Changes in hedonic hunger and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass

Changes in hedonic hunger and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass | 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 Changes in hedonic hunger and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass Can Selim YILMAZ, Zeynep Ayca INCE, Ayse Yagmur AYDEMIR, Hilal CALISKAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4671915/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Following RYGB, patients experience changes in hedonic hunger (the drive to eat food for pleasure in the absence of physiological hunger) and eating behaviors. The aim of this study was to determine changes in hedonic hunger and problematic eating behaviors (PEBs) in adults undergoing Roux-en-Y gastric bypass (RYGB). Methods This study was conducted between January 2024 and April 2024 with 70 adults undergoing RYGB who met the conditions for participation in the study. Hedonic hunger was assessed with the Power of Food Scale (PFS) and PEBs with the Eating Disorders Examination Questionnaire (EDE-Q), a week before and 12 week after surgery by the researcher through face-to-face. The PFS consists of 3 subscales [food available (FA), food present (FP) and food tasted (FT)] and the EDE-Q consists of 4 subscales [restraint (R), eating concern (EC), shape concern (SC) and weight concern (WC)]. Increasing scores for both PFS and EDE-Q represent increased hedonic hunger and severity of PEBs, respectively. SPSS 25.0 package program was applied to evaluate the data. Results A total of 70 participants completed the study (70% females; BMI: 37.4 ± 4.5 kg/m 2 ; age: 32.4 ± 7.9 years). Average weight loss was 18.6 ± 5.3 kg (17.6%). Significantly reductions were observed in total (change in mean score ± SD = 1.16 ± 0.30; p < 0.001) and all subscales score of PFS [− 1,16 ± 0.45; p < 0.001 (FA subscale), − 1.36 ± 0.33; p < 0.001 (FP subscale) and − 0.81 ± 0.15; p < 0.01 (FT subscale)] at 12 weeks after surgery compared to baseline. Similarly significantly reductions were observed in EDE-Q scores in total (− 1.05 ± 0.37; p < 0.05) and subscales [− 1.22 ± 0.51; p < 0.05 (EC subscale),−1.97 ± 0.27; p < 0.001 (SC subscale) and − 1.34 ± 0.18; p < 0.001 (WC subscale)] except for the 'R' subscale (+ 0.31 ± 0.51; p < 0.001). Weight loss were non-significantly positively related to reduction in EDE-Q total and all subscale scores. Conclusions Hedonic hunger and severity of problematic eating behaviors reduced in the early postoperative period (12 week) of RYGB compare to pre-op. Although the relationship was not significantly, weight loss increased as problematic eating behaviors decreased. Hedonic hunger problematic eating behaviors bariatric surgery roux-en-Y gastric bypass Figures Figure 1 Figure 2 Background RYGB is one of the most commonly performed bariatric procedures worldwide, generally associated with substantial weight loss, remission of obesity-related comorbidities and improved quality of life ( 1 – 4 ). It has been suggested that weight loss is induced by a reduced energy intake, which is mainly explained by reduced hunger and increased satiety ( 5 , 6 ). Substantial and sudden changes in appetite sensations after RYGB, potentially mediated by favorable alterations in appetite regulating hormones, are believed to play important roles in postoperative weight loss ( 6 ). In addition, lower preference for energy dense foods, development of an aversion to sweetness, lower frequency of food cravings, and decreased influence of emotions and external food cues on food intake were also reported ( 7 ). A reduced energy intake, as a result of these altered eating behavior, is the main driver for weight loss following bariatric surgery ( 8 ). It has been reported that following RYGB, patients experience reductions in hedonic hunger ( 8 – 11 ) and binge eating problems ( 12 , 13 ). A recent systematic review and meta-analysis of observational and clinical studies ( 14 ) has also showed decreased hedonic hunger after bariatric surgery. Studies have reported changes that may be associated with hedonic hunger following RYGB such as decreased food tolerance ( 15 – 18 ), gastrointestinal side effects such as constipation, diarrhea, reflux, indigestion, pain or dumping symptoms ( 19 , 20 ), more healthy food choices ( 21 – 23 ), specific preference or avoidance of certain food items ( 11 ), reduced hunger in the fasted state, increased post-meal satiety, alteration in taste ( 24 ) may be associated with a decrease in hedonic hunger. Moreover, reduced food cue reactivity following bariatric surgery has been demonstrated in a number of fMRI studies, with reduced reward responses to energy-dense foods ( 8 ). In addition to the physical and medical benefits of bariatric surgery, research has discovered psychosocial benefits as well, including improvements in depressive symptomatology, anxiety, postbariatric eating behaviors and eating disorder symptoms ( 25 , 26 ). Problematic eating behaviors (PEBs) are frequently reported among people with obesity presenting for bariatric surgery, with some rising to the level of meeting criteria for an eating disorder (ED) ( 27 – 29 ). While research has demonstrated that PEBs and EDs generally decrease in post operative period compare to pre-op, a considerable number of patients still report PEBs (upwards of 47%) and/or meet criteria for an ED postoperatively (upwards of 10%) ( 27 , 30 – 34 ). Eating behavior is not only a key determinant of the pathogenesis of obesity but also of post-bariatric surgery weight loss. The changes in eating behavior seen following bariatric surgery have been shown to correlate with changes in gastrointestinal physiology ( 8 ). PEBs and EDs have been found to be associated with worse weight loss ( 28 , 30 , 31 , 34 ). The current study was hypothesized that PFS and EDE-Q scores at the end of 12 weeks would significantly decrease compared to baseline. It was also hypothesized that postoperative weight loss would positevly related with reduction in problematic eating behaviors. The aim of this study was to determine changes in hedonic hunger and and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass (RYGB). Methods The study was conducted with 70 adults who applied to a local private physician clinic in Ankara, Turkey, were scheduled for RYGB and met the conditions for participation in the study. Recruitment and data collection took place between between January 2024 and April 2024. The study was approved by the regional ethics committee (KA24/66) and conducted according to the guidelines laid down in the Declaration of Helsinki. All participants provided written informed consent before enrollment in the study. Inclusion criteria were adult patients (> 18 years), with a BMI ≥ 40 kg/m2 or BMI ≥ 35.0 kg/m2 with an obesity-related co-morbidity, who were planned to undergo an RYGB. Participants had to not enrolled in any other obesity treatment or behavioral program. Participants who had previously undergone bariatric surgery, who used medication known to affect energy metabolism or appetite, and who had a current cancer diagnosis or substance abuse, as well as those presenting with a psychiatric diagnosis that precluded bariatric surgery (such as eating disorders), were excluded from the study. Bariatric surgeries were performed at Ufuk University Hospital in Ankara-Turkey, using standard laparoscopic procedures. The RYGB procedure involved creating a small (20–30 mL) proximal gastric pouch and a stapled gastrojejunostomy. A 75– to 150-cm Roux-Y limb was constructed by transecting the jejunum 60 to 100 cm distal to the ligament of Treitz and performing a stapled jejunostomy at this site. Post-surgery, patients were advised to follow a liquid diet for 2 weeks, followed by softer foods for a further 2 weeks, before resuming a solid diet there after ( 35 ). Measures Demographics/anthropometrics The questionnaire including multiple choice questions including demographics was carried out by the researchers using face-to-face interview method a week before and 12 week after surgery. Anthropometric measurements were made by the researcher and added to the questionnaire form. The height of the participants (cm) were measured with a calibrated Seca brand stadiometer without shoes and with shorts - t-shirt clothing. The weight (kg) was measured using a calibrated digital scale (Simbo,SBS-4439). These data were used to calculate BMI using the standard formula kg/m 2 . Hedonic hunger Hedonic hunger was assessed with the validated Turkish translation of Power of Food Scale (PFS) ( 36 ) a week before and 12 week after surgery. The PFS contains 15 items reflecting an individual’s responsiveness to the food environment grouped into three domains according to food proximity: [1] food readily available in the environment but not physically present (food available = FA), [2] food present but not tasted (food present = FP), and [3] food when first tasted but not consumed (food tasted = FT). For each item, subjects were asked to score their reactions on a five-level scale ranging from 1 = ’I do not agree at all’ to 5 = ‘I strongly agree’. The mean of the items comprising each of the three domain scores was calculated to obtain an aggregated score (total score = TS) ( 10 , 37 ). The higher the PFS score, the higher the hedonic hunger. A mean score above 2.5 indicates the presence of hedonic hunger and being affected by food ( 36 ). Eating disorder The validated Turkish translation of EDE-Q ( 38 ) was used to measure eating disorder psychopathology a week before and 12 week after surgery. The EDE-Q focuses on the previous 28 days and measures key eating disorder behavior and cognitive symptoms. The questions are rated on a 7-point Likert scale from 0 to 6, where a higher score indicates increased frequency of eating disorder symptoms. The EDE-Q contains four subscales (dietary restraint, eating concerns, weight concerns, and shape concerns), and a total EDE-Q score is calculated as the average of the subscale scores. The EDE-Q is a valid tool that has been used to identify eating pathology in the bariatric population ( 39 ). Increasing scores in EDE-Q represent increased severity of problematic eating behavior. Cut-off is defined in normal weight populations as mean total EDE-Q score plus one standard deviation, which is approximately 2.5–2.8, depending on different normative samples ( 40 , 41 ). In the current study, a threshold of ≥ 2.5 was used to define presence of PEBs. Statistical analysis The data obtained in the study were analyzed using the SPSS 25.0 program. While evaluating, descriptive statistics such as mean (X̄), standard deviation (± SD), number (n), percentage (%) values were calculated. The normality of data was evaluated with the Shapiro-Wilk test and Kolmogorov–Simirnov test. The significance of the difference between two means was analyzed by Pearson chi-square test. The non-parametric correlation coefficient Spearman's rho test was used to investigate whether there is a correlation between two quantitative variables. Statistical significance level was accepted as p value less than 0.05. Results Table 1 shows mean characteristics of the participants at baseline (BL) and week 12 (W12). Females were over-represented in the study population (70.0%) and the mean age was 32.4 ± 7.9 years. Participants’ 28.6% had chronic diseases, 55.7% were married and average sleep duration was 7.3 ± 1.4 hours. Participants lost 18.6 ± 5.3 kg (17.6%) from BL to W12 and BMI dropped from 37.4 ± 4.5 kg/m 2 to 30.8 ± 4.2 kg/m 2 . Table 1 Mean characteristics of the participants at baseline and week 12 BL (mean ± SD) W12 (mean ± SD) Age 32.4 ± 7.9 Females, % 70.0 Married, % 55.7 Presence of chronic disease, % 28.6 Sleep duration (h) 7.3 ± 1.4 Body weight (kg) 106.3 ± 15.3 87.7 ± 14.1 Weight loss (kg) -18.6 ± 5.3 Weight loss (%BW) 17.6 ± 4.8 BMI (kg/m 2 ) 37.4 ± 4.5 30.8 ± 4.2 BMI: Body Mass Index, BW: Body weight Hedonic hunger Total and subscale mean scores of the PFS are shown in Fig. 1 . Significantly reduction were observed in aggregated score (A) at W12 compared to BL (BL: 3.58 ± 0.58 ; W12: 2.42 ± 0.28, p < 0.001). Similarly significantly reductions were observed in all subcales at W12 compared to BL [food available (B), BL: 3.56 ± 0.79 ; W12: 2.18 ± 0.34, p < 0.001 - food present (C), BL: 3.39 ± 0.68 ; W12: 2.03 ± 0.35, p < 0.001 - food tasted (D), BL: 3.66 ± 0.74 ; W12: 2.85 ± 0.59, p < 0.01)]. The highest decrease was observed in the 'food available' subscale, while the lowest decrease was observed in the 'food tasted' subscale. Data presented as mean ± SD. Asterics denote significant differences over time (Pearson Chi-square, ***p < 0.001, **p < 0.01). RYGB: Roux-en Y gastric bypass, BL: Baseline, W12: week 12 Problematic eating behaviors Total and subscale mean scores of the EDE-Q are presented in Fig. 2 . Significantly reduction were observed in total score (p < 0.5) and ‘eating concern’ (p < 0.5), ‘shape concern’ (p < 0.001), ‘weight concern’ (p < 0.001) subscale scores at W12 compared to BL. In contrast to the others, a significantly increase was found in 'restraint' subscale at W12 compared to BL (p < 0.001). The BL scores of 'restraint', 'eating concern', 'shape concern' and 'weight concern' subscales were 1.49 ± 1.20; 1.69 ± 0.94; 3.42 ± 0.79 and 3.05 ± 0.66, respectively, while their scores at W12 were 1.80 ± 0.69; 0.47 ± 0.34; 1.45 ± 0.52; 1.71 ± 0.48 and 1.36 ± 0.32, respectively. Mean total score of EDE-Q at BL and at W12 was 2.41 ± 0.69 and 1.36 ± 0.32, respectively. Data presented as mean ± SD. Asterics denote significant differences over time (Pearson Chi-square, ***p < 0.001, *p < 0.05). EDE-Q: Eating Disorders Examination Questionnaire, BL: Baseline, W12: week 12 Number and percentage of participants with a presence of PEBs (≥ 2.5 EDE-Q score) are shown in Table 2 . Number of participants whose subscale scores were above the cut-off value (≥ 2.5 EDE-Q score) and who were identified as having PEBs were 12 (17.1%) (in restraint subscale), 12 (17.1%) (in eating concerns subscale), 63 (90.0%) (in shape concern subscale) and 62 (88.6%) (in weight concern subscale) at BL, this rate decreased to 10 (14.3%), 0.3 (4.3%) and 4 (5.7%), respectively at W12 after surgery. Similarly, a decrease from 31 (44.3%) to 0 was observed in total. Table 2 Distribution of participants according to EDE-Q cut-off score Presence of PEBs (EDE-Q score ≥ 2.5) ¥ EDE-Q BL, n(%) W12, n(%) Restraint 12 (%17.1) 10 (%14.3) Eating concern 12 (%17.1) 0 Shape concern 63 (%90.0) 3 (%4.3) Weight concern 62 (%88.6) 4 (%5.7) Total 31 (%44.3) 0 PFS: Power of Food Scale, EDE-Q: The Eating Disorder Examination Questionnaire, BL: Basaline, W12: Week 12, ¥ ≥2.5 score of EDE-Q define presence of PEBs Table 3 shows the relationship between weight loss (%BW) and decrease in EDE-Q scores at the end of 12 week. Weight loss were non-significantly positively related to reduction in EDE-Q total and all subscale scores at W12. Table 3 The relationship between weight loss and decrease in EDE-Q scores at W12 Weight loss (%BW) Decrease in EDE-Q scores r p Restraint 0.179 0.138 Eating concern 0.088 0.470 Shape concern 0.057 0.637 Weight concern 0.022 0.854 Total 0.122 0.313 Spearman's rho test, *p < 0.05 Discussion The current study examined change in change in hedonic hunger in adults undergoing RYGB. Hedonic hunger assessed by the PFS reduced in the early postoperative period (12 week) of RYGB compare to pre-op. The PFS was developed as a quantitative measure of hedonic hunger in 2009 by Cappelleri et al.( 10 ). Since then, over 50 published studies have used the PFS to evaluate hedonic hunger ( 42 ). These results are consistent with previous research that found reduction in hedonic hunger ( 8 – 11 , 22 , 43 ). Reduced food cue reactivity following bariatric surgery has been demonstrated in a number of fMRI studies and reduced hedonic response to food cues has directly related to increases in meal-stimulated glucagon-like peptide 1 (GLP-1) and peptide YY 36 (PYY) secretion post-RYGB ( 8 , 44 ). On the other hand, reported changes following RYGB including decreased food tolerance ( 15 – 18 ), gastrointestinal side effects ( 19 , 20 ), more healthy food choices ( 21 – 23 ), specific preference or avoidance of certain food items ( 11 ), reduced hunger in the fasted state, increased post-meal satiety, alteration in taste ( 24 ) may also related to decrease in hedonic hunger. The current study also examined change in change in PEBs in adults undergoing RYGB. PEBs assessed by the EDE-Q reduced in the early postoperative period (12 week) of RYGB compare to pre-op. Number of participants with presence of PEBs in total and all subscales decreased significantly at 12 weeks after surgery compared to baseline. The EDE-Q was developed as a quantitative measure of hedonic hunger in 1994 by Fairburn & Beglin ( 45 ). The EDE-Q has been shown to be a valid tool used to identify eating pathology in the bariatric population ( 39 ). These results are consistent with previous research that found reduction PEBs and ED following RYGB ( 12 , 13 , 27 , 30 – 34 , 46 , 47 ). Preoperative evaluation of PEBs and ED symptoms is common in bariatric surgeries. Postoperative re-assessment is less common but may be a critical opportunity to intervene to optimize surgical outcomes. The current study contributes to the short-term outcomes literature and highlights for clinical evaluations. The study by Nasirzadeh et al.