Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective Study

Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective Study Anna Rajtar, Michał Wysocki, Anna Starowicz-Filip, Barbara Bętkowska-Korpała, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9290663/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Purpose Attention-deficit/hyperactivity disorder (ADHD) and affective symptoms are highly prevalent among bariatric surgery candidates, yet their role in postoperative weight-loss outcomes remains insufficiently understood. Previous studies suggest that neurodevelopmental traits and emotional dysregulation may influence adherence and long-term outcomes after bariatric procedures. This study aimed to examine associations between ADHD, affective symptoms, personality pathology, and weight-loss outcomes 12 months after sleeve gastrectomy. Methods Eighty adults undergoing sleeve gastrectomy were assessed preoperatively using structured diagnostic interviews and standardized self-report measures. ADHD was diagnosed using the Diagnostic Interview for ADHD in Adults (DIVA-5), personality disorders with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), and depressive symptoms, anxiety symptoms, and impulsivity were assessed using the Beck Depression Inventory–II (BDI-II), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale–11 (BIS-11), respectively. Weight-loss outcomes (%TWL, %EWL, %EBMIL) were calculated 12 months postoperatively. Group comparisons and multiple linear regression analyses were conducted to identify independent psychological predictors of postoperative weight loss. Results Patients with ADHD exhibited significantly higher levels of depressive symptoms, anxiety symptoms, impulsivity, and a higher prevalence of personality disorders at baseline. At 12-month follow-up, patients with ADHD achieved significantly lower postoperative weight-loss outcomes compared with those without ADHD. In multivariable regression analyses predicting %EBMIL from preoperative baseline, ADHD diagnosis and anxiety symptom severity emerged as independent predictors of postoperative weight loss, whereas depressive symptoms, impulsivity, personality disorder diagnosis, age, and sex were not significant. Conclusion ADHD and anxiety symptoms independently predict weight-loss outcomes after sleeve gastrectomy, highlighting the clinical relevance of neurodevelopmental and affective factors in bariatric care. These findings support the inclusion of targeted psychological assessment and tailored interventions for patients with ADHD traits and elevated anxiety prior to bariatric surgery. Level of Evidence Level III, welldesigned cohort study. Health sciences/Diseases Health sciences/Medical research Biological sciences/Psychology Social science/Psychology ADHD bariatric surgery sleeve gastrectomy anxiety weight loss obesity Introduction Obesity represents a major global health burden and is associated with increased morbidity, mortality, and reduced quality of life. Bariatric surgery is currently the most effective treatment for severe obesity, leading to substantial and sustained weight loss as well as improvements in metabolic and cardiovascular outcomes [ 3 , 8 ]. Despite the overall effectiveness of bariatric procedures, considerable interindividual variability in postoperative weight-loss outcomes persists, suggesting that factors beyond surgical technique and baseline anthropometrics may play an important role [ 8 ]. Psychological and psychiatric factors have increasingly been recognised as relevant contributors to bariatric surgery outcomes. Depression, anxiety, disordered eating, impulsivity, and personality pathology are highly prevalent among bariatric surgery candidates and have been linked to poorer adherence to postoperative recommendations and long-term weight regain in some studies [ 9 , 13 ]. However, findings remain inconsistent, and many studies rely on self-report symptom measures without formal diagnostic assessment or multivariable modelling. Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and impulsivity, frequently persisting into adulthood. Epidemiological studies indicate that ADHD is associated with an increased risk of overweight and obesity, with adults with ADHD showing higher body mass index (BMI) and greater difficulty with weight regulation compared to individuals without ADHD [ 4 , 21 ]. In clinical obesity samples, the prevalence of ADHD appears substantially higher than in the general population [ 20 ]. Several mechanisms have been proposed to explain the association between ADHD and obesity, including impaired inhibitory control, altered reward processing, emotional dysregulation, and difficulties maintaining structured eating and physical activity routines [ 5 , 14 ]. Adults with ADHD also exhibit higher rates of comorbid affective disorders and personality pathology, which may further complicate postoperative adjustment following bariatric surgery [ 9 , 16 ]. Despite growing interest in ADHD within bariatric populations, its impact on postoperative weight-loss outcomes remains unclear. Some observational studies suggest that ADHD symptoms may be associated with poorer long-term weight-loss maintenance and reduced adherence to follow-up after bariatric surgery [ 12 , 23 ]. In contrast, other studies have reported no significant differences in short-term postoperative weight loss between patients with and without ADHD, particularly during the first postoperative year when the restrictive and physiological effects of surgery are strongest [ 18 ]. These mixed findings highlight the need for studies that combine formal