lifestyle recommended habits after a bariatric surgery procedure. The questionnaire consists of 11 items divided into four functional domains: domain A (food) assess the number of meals per day, whether there is a regular consumption of sweets, etc.; domain B (drinks) refers to the assessment of regular intake of alcohol, sparkling drinks, etc.; domain C (behaviors) evaluates satiety after eating, intake speed, etc.; and domain S (lifestyle) assess how often the subject weighs himself, the frequency of physical activity, etc. Each answer is given a score from 0 to 2. The higher the final score, the better the subjects\u0026rsquo; adherence to the recommended habits post bariatric surgery. The Italian version of the survey showed a good internal validity (Cronhbach\u0026rsquo;s alpha 0.743, Hotelling\u0026rsquo;s T-square test p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, a direct significant correlation was found between both question 6 (domain B, \u0026ldquo;How many times a week do you drink sparkling beverages?\u0026rdquo;) (Rho 0.327, p\u0026thinsp;=\u0026thinsp;0.037) and question 10 (domain S, \u0026ldquo;how much time do you spend on physical activity?\u0026rdquo;) (Rho 0.311, p\u0026thinsp;=\u0026thinsp;0.048) and the weight loss maintenance. Furthermore, only the S domain was directly related with the percentage of weight loss maintained (Rho 0.305, p\u0026thinsp;=\u0026thinsp;0.048) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A Spanish version of this questionnaire was designed by literally translating the questions from the original test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Sociodemographic and clinical parameters\u003c/h2\u003e \u003cp\u003eGender, age, height, weight, BMI, educational level, partnership status and employment situation were recorded from electronic medical records. We obtained initial weight and BMI from computerized medical history. Significant weight regain was defined as an increase of more than 10% of the minimum weight loss achieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) or median with interquartile range (IQR), depending on their distribution, while categorical variables were expressed as frequencies and percentages. Normality of the data was assessed using the Shapiro-Wilk test. For normally distributed variables, comparisons between groups were performed using Student\u0026rsquo;s t-test, whereas non-parametric variables were compared using the Mann-Whitney U test.\u003c/p\u003e \u003cp\u003eAssociations between categorical variables were evaluated using Chi-square or Fisher's exact test, as appropriate. Pearson or Spearman correlation coefficients were used to assess relationships between continuous variables, depending on the distribution. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eReceiver Operating Characteristic (ROC) analysis was conducted to determine the optimal cutoff value for EBBS scores associated with excess weight loss (EWL) greater than 50%. Sensitivity and specificity values were reported to evaluate the discriminative power of the EBBS score. The area under the curve (AUC) was also calculated to assess the model\u0026rsquo;s overall accuracy.\u003c/p\u003e \u003cp\u003eBinary logistic regression analysis was employed to determine the association between EBBS scores and successful weight loss outcomes (defined as EWL\u0026thinsp;\u0026gt;\u0026thinsp;50%). Both crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Confounders such as age, gender, time since surgery, and pre-surgical BMI were adjusted in the multivariate model. A two-tailed p-value of less than 0.05 was considered statistically significant. All statistical analyses were performed using SPSS software (version 24.0; IBM, Armonk, NY, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Descriptive analysis\u003c/h2\u003e \u003cp\u003eA total of 100 patients who completed the EBBS questionnaire were included as part of a standard follow-up visit after BS, during which anthropometric, metabolic, and psychological variables were assessed. Among the patients, 66% were female, and the mean age was 53.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11 years. The study visit took place on average 90.4\u0026thinsp;\u0026plusmn;\u0026thinsp;46 months after BS, with a mean BMI of 32.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 kg/m\u0026sup2; at that time. The pre-surgical BMI was 45.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 kg/m\u0026sup2;, while the nadir weight after surgery was 85.1\u0026thinsp;\u0026plusmn;\u0026thinsp;19.2 kg. The percentage of excess weight loss (%EWL) was 35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2%. Notably, up to 65% of patients reported emotional eating, and 53% had significant depressive symptoms at the time of evaluation. Furthermore, 70 patients experienced significant weight regain after the surgical procedure (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\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\u003eClinical and sociodemographic characteristics of patients. Values are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or frequency (percentage).\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=\"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\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;100\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \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\u003eGender (female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from Bariatric surgery (motnhs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \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\u003eBIM pre-surgery (kg/cm2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,9\u003c/p\u003e \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\u003eBMI post-surgery (kg/cm2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,4\u003c/p\u003e \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\u003eExcess of Weight Loss (% EWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \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\u003eTotal Weight Loss (% TWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \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\u003eWeight regain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiet adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVisit adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the percentage of participants by BMI categories before (pre-BMI) and after (post-BMI) BS. Before surgery, 98% of patients presented with class III obesity (BMI\u0026thinsp;\u0026gt;\u0026thinsp;40 kg/m\u0026sup2;). After surgery, the distribution shifted, with 10%, 29%, 13%, and 14% of patients classified as having normal weight, overweight, obesity class I, and obesity class II, respectively.