( 48 ) reported significant reductions in in eating pathology including binge eating, loss of control over eating, night eating, emotional eating, as well as global scores on the EDE-Q during the first year after bariatric surgery. However, between the first and third years after surgery, significantly increases have reported in mean scores of all EDE-Q. The researchers reported that this result may be due to the fact that the EDE-Q measures general eating pathology rather than specific eating pathology. Eating behavior is not only a key determinant of the pathogenesis of obesity but also of post-bariatric surgery weight loss. The changes in eating behavior seen following bariatric surgery have been shown to correlate with changes in gastrointestinal physiology ( 8 ). The current study examined correlation between post-bariatric weight loss (at the end of 12 week) and change in EDE-Q score. Weight loss were non-significantly positively related to reduction in EDE-Q total and all subscale scores at W12. These results are consistent with previous research ( 49 , 50 ) that found positive correlation between post-bariatric weight loss and change in EDE-Q score. It has been suggested that post-bariatric surgery weight loss may partially contribute to the improvement of eating disorder symptoms. On the other hand, nutritional counseling after surgery might also have assisted in the observed improvement of EDE-Q scores ( 51 ). There are a number of limitations in this study with consequent directions for future research. First, while the sample was large enough to detect important statistical trends within this specific cohort of adult RYGB patients, the sample size is not large enough to draw definitive inferences about the total population of adults who undergo bariatric surgery. Furthermore, these bariatric outcome data are limited to a 3-month follow-up window. Prospective and larger sample studies that are longer-term will provide evidence for evaluate long term effects of bariatric surgery on hedonic hunger and PEBs or ED and to elucidate physiological mechanisms. Conclusion Hedonic hunger and severity of problematic eating behaviors reduced in the early postoperative period (12 week) of RYGB compare to pre-op. Reported changes following RYGB such as decreased food tolerance, gastrointestinal side effects, food choices, specific preference or avoidance of certain food items, reduced hunger in the fasted state, increased post-meal satiety, alteration in taste and reduced food cue reactivity may be associated with a decrease in hedonic hunger. Additionally, identifying psychosocial variables associated with ED symptoms and behaviors may help to identify targets for postoperative interventions to reduce these behaviors and further optimize surgery outcomes. Improving our understanding of mechanisms and how it changes following bariatric surgery may pave the way for explain the changes in hedonic hunger and eating behaviors. Thus, more high quality evidence of the comparable effects of RYGB on hedonic hunger and problematic eating behaviors. Declarations Ethics approval and consent to participate The study was approved by the regional ethics committee (KA24/66) and conducted according to the guidelines laid down in the Declaration of Helsinki. All participants provided written informed consent before enrollment in the study. Competing interests The authors declare that they have no competing interests Author Contribution Can Selim Yilmaz and Hilal Caliskan gave substantial contributions to the conception or the design of the manuscript, analysis and interpretation of the data. Zeynep Ayca Ince contributed to to the acquisition and interpretation of the performance data. Ayse Yagmur Aydemir contributed to the literature review and discussion section of the manuscript. All authors participated to drafting the manuscript. All authors read and approved the final version of the manuscript. Acknowledgement We thank all of the participants who gave their time to participate in this research. This research was conducted as a research project with no associated funding. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Schauer PR, Bhatt DL, Kirwan JP, Wolski K et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes. N Engl J Med. 2017;376(7):641-51. Adams TD, Davidson LE, Litwin SE, Kim J. et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass. N Engl J Med. 2017;377(12):1143-55. Kolotkin RL, Davidson LE, Crosby RD, Hunt SC, Adams TD. Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. SOARD. 2012;8(5):625-33. Angrisani L, Santonicola A, Iovino P, Vitiello A, et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. OBES SURG. 2018;28(12):3783-94. Ionut V, Burch M, Youdim A, Bergman RN. Gastrointestinal hormones and bariatric surgery-induced weight loss: Gut Hormones and Bariatric Surgery. Obesity. 2013;21(6):1093-103. Harvey EJ, Arroyo K, Korner J, Inabnet WB. Hormone changes affecting energy homeostasis after metabolic surgery. Mt Sinai J Med.2010;77(5):446-65. Saper CB, Chou TC, Elmquist JK. The need to feed: homeostatic and hedonic control of eating. Neuron. 2002;36(2):199-211. Makaronidis JM, Pucci A, Adamo M, Jenkinson A, Elkalaawy M, Batterham RL. Impact of sleeve gastrectomy compared to Roux-en-y gastric bypass upon hedonic hunger and the relationship to post-operative weight loss. Intern Emerg Med. 2022;17(7):2031-8. Schultes B, Ernst B, Wilms B, Thurnheer M, Hallschmid M. Hedonic hunger is increased in severely obese patients and is reduced after gastric bypass surgery.AJCN. 2010;92(2):277-83. Cappelleri JC, Bushmakin AG, Gerber RA, Leidy NK, et al. Evaluating the Power of Food Scale in obese subjects and a general sample of individuals: development and measurement properties. IJO. 2009;33(8):913-22. Barstad LH, Johnson LK, Borgeraas H, Hofsø D et al. Changes in dietary intake, food tolerance, hedonic hunger, binge eating problems, and gastrointestinal symptoms after sleeve gastrectomy compared with after gastric bypass; 1-year results from the Oseberg study—a randomized controlled trial. AJCN. 2023;117(3):586-98. Opozda M, Chur‐Hansen A, Wittert G. Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre‐post studies. Obes Rev.2016;17(8):770-92. Wadden TA, Faulconbridge LF, Jones‐Corneille LR, Sarwer DB, et al. Binge Eating Disorder and the Outcome of Bariatric Surgery at One Year: A Prospective, Observational Study. Obesity. 2011;19(6):1220-8. Guyot E, Dougkas A, Nazare J, Bagot S,et al. A systematic review and meta‐analyses of food preference modifications after bariatric surgery. Obes Rev. 2021;22(10):e13315. Schweiger C, Weiss R, Keidar A. Effect of Different Bariatric Operations on Food Tolerance and Quality of Eating. OBES SURG.2010;20(10):1393-9. Suter M, Calmes JM, Paroz A, Giusti V. A New Questionnaire for Quick Assessment of Food Tolerance after Bariatric Surgery. OBES SURG. 2007;17(1):2-8. Freeman RA, Overs SE, Zarshenas N, Walton KL, Jorgensen JO. Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass. OBES RES CLIN PRACT. 2014;8(2):e183-91. Coluzzi I, Raparelli L, Guarnacci L, Paone E, Del Genio G, Le Roux CW, vd. Food Intake and Changes in Eating Behavior After Laparoscopic Sleeve Gastrectomy. OBES SURG. 2016;26(9):2059-67. Al-Najim W, Docherty NG, Le Roux CW. Food Intake and Eating Behavior After Bariatric Surgery. Physiol. Rev. 2018;98(3):1113-41. El Labban S, Safadi B, Olabi A. The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study. OBES SURG.2015;25(12):2393-9. Netto BDM, Earthman CP, Farias G, Masquio DCL,et al. Eating patterns and food choice as determinant of weight loss and improvement of metabolic profile after RYGB. Nutrition. 2017;33:125-31. Ullrich J, Ernst B, Wilms B, Thurnheer M, Schultes B. Roux-en Y gastric bypass surgery reduces hedonic hunger and improves dietary habits in severely obese subjects. Obesity surgery. 2013;23:50-5. Laurenius A, Larsson I, Melanson KJ, Lindroos AK, Lönroth H, Bosaeus I, vd. Decreased energy density and changes in food selection following Roux-en-Y gastric bypass. Eur. J. Clin. Nutr. 2013;67(2):168-73. Makaronidis JM, Neilson S, Cheung WH, Tymoszuk U, Pucci A, Finer N, vd. Reported appetite, taste and smell changes following Roux-en-Y gastric bypass and sleeve gastrectomy: effect of gender, type 2 diabetes and relationship to post-operative weight loss. Appetite. 2016;107:93-105. Mamplekou E, Komesidou V, Bissias CH, Papakonstantinou A, Melissas J. Psychological condition and quality of life in patients with morbid obesity before and after surgical weight loss. OBES SURG. 2005;15(8):1177-84. Nickel C, Widermann C, Harms D, Leiberich PL, Tritt K, Kettler C, vd. Patients with Extreme Obesity: Change in Mental Symptoms Three Years after Gastric Banding. Int J Psychiatry Med.2005;35(2):109-22. Conceição EM, Utzinger LM, Pisetsky EM. Eating Disorders and Problematic Eating Behaviours Before and After Bariatric Surgery: Characterization, Assessment and Association with Treatment Outcomes. Eur. Eat. Disord.2015;23(6):417-25. Pizato N, Botelho PB, Gonçalves VS, Dutra ES, de Carvalho KM. Effect of grazing behavior on weight regain post-bariatric surgery: a systematic review. Nutrients. 2017;9(12):1322. Sarwer DB, Allison KC, Wadden TA, Ashare R,et al. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. SOARD. 2019;15(4):650-5. Devlin MJ, King WC, Kalarchian MA, White GE et al. Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3‐year follow‐up. Int J Eat Disord. 2016;49(12):1058-67. Conceição E, Mitchell JE, Vaz AR, Bastos AP, et al. The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain. Eat. behav. 2014;15(4):558-62. Marino JM, Ertelt TW, Lancaster K, Steffen K, et al. The emergence of eating pathology after bariatric surgery: A rare outcome with important clinical implications. Int J Eat Disord.2012;45(2):179-84. White MA, Kalarchian MA, Masheb RM, Marcus MD, Grilo CM. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. J Clin Psychiatry. 2010;71(2):175. Martin-Fernandez KW, Martin-Fernandez J, Marek RJ, Ben-Porath YS, Heinberg LJ. Associations among psychopathology and eating disorder symptoms and behaviors in post-bariatric surgery patients. Eat Weight Disord.2021;26(8):2545-53. Manning S, Carter NC, Pucci A, Jones A, et al. Age-and sex-specific effects on weight loss outcomes in a comparison of sleeve gastrectomy and Roux-en-Y gastric bypass: a retrospective cohort study. BMC obesity. 