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Eating Behavior after Bariatric Surgery Questionnaire (EBBS)\u003c/h2\u003e \u003cp\u003eThe EBBS demonstrated good internal consistency (Cronbach\u0026rsquo;s alpha\u0026thinsp;=\u0026thinsp;0.662; Hotelling's T-squared test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean total EBBS score was 13.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4. Descriptive analyses for each domain of eating behavior are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The A-domain, which relates to food consumption behaviors, scored 4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5, indicating relatively good compliance with dietary recommendations. The B-domain, which assesses drink consumption behaviors, scored 3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3, suggesting modest but generally poor adherence to post-BS drinking guidelines. The C-domain, related to hunger and speed of eating, scored 3.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1, reflecting low compliance. Finally, the S-domain, which assesses lifestyle habits, scored 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3, indicating above-average adherence to physical activity and regular self-weighing.\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\u003eEating behavior after bariatric surgery (EBBS) score distribution among questions and domains. Values are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD and median (interquartile range).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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=\"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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. How many meals do you eat per day?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 How quickly do you consume the main meals?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 How much water do you drink during the meal?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 How many times a week do you eat sweets?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 How many times a week do you drink wine or alcohol?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 How many times a week do you drink sparkling beverages?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 How hungry do you feel before meals?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8 How full do you feel after meals?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9 How is the portion of vegetables you consume during the meal?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 How much time do you spend on physical activity?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11 How often do you weigh yourself?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDomains and total puntuation\u003c/b\u003e\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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA-FOOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-DRINKS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-BEHAVIORS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-LIFESTYLE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBBS TOTAL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13,1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCorrelation analysis was conducted using bivariate Pearson's correlation to determine the relationships between post-BS eating behaviors and anthropometric outcomes. A positive correlation between total EBBS score and weight regain was observed (r\u0026thinsp;=\u0026thinsp;0.28, p\u0026thinsp;=\u0026thinsp;0.004). Additionally, a positive correlation was found between food consumption behavior (A-domain) and pre-surgical BMI (r\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;0.04), as well as %EWL (r\u0026thinsp;=\u0026thinsp;0.19, p\u0026thinsp;=\u0026thinsp;0.04). Adherence to drinking behaviors was also positively correlated with %EWL (r\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;0.04). Furthermore, behavior patterns assessed by the C-domain showed positive correlations with both current BMI (r\u0026thinsp;=\u0026thinsp;0.2, p\u0026thinsp;=\u0026thinsp;0.04) and pre-surgical BMI (r\u0026thinsp;=\u0026thinsp;0.24, p\u0026thinsp;=\u0026thinsp;0.01). Weight regain, on the other hand, was negatively associated with adherence to lifestyle behaviors after BS (S-domain) (r = -2.5, p\u0026thinsp;=\u0026thinsp;0.01). These correlations are summarized in 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\u003eCoefficient of correlation between EBBS questionnarie and demographic data. \u003cem\u003eBMI\u003c/em\u003e-\u003cem\u003epre\u003c/em\u003e, BMI pre-surgery; \u003cem\u003eBMI-post\u003c/em\u003e, BMI post-surgery; \u003cem\u003eTWL\u003c/em\u003e, total weight loss; \u003cem\u003e%TWL\u003c/em\u003e, percent total weight loss; \u003cem\u003e%EWL\u003c/em\u003e, percent excess weight loss; **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEBBS TOTAL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA-FOOD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eB-DRINKS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eC-BEHAVIOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eS-LIFESTYLE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEDAD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBMI-pre (kg/cm2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBMI-post (kg/cm2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e%EPP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e%TPP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBBS TOTAL\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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA-FOOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e,299\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-DRINKS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e,426\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,178\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 \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-BEHAVIOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e,579\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS-LIFESTYLE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e,433\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\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\u003e-0,023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,214\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0,065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI-pre (kg/cm2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,206\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,247\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0,109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI-post (kg/cm2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0,070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e,207\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0,038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,535\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%EWL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0,045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,198\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,202\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0,051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0,132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e,372\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-,208\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e%TWL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e,245\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0,102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0,105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0,112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-,831\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e,566\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Weight and psychological parameters and EBBS questionnaire\u003c/h2\u003e \u003cp\u003ePatients with significant depressive symptoms exhibited significantly lower total EBBS scores compared to patients without depression (12.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 vs. 13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2; p\u0026thinsp;=\u0026thinsp;0.007). Moreover, a lower percentage of patients with depression engaged in more than 150 minutes of exercise per week compared to those without depression (17% vs. 55%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Adherence to follow-up visits was also lower among patients with depression (34% vs. 72%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eEmotional eating was associated with lower total EBBS scores (12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 vs. 13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7; p\u0026thinsp;=\u0026thinsp;0.006). However, no significant differences were found across the individual subdomains (A, B, C, or S). Additionally, patients who experienced significant weight regain had lower total EBBS scores (12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 vs. 14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5; p\u0026thinsp;=\u0026thinsp;0.001), though again, no differences were observed in the subdomains.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Excess of weight loss and EBBS Questionnaire\u003c/h2\u003e \u003cp\u003ePatients with an %EWL greater than 50% had higher total EBBS scores (14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 vs. 12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4; p\u0026thinsp;=\u0026thinsp;0.04). Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the total EBBS scores and domain-specific scores for patients who achieved over 50% EWL compared to those with less than 50% EWL. Patients with higher EWL showed significantly greater scores in overall EBBS and lifestyle domains (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe ROC analysis of EBBS scores for predicting EWL greater than 50% was also conducted (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The area under the curve (AUC) was 0.696 (95% CI: 0.534\u0026ndash;0.858), indicating moderate discriminative ability. An optimal cutoff value of 13.5 for the EBBS score was identified, associated with EWL greater than 50%. This cutoff demonstrated reasonable sensitivity (87.5%) and specificity (54.9%) for predicting successful weight loss outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFinally, binary logistic regression was also performed to study the association between EBBS and percentage of excess of weight loss upper 50%. The results presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicate a significant association between higher EBBS scores (greater than 13.5, using the optimal cutoff value) and achieving excess weight loss (EWL) greater than 50%, compared to EWL below 50% (crude odds ratio [OR]\u0026thinsp;=\u0026thinsp;14.5, 95% CI: 1.7\u0026ndash;123.0, p\u0026thinsp;=\u0026thinsp;0.014). After adjusting for confounding factors, including age, gender, time since bariatric surgery, and pre-surgery BMI, the adjusted OR increases to 17.8 (95% CI: 17.7\u0026ndash;158.4, p\u0026thinsp;=\u0026thinsp;0.010), indicating an even stronger association. These findings suggest that higher EBBS scores may be a predictor of successful weight loss outcomes post-bariatric surgery, emphasizing the importance of psychological and behavioral assessments in predicting long-term weight loss success.\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\u003eCrude and adjusted Odds Ratio (O.R) of EBBS Questuinnarie upper than 13,5 (using optimal cut off value) associated to EWL upper than 50% (vs. EWL\u0026thinsp;\u0026lt;\u0026thinsp;50% as reference).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude O.R.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003e(95% C.I.for O.R.)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eAdjusted O.R.*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c15\" namest=\"c11\"\u003e \u003cp\u003e(95% C.I.for O.R.)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEBBS\u0026thinsp;\u0026gt;\u0026thinsp;13,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14,5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e123,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0,014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e17,8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e(\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17,7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e158,4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0,010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"16\" nameend=\"c16\" namest=\"c1\"\u003e \u003cp\u003e* Adjusted for age (years), gender (male/female), time from bariatric surgery(months and BMI before surgery (kg/cm2).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. CONCLUSIONS","content":"\u003cp\u003eThis study provides valuable insights into the role of eating behaviors post-bariatric surgery, as assessed by the EBBS questionnaire, in predicting weight loss outcomes. Our findings suggest that higher EBBS scores are significantly associated with greater excess weight loss, highlighting the importance of adherence to recommended dietary behaviors after surgery for achieving favorable weight outcomes. The adjusted OR of 17.8 further underscores the strength of this association, even when accounting for critical confounders like age, gender, and pre-surgical BMI.\u003c/p\u003e \u003cp\u003eA significant prevalence of emotional eating (65%) and depressive symptoms (53%) was observed among the patients. These factors were negatively correlated with EBBS scores, suggesting that they adversely affect the ability to adhere to recommended dietary and lifestyle modifications post-surgery. Specifically, patients with depression showed lower adherence to exercise and fewer follow-up visits, which may contribute to the high rate of weight regain observed in this cohort (70%). These results point to the necessity of incorporating targeted psychological interventions to address emotional eating and depressive symptoms, thereby improving adherence and surgical outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, patients with higher EWL had better overall EBBS scores, particularly in domains related to lifestyle and physical activity. This emphasizes the role of an active lifestyle, including physical activity and self-monitoring, in mitigating weight regain and promoting sustained weight loss. The negative association between weight regain and lifestyle adherence also highlights the need for consistent lifestyle interventions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this regard, our results align with the Italian study by Spaggiari et al. who found that patients who, according to the EBBS, reported consuming fewer carbonated beverages and those who engaged in regular physical activity\u0026mdash;specifically 30 to 60 minutes at least 5 times a week\u0026mdash;experienced less weight regain [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, unlike our findings, Spaggiari et al. did not observe any correlation between the presence of psychological disorders and weight regain [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. One of the main differences from our study is that they did not assess the presence of emotional eating in patients, focusing only on mood disorders, well-being, and body image perception.\u003c/p\u003e \u003cp\u003eFurthermore, Alsehemi et al, validated an Arabic translation of the EBBS. They also found an association between weight-related outcomes and the EBBS scales. Moreover, participant compliance with food consumption behaviors did not correlate with weight loss maintenance. However, subjects were 22 times more likely to maintain weight loss when complying with drinking behaviors and 40 times more when they had a regular adherence to physical activity and lifestyle behaviors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe similarity in results demonstrates the validity and consistency of this test in different populations for identifying patients at risk of long-term weight regain after bariatric surgery.\u003c/p\u003e \u003cp\u003eFurthermore, the ROC analysis also indicated an optimal EBBS score cutoff of 13.5 for predicting successful weight loss outcomes (EWL\u0026thinsp;\u0026gt;\u0026thinsp;50%). This threshold can serve as a useful tool for identifying patients at risk of suboptimal weight loss, allowing for tailored interventions to enhance adherence and improve outcomes.\u003c/p\u003e \u003cp\u003eSignificant long-term weight regain after BS is more common than desired, with up to one-third of patients experiencing a regain of more than 25% of the total weight lost. This is because 51 to 70% of patients report suboptimal adherence to food/lifestyle guidelines after BS. However, the causes of this weight regain are multifactorial, ranging from psychological factors to loss of adherence to healthy habits or failure to follow-up with the BS team. Therefore, it is essential to develop protocols or tools that can be applied in clinical practice to help identify, at an early stage, those patients who, due to their dietary patterns, lifestyle, or the presence of psychological issues, are at higher risk. This would allow for closer follow-up and individualized intervention [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The EBBS is a simple tool to detect patients who, in the long term after BS, exhibit lifestyle patterns that predispose them to regain weight [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, long-term follow-up of these patients is crucial to prevent weight regain.\u003c/p\u003e \u003cp\u003eThere are some limitations to this study that must be acknowledged. First, the cross-sectional design limits our ability to establish causation between eating behaviors and weight outcomes. Additionally, the use of self-reported data in the EBBS questionnaire may introduce bias, such as recall or social desirability bias. The sample size, although informative, may not be sufficient to detect smaller or more nuanced effects, and the wide confidence intervals observed indicate potential variability and imprecision in effect estimates. The homogeneity of the sample, which includes only patients who underwent sleeve gastrectomy, should be considered when applying the EBBS questionnaire to patients who have undergone other surgical procedures. Future research with larger and more diverse populations is necessary to confirm these findings.