2014;1:1-7. Mehtap AO, Melisa H. Validation of the Turkish version Power of the Food Scale (PFS) for determining hedonic hunger status and correlate between PFS and body mass index. Malays. J. Nutr. 2020;26(3). Lowe MR, Butryn ML. Hedonic hunger: a new dimension of appetite? Physiol. Behav. 2007;91(4):432-9. Yucel B, Polat A, Ikiz T, Dusgor BP, Elif Yavuz A, Sertel Berk O. The Turkish Version of the Eating Disorder Examination Questionnaire: Reliability and Validity in Adolescents. Eur Eat Dısord Rev.2011;19(6):509-11. Elder KA, Grilo CM, Masheb RM, Rothschild BS, Burke-Martindale CH, Brody ML. Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates. Behav Res Ther.2006;44(4):545-60. Morseth MS, Hanvold SE, Rø Ø, Risstad H, et al. Self-Reported Eating Disorder Symptoms Before and After Gastric Bypass and Duodenal Switch for Super Obesity—a 5-Year Follow-Up Study. OBES SURG.2016;26(3):588-94. Mond JM, Hay PJ, Rodgers B, Owen C. Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. Behav Res Ther. 2006;44(1):53-62. Espel‐Huynh HM, Muratore AF, Lowe MR. A narrative review of the construct of hedonic hunger and its measurement by the Power of Food Scale. Obes. Sci. Pract. 2018;4(3):238-49. Cushing CC, Benoit SC, Peugh JL, Reiter-Purtill J, Inge TH, Zeller MH. Longitudinal trends in hedonic hunger after Roux-en-Y gastric bypass in adolescents. SOARD. 2014;10(1):125-30. Pucci A, Batterham RL. Endocrinology of the Gut and the Regulation of Body Weight and Metabolism. [Updated 2020 Apr 25]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK556470. Fairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self‐report questionnaire? Int J Eat Disord. 1994;16(4):363-70. Hrabosky J, Masheb R, White M, Rothschild B, Burke-Martindale C, Grilo C. A Prospective Study of Body Dissatisfaction and Concerns in Extremely Obese Gastric Bypass Patients: 6- and 12-Month Postoperative Outcomes. Obes Surg. 2006;16(12):1615-21. Castellini G, Godini L, Amedei SG, Faravelli C, Lucchese M, Ricca V. Psychological effects and outcome predictors of three bariatric surgery interventions: a 1-year follow-up study. Eat Weight Disord. 2014;19(2):217-24. Nasirzadeh Y, Kantarovich K, Wnuk S, Okrainec A, Cassin SE, Hawa R, vd. Binge Eating, Loss of Control over Eating, Emotional Eating, and Night Eating After Bariatric Surgery: Results from the Toronto Bari-PSYCH Cohort Study. OBES SURG.2018;28(7):2032-9. Gero D, Tzafos S, Milos G, Gerber PA, Vetter D, Bueter M. Predictors of a Healthy Eating Disorder Examination-Questionnaire (EDE-Q) Score 1 Year After Bariatric Surgery. OBES SURG. 2019;29(3):928-34. Conceição EM, Mitchell JE, Pinto-Bastos A, Arrojado F, Brandão I, Machado PP. Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study. SOARD. 2017;13(6):1063-70. Spitznagel MB, Garcia S, Miller LA, Strain G, Devlin M, Wing R, vd. Cognitive function predicts weight loss after bariatric surgery. SOARD. 2013;9(3):453-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4671915","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":327394041,"identity":"bd1ae2c0-1c5d-4bdc-bcae-421829fb8eda","order_by":0,"name":"Can Selim YILMAZ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDCCAxCKhw9EfgBiNnaCWpghWtiABOMMkBZmIrUwgLQw84BYhLTw3cg/+OHnjsMybGKHH3+2+bVNno+ZgfHDxxzcWiRvJDNL9p45zMMmnWZgnNt327CNmYFZcuY23FoMbiSzMfC2gbQkGCTn9txmBGphY+YloIXxL1hL+ofDlj237YnSwgyxJcewmeHH7USCWiTPPDaWlm1LB2kpZuxtuJ3cxszYjNcvfMcTH35822Ztzy+dvvnDjz+3bee3Nx/88BGPFgaBBBDZDOEwtoHJBjzqgYD/AIisg/L+4Fc8CkbBKBgFIxMAAE8pTaeZIXN3AAAAAElFTkSuQmCC","orcid":"","institution":"Başkent University","correspondingAuthor":true,"prefix":"","firstName":"Can","middleName":"Selim","lastName":"YILMAZ","suffix":""},{"id":327394043,"identity":"54f67b0b-7ad3-44ee-899b-657e252568d0","order_by":1,"name":"Zeynep Ayca INCE","email":"","orcid":"","institution":"Başkent University","correspondingAuthor":false,"prefix":"","firstName":"Zeynep","middleName":"Ayca","lastName":"INCE","suffix":""},{"id":327394045,"identity":"3cf537e4-21f5-4f10-a1c1-db1793e7505c","order_by":2,"name":"Ayse Yagmur AYDEMIR","email":"","orcid":"","institution":"Başkent University","correspondingAuthor":false,"prefix":"","firstName":"Ayse","middleName":"Yagmur","lastName":"AYDEMIR","suffix":""},{"id":327394046,"identity":"e69b4354-1529-48b1-aca8-2bf2962e4730","order_by":3,"name":"Hilal CALISKAN","email":"","orcid":"","institution":"Başkent University","correspondingAuthor":false,"prefix":"","firstName":"Hilal","middleName":"","lastName":"CALISKAN","suffix":""}],"badges":[],"createdAt":"2024-07-02 06:32:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4671915/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4671915/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61358842,"identity":"1275ea51-84ea-4c83-8228-49f39f8010a4","added_by":"auto","created_at":"2024-07-29 21:24:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22026,"visible":true,"origin":"","legend":"\u003cp\u003ePower of Food Scale scores.\u003c/p\u003e\n\u003cp\u003eData presented as mean ± SD. Asterics denote significant differences over time (Pearson Chi-square,***p\u0026lt;0.001, **p\u0026lt;0.01). RYGB: Roux-en Y gastric bypass, BL: Baseline, W12: week 12\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4671915/v1/93f3ae6bf2e13d75bf8d6368.png"},{"id":61358118,"identity":"7b74ee2b-5a05-422b-9db3-034a8d24541c","added_by":"auto","created_at":"2024-07-29 21:16:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15500,"visible":true,"origin":"","legend":"\u003cp\u003eEating Disorders Examination Questionnaire scores.\u003c/p\u003e\n\u003cp\u003eData presented as mean ± SD. Asterics denote significant differences over time (Pearson Chi-square, ***p\u0026lt;0.001, *p\u0026lt;0.05). EDE-Q: Eating Disorders Examination Questionnaire, BL: Baseline, W12: week 12\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4671915/v1/3f53e53b65ccc3216e482117.png"},{"id":61438434,"identity":"a20cf47e-0ca4-4ae0-aa08-c38d8e1cd25a","added_by":"auto","created_at":"2024-07-30 18:51:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":449058,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4671915/v1/a9a53693-3d73-486a-870f-a8271514853c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Changes in hedonic hunger and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass","fulltext":[{"header":"Background","content":"\u003cp\u003eRYGB is one of the most commonly performed bariatric procedures worldwide, generally associated with substantial weight loss, remission of obesity-related comorbidities and improved quality of life (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It has been suggested that weight loss is induced by a reduced energy intake, which is mainly explained by reduced hunger and increased satiety (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Substantial and sudden changes in appetite sensations after RYGB, potentially mediated by favorable alterations in appetite regulating hormones, are believed to play important roles in postoperative weight loss (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In addition, lower preference for energy dense foods, development of an aversion to sweetness, lower frequency of food cravings, and decreased influence of emotions and external food cues on food intake were also reported (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A reduced energy intake, as a result of these altered eating behavior, is the main driver for weight loss following bariatric surgery (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt has been reported that following RYGB, patients experience reductions in hedonic hunger (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and binge eating problems (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A recent systematic review and meta-analysis of observational and clinical studies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) has also showed decreased hedonic hunger after bariatric surgery. Studies have reported changes that may be associated with hedonic hunger following RYGB such as decreased food tolerance (\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), gastrointestinal side effects such as constipation, diarrhea, reflux, indigestion, pain or dumping symptoms (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), more healthy food choices (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), specific preference or avoidance of certain food items (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), reduced hunger in the fasted state, increased post-meal satiety, alteration in taste (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) may be associated with a decrease in hedonic hunger. Moreover, reduced food cue reactivity following bariatric surgery has been demonstrated in a number of fMRI studies, with reduced reward responses to energy-dense foods (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to the physical and medical benefits of bariatric surgery, research has discovered psychosocial benefits as well, including improvements in depressive symptomatology, anxiety, postbariatric eating behaviors and eating disorder symptoms (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Problematic eating behaviors (PEBs) are frequently reported among people with obesity presenting for bariatric surgery, with some rising to the level of meeting criteria for an eating disorder (ED) (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). While research has demonstrated that PEBs and EDs generally decrease in post operative period compare to pre-op, a considerable number of patients still report PEBs (upwards of 47%) and/or meet criteria for an ED postoperatively (upwards of 10%) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Eating behavior is not only a key determinant of the pathogenesis of obesity but also of post-bariatric surgery weight loss. The changes in eating behavior seen following bariatric surgery have been shown to correlate with changes in gastrointestinal physiology (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). PEBs and EDs have been found to be associated with worse weight loss (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study was hypothesized that PFS and EDE-Q scores at the end of 12 weeks would significantly decrease compared to baseline. It was also hypothesized that postoperative weight loss would positevly related with reduction in problematic eating behaviors. The aim of this study was to determine changes in hedonic hunger and and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass (RYGB).