\u003c/p\u003e \u003cp\u003eWe are the first to adapt the EBBS questionnaire for Spanish-speaking patients. Our results suggest that it is a promising tool for predicting weight outcomes in a real word-scenario, with scores above 13.5 being associated with more favorable results. Future studies should aim to validate these findings in larger samples and explore interventions to improve psychological support and adherence to post-surgery recommendations, ultimately enhancing long-term weight management and patient outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJN wrote the manuscript, researched data, and gave final approval of the version. PS made the statistics and reviewed the manuscript. LA collected the data and gave the final approval of the manuscript. AP, MIT and GS collected the data, conceived the graphical abstract and gave the final approval of the manuscript. LM contributed to the discussion, reviewed the manuscript, and gave final approval of the manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFUNDING\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eCOMPLIANCE WITH ETICAL STANDARDS\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll studies involved in studies performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants included in the study understood the information related to the study, understood, and signed a written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors signed that there is no current or potential conflict of interest in relation to this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eDATA AVAILABILITY STATEMENT:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ehttps://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. \u003c/li\u003e\n\u003cli\u003eRalston J, Brinsden H, Buse K, Candeias V, Caterson I, Hassell T, et al. Time for a new obesity narrative. Lancet. 2018;392:1384\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWharton S, Lau DCW, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192:E875\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eIstfan NW, Lipartia M, Anderson WA, Hess DT, Apovian CM. Approach to the Patient: Management of the Post\u0026ndash;Bariatric Surgery Patient With Weight Regain. The Journal of Clinical Endocrinology \u0026amp; Metabolism. 2021;106:251\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eKheniser K, Saxon DR, Kashyap SR. Long-Term Weight Loss Strategies for Obesity. J Clin Endocrinol Metab. 2021;106:1854\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eAthanasiadis DI, Martin A, Kapsampelis P, Monfared S, Stefanidis D. Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc. 2021;35:4069\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eTolvanen L, Christenson A, Surkan PJ, Lagerros YT. Patients\u0026rsquo; Experiences of Weight Regain After Bariatric Surgery. Obes Surg. 2022;32:1498\u0026ndash;507. \u003c/li\u003e\n\u003cli\u003eEl Ansari W, Elhag W. Weight Regain and Insufficient Weight Loss After Bariatric Surgery: Definitions, Prevalence, Mechanisms, Predictors, Prevention and Management Strategies, and Knowledge Gaps-a Scoping Review. Obes Surg. 2021;31:1755\u0026ndash;66. \u003c/li\u003e\n\u003cli\u003eSpaggiari G, Santi D, Budriesi G, Dondi P, Cavedoni S, Leonardi L, et al. Eating Behavior after Bariatric Sur\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":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"obesity, bariatric surgery, weight regain, eating behavior, EBBS, lifestyle adherence, weight loss maintenance, long-term","lastPublishedDoi":"10.21203/rs.3.rs-5354771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5354771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: Bariatric surgery (BS) is an effective treatment for severe obesity, yet weight regain (WR) affects a significant proportion of patients in the long term. The lack of useful and standardized tools makes the follow-up of these patients more difficult. The Eating Behavior After Bariatric Surgery (EBBS) questionnaire was designed to assess adherence to post-surgical lifestyle recommendations, which may predict successful weight maintenance. This study aimed to adapt the EBBS for Spanish-speaking patients and evaluate its utility in assessing adherence to long-term lifestyle changes and its association with weight outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and methods:\u003c/strong\u003e A total of 100 patients who underwent a sleeve gastrectomy (mean follow-up: 90.4 ± 46 months) were included. The EBBS was administered to evaluate food, drink, behavior, and lifestyle domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Significant weight regain was observed in 70% of participants, and emotional eating (65%) and depression (53%) were common. The EBBS demonstrated good internal consistency (Cronbach’s alpha = 0.662). Higher total EBBS scores were significantly associated with greater excess weight loss (EWL), particularly for patients maintaining over 50% EWL (p = 0.04). Logistic regression revealed that EBBS scores \u0026gt;13.5 predicted EWL \u0026gt;50% (OR = 17.8, p = 0.010), underscoring the value of this tool in identifying patients at risk for WR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eThe Spanish version of the EBBS is a reliable tool for assessing post-BS eating behaviors and predicting long-term weight outcomes. Tailored interventions based on EBBS results may improve adherence to dietary and lifestyle recommendations, reducing the risk of WR.\u003c/p\u003e","manuscriptTitle":"The EBBS questionnaire (Eating Behavior after Bariatric Surgery) is a useful tool for identifying individuals at risk of long-term weight regain after bariatric surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-01 16:09:22","doi":"10.21203/rs.3.rs-5354771/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-11T22:29:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-08T19:19:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"22093793876560556429096126082480782913","date":"2024-12-30T14:05:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-03T21:51:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79514232969553454115080971628288694110","date":"2024-11-11T08:19:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-07T16:38:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-02T21:00:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-01T04:43:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2024-10-29T13:35:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c45f9a8f-ac71-44ae-8e63-6416b16a8c9a","owner":[],"postedDate":"December 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-07T16:05:35+00:00","versionOfRecord":{"articleIdentity":"rs-5354771","link":"https://doi.org/10.1007/s11695-025-07836-2","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2025-04-03 15:57:16","publishedOnDateReadable":"April 3rd, 2025"},"versionCreatedAt":"2024-12-01 16:09:22","video":"","vorDoi":"10.1007/s11695-025-07836-2","vorDoiUrl":"https://doi.org/10.1007/s11695-025-07836-2","workflowStages":[]},"version":"v1","identity":"rs-5354771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5354771","identity":"rs-5354771","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}