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted with 70 adults who applied to a local private physician clinic in Ankara, Turkey, were scheduled for RYGB and met the conditions for participation in the study. Recruitment and data collection took place between between January 2024 and April 2024. The study was approved by the regional ethics committee (KA24/66) and conducted according to the guidelines laid down in the Declaration of Helsinki. All participants provided written informed consent before enrollment in the study.\u003c/p\u003e \u003cp\u003eInclusion criteria were adult patients (\u0026gt;\u0026thinsp;18 years), with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;40 kg/m2 or BMI\u0026thinsp;\u0026ge;\u0026thinsp;35.0 kg/m2 with an obesity-related co-morbidity, who were planned to undergo an RYGB. Participants had to not enrolled in any other obesity treatment or behavioral program. Participants who had previously undergone bariatric surgery, who used medication known to affect energy metabolism or appetite, and who had a current cancer diagnosis or substance abuse, as well as those presenting with a psychiatric diagnosis that precluded bariatric surgery (such as eating disorders), were excluded from the study.\u003c/p\u003e \u003cp\u003eBariatric surgeries were performed at Ufuk University Hospital in Ankara-Turkey, using standard laparoscopic procedures. The RYGB procedure involved creating a small (20\u0026ndash;30 mL) proximal gastric pouch and a stapled gastrojejunostomy. A 75\u0026ndash; to 150-cm Roux-Y limb was constructed by transecting the jejunum 60 to 100 cm distal to the ligament of Treitz and performing a stapled jejunostomy at this site. Post-surgery, patients were advised to follow a liquid diet for 2 weeks, followed by softer foods for a further 2 weeks, before resuming a solid diet there after (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDemographics/anthropometrics\u003c/h2\u003e \u003cp\u003eThe questionnaire including multiple choice questions including demographics was carried out by the researchers using face-to-face interview method a week before and 12 week after surgery. Anthropometric measurements were made by the researcher and added to the questionnaire form. The height of the participants (cm) were measured with a calibrated Seca brand stadiometer without shoes and with shorts - t-shirt clothing. The weight (kg) was measured using a calibrated digital scale (Simbo,SBS-4439). These data were used to calculate BMI using the standard formula kg/m\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eHedonic hunger\u003c/h2\u003e \u003cp\u003eHedonic hunger was assessed with the validated Turkish translation of Power of Food Scale (PFS) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) a week before and 12 week after surgery. The PFS contains 15 items reflecting an individual\u0026rsquo;s responsiveness to the food environment grouped into three domains according to food proximity: [1] food readily available in the environment but not physically present (food available\u0026thinsp;=\u0026thinsp;FA), [2] food present but not tasted (food present\u0026thinsp;=\u0026thinsp;FP), and [3] food when first tasted but not consumed (food tasted\u0026thinsp;=\u0026thinsp;FT). For each item, subjects were asked to score their reactions on a five-level scale ranging from 1 = \u0026rsquo;I do not agree at all\u0026rsquo; to 5 = \u0026lsquo;I strongly agree\u0026rsquo;. The mean of the items comprising each of the three domain scores was calculated to obtain an aggregated score (total score\u0026thinsp;=\u0026thinsp;TS) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The higher the PFS score, the higher the hedonic hunger. A mean score above 2.5 indicates the presence of hedonic hunger and being affected by food (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEating disorder\u003c/h2\u003e \u003cp\u003eThe validated Turkish translation of EDE-Q (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) was used to measure eating disorder psychopathology a week before and 12 week after surgery. The EDE-Q focuses on the previous 28 days and measures key eating disorder behavior and cognitive symptoms. The questions are rated on a 7-point Likert scale from 0 to 6, where a higher score indicates increased frequency of eating disorder symptoms. The EDE-Q contains four subscales (dietary restraint, eating concerns, weight concerns, and shape concerns), and a total EDE-Q score is calculated as the average of the subscale scores. The EDE-Q is a valid tool that has been used to identify eating pathology in the bariatric population (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Increasing scores in EDE-Q represent increased severity of problematic eating behavior. Cut-off is defined in normal weight populations as mean total EDE-Q score plus one standard deviation, which is approximately 2.5\u0026ndash;2.8, depending on different normative samples (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In the current study, a threshold of \u0026ge;\u0026thinsp;2.5 was used to define presence of PEBs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data obtained in the study were analyzed using the SPSS 25.0 program. While evaluating, descriptive statistics such as mean (X̄), standard deviation (\u0026plusmn;\u0026thinsp;SD), number (n), percentage (%) values were calculated. The normality of data was evaluated with the Shapiro-Wilk test and Kolmogorov\u0026ndash;Simirnov test. The significance of the difference between two means was analyzed by Pearson chi-square test. The non-parametric correlation coefficient Spearman's rho test was used to investigate whether there is a correlation between two quantitative variables. Statistical significance level was accepted as p value less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows mean characteristics of the participants at baseline (BL) and week 12 (W12). Females were over-represented in the study population (70.0%) and the mean age was 32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 years. Participants\u0026rsquo; 28.6% had chronic diseases, 55.7% were married and average sleep duration was 7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 hours. Participants lost 18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 kg (17.6%) from BL to W12 and BMI dropped from 37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 kg/m\u003csup\u003e2\u003c/sup\u003e to 30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 kg/m\u003csup\u003e2\u003c/sup\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\u003eMean characteristics of the participants at baseline and week 12\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBL (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eW12 (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemales, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of chronic disease, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep duration (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.7\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight loss (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight loss (%BW)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eBMI: Body Mass Index, BW: Body weight\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eHedonic hunger\u003c/h2\u003e \u003cp\u003eTotal and subscale mean scores of the PFS are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Significantly reduction were observed in aggregated score (A) at W12 compared to BL (BL: 3.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58 ; W12: 2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly significantly reductions were observed in all subcales at W12 compared to BL [food available (B), BL: 3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 ; W12: 2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 - food present (C), BL: 3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68 ; W12: 2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 - food tasted (D), BL: 3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74 ; W12: 2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)]. The highest decrease was observed in the 'food available' subscale, while the lowest decrease was observed in the 'food tasted' subscale.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Asterics denote significant differences over time (Pearson Chi-square, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). RYGB: Roux-en Y gastric bypass, BL: Baseline, W12: week 12\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eProblematic eating behaviors\u003c/h2\u003e \u003cp\u003eTotal and subscale mean scores of the EDE-Q are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Significantly reduction were observed in total score (p\u0026thinsp;\u0026lt;\u0026thinsp;0.5) and \u0026lsquo;eating concern\u0026rsquo; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.5), \u0026lsquo;shape concern\u0026rsquo; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), \u0026lsquo;weight concern\u0026rsquo; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) subscale scores at W12 compared to BL. In contrast to the others, a significantly increase was found in 'restraint' subscale at W12 compared to BL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The BL scores of 'restraint', 'eating concern', 'shape concern' and 'weight concern' subscales were 1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20; 1.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94; 3.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79 and 3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66, respectively, while their scores at W12 were 1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69; 0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34; 1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52; 1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 and 1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32, respectively. Mean total score of EDE-Q at BL and at W12 was 2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69 and 1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32, respectively.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eData presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. Asterics denote significant differences over time (Pearson Chi-square, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). EDE-Q: Eating Disorders Examination Questionnaire, BL: Baseline, W12: week 12\u003c/p\u003e \u003cp\u003eNumber and percentage of participants with a presence of PEBs (\u0026ge;\u0026thinsp;2.5 EDE-Q score) are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Number of participants whose subscale scores were above the cut-off value (\u0026ge;\u0026thinsp;2.5 EDE-Q score) and who were identified as having PEBs were 12 (17.1%) (in restraint subscale), 12 (17.1%) (in eating concerns subscale), 63 (90.0%) (in shape concern subscale) and 62 (88.6%) (in weight concern subscale) at BL, this rate decreased to 10 (14.3%), 0.3 (4.3%) and 4 (5.7%), respectively at W12 after surgery. Similarly, a decrease from 31 (44.3%) to 0 was observed in total.\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\u003eDistribution of participants according to EDE-Q cut-off score\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of PEBs (EDE-Q score\u0026thinsp;\u0026ge;\u0026thinsp;2.5) \u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEDE-Q\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBL, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eW12, n(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRestraint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (%17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (%14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEating concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (%17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShape concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (%90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (%4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (%88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (%5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (%44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePFS: Power of Food Scale, EDE-Q: The Eating Disorder Examination Questionnaire, BL: Basaline, W12: Week 12, \u003csup\u003e\u0026yen;\u003c/sup\u003e \u0026ge;2.5 score of EDE-Q define presence of PEBs\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\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the relationship between weight loss (%BW) and decrease in EDE-Q scores at the end of 12 week. Weight loss were non-significantly positively related to reduction in EDE-Q total and all subscale scores at W12.\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\u003eThe relationship between weight loss and decrease in EDE-Q scores at W12\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWeight loss (%BW)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecrease in EDE-Q scores\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRestraint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEating concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShape concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight concern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eSpearman's rho test, \u003cb\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\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 \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study examined change in change in hedonic hunger in adults undergoing RYGB. Hedonic hunger assessed by the PFS reduced in the early postoperative period (12 week) of RYGB compare to pre-op. The PFS was developed as a quantitative measure of hedonic hunger in 2009 by Cappelleri et al.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Since then, over 50 published studies have used the PFS to evaluate hedonic hunger (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). These results are consistent with previous research that found reduction in hedonic hunger (\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Reduced food cue reactivity following bariatric surgery has been demonstrated in a number of fMRI studies and reduced hedonic response to food cues has directly related to increases in meal-stimulated glucagon-like peptide 1 (GLP-1) and peptide YY 36 (PYY) secretion post-RYGB (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). On the other hand, reported changes following RYGB including decreased food tolerance (\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), gastrointestinal side effects (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), more healthy food choices (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), specific preference or avoidance of certain food items (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), reduced hunger in the fasted state, increased post-meal satiety, alteration in taste (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) may also related to decrease in hedonic hunger.\u003c/p\u003e \u003cp\u003eThe current study also examined change in change in PEBs in adults undergoing RYGB. PEBs assessed by the EDE-Q reduced in the early postoperative period (12 week) of RYGB compare to pre-op. Number of participants with presence of PEBs in total and all subscales decreased significantly at 12 weeks after surgery compared to baseline. The EDE-Q was developed as a quantitative measure of hedonic hunger in 1994 by Fairburn \u0026amp; Beglin (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). The EDE-Q has been shown to be a valid tool used to identify eating pathology in the bariatric population (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). These results are consistent with previous research that found reduction PEBs and ED following RYGB (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Preoperative evaluation of PEBs and ED symptoms is common in bariatric surgeries. Postoperative re-assessment is less common but may be a critical opportunity to intervene to optimize surgical outcomes. The current study contributes to the short-term outcomes literature and highlights for clinical evaluations. The study by Nasirzadeh et al.(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) reported significant reductions in in eating pathology including binge eating, loss of control over eating, night eating, emotional eating, as well as global scores on the EDE-Q during the first year after bariatric surgery. However, between the first and third years after surgery, significantly increases have reported in mean scores of all EDE-Q. The researchers reported that this result may be due to the fact that the EDE-Q measures general eating pathology rather than specific eating pathology.\u003c/p\u003e \u003cp\u003eEating behavior is not only a key determinant of the pathogenesis of obesity but also of post-bariatric surgery weight loss. The changes in eating behavior seen following bariatric surgery have been shown to correlate with changes in gastrointestinal physiology (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The current study examined correlation between post-bariatric weight loss (at the end of 12 week) and change in EDE-Q score. Weight loss were non-significantly positively related to reduction in EDE-Q total and all subscale scores at W12. These results are consistent with previous research (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e) that found positive correlation between post-bariatric weight loss and change in EDE-Q score. It has been suggested that post-bariatric surgery weight loss may partially contribute to the improvement of eating disorder symptoms. On the other hand, nutritional counseling after surgery might also have assisted in the observed improvement of EDE-Q scores (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are a number of limitations in this study with consequent directions for future research. First, while the sample was large enough to detect important statistical trends within this specific cohort of adult RYGB patients, the sample size is not large enough to draw definitive inferences about the total population of adults who undergo bariatric surgery. Furthermore, these bariatric outcome data are limited to a 3-month follow-up window. Prospective and larger sample studies that are longer-term will provide evidence for evaluate long term effects of bariatric surgery on hedonic hunger and PEBs or ED and to elucidate physiological mechanisms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHedonic hunger and severity of problematic eating behaviors reduced in the early postoperative period (12 week) of RYGB compare to pre-op. Reported changes following RYGB such as decreased food tolerance, gastrointestinal side effects, food choices, specific preference or avoidance of certain food items, reduced hunger in the fasted state, increased post-meal satiety, alteration in taste and reduced food cue reactivity may be associated with a decrease in hedonic hunger. Additionally, identifying psychosocial variables associated with ED symptoms and behaviors may help to identify targets for postoperative interventions to reduce these behaviors and further optimize surgery outcomes. Improving our understanding of mechanisms and how it changes following bariatric surgery may pave the way for explain the changes in hedonic hunger and eating behaviors. Thus, more high quality evidence of the comparable effects of RYGB on hedonic hunger and problematic eating behaviors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the regional ethics committee (KA24/66) and conducted according to the guidelines laid down in the Declaration of Helsinki. All participants provided written informed consent before enrollment in the study.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eCan Selim Yilmaz and Hilal Caliskan gave substantial contributions to the conception or the design of the manuscript, analysis and interpretation of the data. Zeynep Ayca Ince contributed to to the acquisition and interpretation of the performance data. Ayse Yagmur Aydemir contributed to the literature review and discussion section of the manuscript. All authors participated to drafting the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe thank all of the participants who gave their time to participate in this research. This research was conducted as a research project with no associated funding.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchauer PR, Bhatt DL, Kirwan JP, Wolski K et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes \u0026mdash; 5-Year Outcomes. N Engl J Med. 2017;376(7):641-51. \u003c/li\u003e\n\u003cli\u003eAdams TD, Davidson LE, Litwin SE, Kim J. et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass. N Engl J Med. 2017;377(12):1143-55. \u003c/li\u003e\n\u003cli\u003eKolotkin RL, Davidson LE, Crosby RD, Hunt SC, Adams TD. Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. SOARD. 2012;8(5):625-33. \u003c/li\u003e\n\u003cli\u003eAngrisani L, Santonicola A, Iovino P, Vitiello A, et al. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. OBES SURG. 2018;28(12):3783-94. \u003c/li\u003e\n\u003cli\u003eIonut V, Burch M, Youdim A, Bergman RN. Gastrointestinal hormones and bariatric surgery-induced weight loss: Gut Hormones and Bariatric Surgery. Obesity. 2013;21(6):1093-103. \u003c/li\u003e\n\u003cli\u003eHarvey EJ, Arroyo K, Korner J, Inabnet WB. Hormone changes affecting energy homeostasis after metabolic surgery. Mt Sinai J Med.2010;77(5):446-65. \u003c/li\u003e\n\u003cli\u003eSaper CB, Chou TC, Elmquist JK. The need to feed: homeostatic and hedonic control of eating. Neuron. 2002;36(2):199-211. \u003c/li\u003e\n\u003cli\u003eMakaronidis JM, Pucci A, Adamo M, Jenkinson A, Elkalaawy M, Batterham RL. Impact of sleeve gastrectomy compared to Roux-en-y gastric bypass upon hedonic hunger and the relationship to post-operative weight loss. Intern Emerg Med. 2022;17(7):2031-8. \u003c/li\u003e\n\u003cli\u003eSchultes B, Ernst B, Wilms B, Thurnheer M, Hallschmid M. Hedonic hunger is increased in severely obese patients and is reduced after gastric bypass surgery.AJCN. 2010;92(2):277-83. \u003c/li\u003e\n\u003cli\u003eCappelleri JC, Bushmakin AG, Gerber RA, Leidy NK, et al. Evaluating the Power of Food Scale in obese subjects and a general sample of individuals: development and measurement properties. IJO. 2009;33(8):913-22. \u003c/li\u003e\n\u003cli\u003eBarstad LH, Johnson LK, Borgeraas H, Hofs\u0026oslash; D et al. Changes in dietary intake, food tolerance, hedonic hunger, binge eating problems, and gastrointestinal symptoms after sleeve gastrectomy compared with after gastric bypass; 1-year results from the Oseberg study\u0026mdash;a randomized controlled trial. AJCN. 2023;117(3):586-98. \u003c/li\u003e\n\u003cli\u003eOpozda M, Chur‐Hansen A, Wittert G. Changes in problematic and disordered eating after gastric bypass, adjustable gastric banding and vertical sleeve gastrectomy: a systematic review of pre‐post studies. Obes Rev.2016;17(8):770-92. \u003c/li\u003e\n\u003cli\u003eWadden TA, Faulconbridge LF, Jones‐Corneille LR, Sarwer DB, et al. Binge Eating Disorder and the Outcome of Bariatric Surgery at One Year: A Prospective, Observational Study. Obesity. 2011;19(6):1220-8. \u003c/li\u003e\n\u003cli\u003eGuyot E, Dougkas A, Nazare J, Bagot S,et al. A systematic review and meta‐analyses of food preference modifications after bariatric surgery. Obes Rev. 2021;22(10):e13315. \u003c/li\u003e\n\u003cli\u003eSchweiger C, Weiss R, Keidar A. Effect of Different Bariatric Operations on Food Tolerance and Quality of Eating. OBES SURG.2010;20(10):1393-9. \u003c/li\u003e\n\u003cli\u003eSuter M, Calmes JM, Paroz A, Giusti V. A New Questionnaire for Quick Assessment of Food Tolerance after Bariatric Surgery. OBES SURG. 2007;17(1):2-8. \u003c/li\u003e\n\u003cli\u003eFreeman RA, Overs SE, Zarshenas N, Walton KL, Jorgensen JO. Food tolerance and diet quality following adjustable gastric banding, sleeve gastrectomy and Roux-en-Y gastric bypass. OBES RES CLIN PRACT. 2014;8(2):e183-91. \u003c/li\u003e\n\u003cli\u003eColuzzi I, Raparelli L, Guarnacci L, Paone E, Del Genio G, Le Roux CW, vd. Food Intake and Changes in Eating Behavior After Laparoscopic Sleeve Gastrectomy. OBES SURG. 2016;26(9):2059-67. \u003c/li\u003e\n\u003cli\u003eAl-Najim W, Docherty NG, Le Roux CW. Food Intake and Eating Behavior After Bariatric Surgery. Physiol. Rev. 2018;98(3):1113-41. \u003c/li\u003e\n\u003cli\u003eEl Labban S, Safadi B, Olabi A. The Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Surgery on Dietary Intake, Food Preferences, and Gastrointestinal Symptoms in Post-Surgical Morbidly Obese Lebanese Subjects: A Cross-Sectional Pilot Study. OBES SURG.2015;25(12):2393-9. \u003c/li\u003e\n\u003cli\u003eNetto BDM, Earthman CP, Farias G, Masquio DCL,et al. Eating patterns and food choice as determinant of weight loss and improvement of metabolic profile after RYGB. Nutrition. 2017;33:125-31. \u003c/li\u003e\n\u003cli\u003eUllrich J, Ernst B, Wilms B, Thurnheer M, Schultes B. Roux-en Y gastric bypass surgery reduces hedonic hunger and improves dietary habits in severely obese subjects. Obesity surgery. 2013;23:50-5. \u003c/li\u003e\n\u003cli\u003eLaurenius A, Larsson I, Melanson KJ, Lindroos AK, L\u0026ouml;nroth H, Bosaeus I, vd. Decreased energy density and changes in food selection following Roux-en-Y gastric bypass. Eur. J. Clin. Nutr. 2013;67(2):168-73. \u003c/li\u003e\n\u003cli\u003eMakaronidis JM, Neilson S, Cheung WH, Tymoszuk U, Pucci A, Finer N, vd. Reported appetite, taste and smell changes following Roux-en-Y gastric bypass and sleeve gastrectomy: effect of gender, type 2 diabetes and relationship to post-operative weight loss. Appetite. 2016;107:93-105. \u003c/li\u003e\n\u003cli\u003eMamplekou E, Komesidou V, Bissias CH, Papakonstantinou A, Melissas J. Psychological condition and quality of life in patients with morbid obesity before and after surgical weight loss. OBES SURG. 2005;15(8):1177-84. \u003c/li\u003e\n\u003cli\u003eNickel C, Widermann C, Harms D, Leiberich PL, Tritt K, Kettler C, vd. Patients with Extreme Obesity: Change in Mental Symptoms Three Years after Gastric Banding. Int J Psychiatry Med.2005;35(2):109-22. \u003c/li\u003e\n\u003cli\u003eConcei\u0026ccedil;\u0026atilde;o EM, Utzinger LM, Pisetsky EM. Eating Disorders and Problematic Eating Behaviours Before and After Bariatric Surgery: Characterization, Assessment and Association with Treatment Outcomes. Eur. Eat. Disord.2015;23(6):417-25. \u003c/li\u003e\n\u003cli\u003ePizato N, Botelho PB, Gon\u0026ccedil;alves VS, Dutra ES, de Carvalho KM. Effect of grazing behavior on weight regain post-bariatric surgery: a systematic review. Nutrients. 2017;9(12):1322. \u003c/li\u003e\n\u003cli\u003eSarwer DB, Allison KC, Wadden TA, Ashare R,et al. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. SOARD. 2019;15(4):650-5. \u003c/li\u003e\n\u003cli\u003eDevlin MJ, King WC, Kalarchian MA, White GE et al. Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3‐year follow‐up. Int J Eat Disord. 2016;49(12):1058-67. \u003c/li\u003e\n\u003cli\u003eConcei\u0026ccedil;\u0026atilde;o E, Mitchell JE, Vaz AR, Bastos AP, et al. The presence of maladaptive eating behaviors after bariatric surgery in a cross sectional study: importance of picking or nibbling on weight regain. Eat. behav. 2014;15(4):558-62. \u003c/li\u003e\n\u003cli\u003eMarino JM, Ertelt TW, Lancaster K, Steffen K, et al. The emergence of eating pathology after bariatric surgery: A rare outcome with important clinical implications. Int J Eat Disord.2012;45(2):179-84. \u003c/li\u003e\n\u003cli\u003eWhite MA, Kalarchian MA, Masheb RM, Marcus MD, Grilo CM. Loss of control over eating predicts outcomes in bariatric surgery patients: a prospective, 24-month follow-up study. J Clin Psychiatry. 2010;71(2):175. \u003c/li\u003e\n\u003cli\u003eMartin-Fernandez KW, Martin-Fernandez J, Marek RJ, Ben-Porath YS, Heinberg LJ. Associations among psychopathology and eating disorder symptoms and behaviors in post-bariatric surgery patients. Eat Weight Disord.2021;26(8):2545-53. \u003c/li\u003e\n\u003cli\u003eManning S, Carter NC, Pucci A, Jones A, et al. Age-and sex-specific effects on weight loss outcomes in a comparison of sleeve gastrectomy and Roux-en-Y gastric bypass: a retrospective cohort study. BMC obesity. 2014;1:1-7. \u003c/li\u003e\n\u003cli\u003eMehtap AO, Melisa H. Validation of the Turkish version Power of the Food Scale (PFS) for determining hedonic hunger status and correlate between PFS and body mass index. Malays. J. Nutr. 2020;26(3). \u003c/li\u003e\n\u003cli\u003eLowe MR, Butryn ML. Hedonic hunger: a new dimension of appetite? Physiol. Behav. 2007;91(4):432-9. \u003c/li\u003e\n\u003cli\u003eYucel B, Polat A, Ikiz T, Dusgor BP, Elif Yavuz A, Sertel Berk O. The Turkish Version of the Eating Disorder Examination Questionnaire: Reliability and Validity in Adolescents. Eur Eat Dısord Rev.2011;19(6):509-11. \u003c/li\u003e\n\u003cli\u003eElder KA, Grilo CM, Masheb RM, Rothschild BS, Burke-Martindale CH, Brody ML. Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates. Behav Res Ther.2006;44(4):545-60. \u003c/li\u003e\n\u003cli\u003eMorseth MS, Hanvold SE, R\u0026oslash; \u0026Oslash;, Risstad H, et al. Self-Reported Eating Disorder Symptoms Before and After Gastric Bypass and Duodenal Switch for Super Obesity\u0026mdash;a 5-Year Follow-Up Study. OBES SURG.2016;26(3):588-94. \u003c/li\u003e\n\u003cli\u003eMond JM, Hay PJ, Rodgers B, Owen C. Eating Disorder Examination Questionnaire (EDE-Q): norms for young adult women. Behav Res Ther. 2006;44(1):53-62. \u003c/li\u003e\n\u003cli\u003eEspel‐Huynh HM, Muratore AF, Lowe MR. A narrative review of the construct of hedonic hunger and its measurement by the Power of Food Scale. Obes. Sci. Pract. 2018;4(3):238-49. \u003c/li\u003e\n\u003cli\u003eCushing CC, Benoit SC, Peugh JL, Reiter-Purtill J, Inge TH, Zeller MH. Longitudinal trends in hedonic hunger after Roux-en-Y gastric bypass in adolescents. SOARD. 2014;10(1):125-30. \u003c/li\u003e\n\u003cli\u003ePucci A, Batterham RL. Endocrinology of the Gut and the Regulation of Body Weight and Metabolism. [Updated 2020 Apr 25]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK556470.\u003c/li\u003e\n\u003cli\u003eFairburn CG, Beglin SJ. Assessment of eating disorders: Interview or self‐report questionnaire? Int J Eat Disord. 1994;16(4):363-70. \u003c/li\u003e\n\u003cli\u003eHrabosky J, Masheb R, White M, Rothschild B, Burke-Martindale C, Grilo C. A Prospective Study of Body Dissatisfaction and Concerns in Extremely Obese Gastric Bypass Patients: 6- and 12-Month Postoperative Outcomes. Obes Surg. 2006;16(12):1615-21. \u003c/li\u003e\n\u003cli\u003eCastellini G, Godini L, Amedei SG, Faravelli C, Lucchese M, Ricca V. Psychological effects and outcome predictors of three bariatric surgery interventions: a 1-year follow-up study. Eat Weight Disord. 2014;19(2):217-24. \u003c/li\u003e\n\u003cli\u003eNasirzadeh Y, Kantarovich K, Wnuk S, Okrainec A, Cassin SE, Hawa R, vd. Binge Eating, Loss of Control over Eating, Emotional Eating, and Night Eating After Bariatric Surgery: Results from the Toronto Bari-PSYCH Cohort Study. OBES SURG.2018;28(7):2032-9. \u003c/li\u003e\n\u003cli\u003eGero D, Tzafos S, Milos G, Gerber PA, Vetter D, Bueter M. Predictors of a Healthy Eating Disorder Examination-Questionnaire (EDE-Q) Score 1 Year After Bariatric Surgery. OBES SURG. 2019;29(3):928-34. \u003c/li\u003e\n\u003cli\u003eConcei\u0026ccedil;\u0026atilde;o EM, Mitchell JE, Pinto-Bastos A, Arrojado F, Brand\u0026atilde;o I, Machado PP. Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study. SOARD. 2017;13(6):1063-70. \u003c/li\u003e\n\u003cli\u003eSpitznagel MB, Garcia S, Miller LA, Strain G, Devlin M, Wing R, vd. Cognitive function predicts weight loss after bariatric surgery. SOARD. 2013;9(3):453-9. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hedonic hunger, problematic eating behaviors, bariatric surgery, roux-en-Y gastric bypass","lastPublishedDoi":"10.21203/rs.3.rs-4671915/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4671915/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFollowing RYGB, patients experience changes in hedonic hunger (the drive to eat food for pleasure in the absence of physiological hunger) and eating behaviors. The aim of this study was to determine changes in hedonic hunger and problematic eating behaviors (PEBs) in adults undergoing Roux-en-Y gastric bypass (RYGB).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study was conducted between January 2024 and April 2024 with 70 adults undergoing RYGB who met the conditions for participation in the study. Hedonic hunger was assessed with the Power of Food Scale (PFS) and PEBs with the Eating Disorders Examination Questionnaire (EDE-Q), a week before and 12 week after surgery by the researcher through face-to-face. The PFS consists of 3 subscales [food available (FA), food present (FP) and food tasted (FT)] and the EDE-Q consists of 4 subscales [restraint (R), eating concern (EC), shape concern (SC) and weight concern (WC)]. Increasing scores for both PFS and EDE-Q represent increased hedonic hunger and severity of PEBs, respectively. SPSS 25.0 package program was applied to evaluate the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 70 participants completed the study (70% females; BMI: 37.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 kg/m\u003csup\u003e2\u003c/sup\u003e; age: 32.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 years). Average weight loss was 18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 kg (17.6%). Significantly reductions were observed in total (change in mean score\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and all subscales score of PFS [\u0026minus;\u0026thinsp;1,16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (FA subscale), \u0026minus;\u0026thinsp;1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (FP subscale) and \u0026minus;\u0026thinsp;0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (FT subscale)] at 12 weeks after surgery compared to baseline. Similarly significantly reductions were observed in EDE-Q scores in total (\u0026minus;\u0026thinsp;1.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and subscales [\u0026minus;\u0026thinsp;1.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (EC subscale),\u0026minus;1.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (SC subscale) and \u0026minus;\u0026thinsp;1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (WC subscale)] except for the 'R' subscale (+\u0026thinsp;0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Weight loss were non-significantly positively related to reduction in EDE-Q total and all subscale scores.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHedonic hunger and severity of problematic eating behaviors reduced in the early postoperative period (12 week) of RYGB compare to pre-op. Although the relationship was not significantly, weight loss increased as problematic eating behaviors decreased.\u003c/p\u003e","manuscriptTitle":"Changes in hedonic hunger and problematic eating behaviors in adults undergoing Roux-en-Y gastric bypass","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 21:16:02","doi":"10.21203/rs.3.rs-4671915/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b98b324d-679f-44a1-84a9-a316e2a5a76b","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-30T18:42:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-29 21:16:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4671915","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4671915","identity":"rs-4671915","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}