ADHD diagnosis with comprehensive psychological assessment and multivariable statistical approaches. Beyond ADHD, affective symptoms such as depression and anxiety have been extensively examined in bariatric populations, though their independent predictive value remains debated. While some studies report that higher levels of depressive or anxiety symptoms predict poorer postoperative outcomes, others fail to find significant effects after adjusting for demographic and clinical covariates [ 15 , 13 ]. Personality disorders and impulsivity have also been associated with maladaptive eating behaviours and psychosocial impairment, yet their unique contribution to weight-loss outcomes following bariatric surgery remains insufficiently established [ 1 , 16 ]. Importantly, many previous studies have examined these psychological factors in isolation, without accounting for their substantial overlap and comorbidity. In particular, it remains unclear whether ADHD exerts an independent effect on postoperative weight loss beyond co-occurring affective symptoms, impulsivity, and personality pathology. Therefore, the aim of the present study was to investigate the associations between ADHD diagnosis, affective symptoms (depression and anxiety), personality disorders, and impulsivity with weight-loss outcomes 12 months after sleeve gastrectomy. Using structured diagnostic interviews and validated self-report measures, we sought to identify independent psychological predictors of postoperative weight loss in a multivariable regression model. We hypothesised that ADHD diagnosis and anxiety severity would be independently associated with postoperative weight-loss outcomes after controlling for demographic variables and co-occurring psychopathology. Methods This observational cohort study was conducted at an academic hospital in Poland between May 2024 and October 2025 as part of the routine multidisciplinary qualification process for bariatric surgery. Adult patients with obesity referred for surgical evaluation were consecutively recruited during standard preoperative psychological assessment. Eligibility criteria included age ≥ 18 years and qualification for bariatric surgery according to national and international guidelines. Patients with severe cognitive impairment or acute psychiatric decompensation preventing valid assessment were excluded. All participants underwent a comprehensive preoperative psychological evaluation conducted by trained clinical neuropsychologists and clinical psychologists. Written informed consent was obtained from all participants prior to inclusion. The study protocol was approved by the Bioethics Committee of the Jagiellonian University Medical College (decision no. 118.6120.108.2023) and was carried out in accordance with the Declaration of Helsinki. Attention-deficit/hyperactivity disorder (ADHD) was diagnosed using the Diagnostic Interview for ADHD in Adults, version 5 (DIVA-5), a structured clinical interview based on DSM-5 criteria assessing childhood and adulthood symptoms of inattention and hyperactivity/impulsivity as well as associated functional impairment. Depressive symptom severity was assessed with the Beck Depression Inventory–II (BDI-II), and anxiety symptom severity with the Beck Anxiety Inventory (BAI). Trait impulsivity was measured using the Barratt Impulsiveness Scale–11 (BIS-11). All instruments have well-established psychometric properties and are widely used in clinical and bariatric populations. Anthropometric data, including body mass index (BMI), were obtained from medical records at baseline and at postoperative follow-up. Weight-loss outcomes were calculated at 12 months after surgery and expressed as percentage total weight loss (%TWL), percentage excess weight loss (%EWL), and percentage excess BMI loss (%EBMIL) relative to preoperative baseline values. %TWL was treated as the primary descriptive outcome, while %EBMIL served as the primary dependent variable in regression analyses due to its clinical relevance and normalization for baseline BMI. Descriptive statistics were calculated for demographic, clinical, psychological, and weight-loss variables. Continuous variables are presented as means and standard deviations, and categorical variables as frequencies and percentages. Between-group comparisons were conducted using independent-samples t-tests or Mann–Whitney U tests for continuous variables and χ² or Fisher’s exact tests for categorical variables, as appropriate. Effect sizes were reported as Cohen’s d or Cramér’s V/φ. To examine independent predictors of postoperative weight-loss outcomes, multiple linear regression analysis was performed with %EBMIL at 12-month follow-up as the dependent variable. Predictor variables entered simultaneously into the model included age, sex, ADHD diagnosis (yes/no), presence of any personality disorder, depressive symptom severity (BDI-II score), anxiety symptom severity (BAI score), and trait impulsivity (BIS-11 total score). Regression assumptions were verified by inspection of residuals, and multicollinearity was assessed using variance inflation factors (all VIF values < 2.5). Model fit was evaluated using R, R², adjusted R², and the F statistic. All statistical analyses were performed using Statistica version 13.3 (TIBCO Software Inc.), with two-tailed tests and a significance threshold of p < .05. Results The study sample comprised 80 adults undergoing sleeve gastrectomy, predominantly female, with a mean age of approximately 39 years. ADHD was diagnosed in 17.5% of participants, while any personality disorder was identified in 42.5% of the sample. At baseline, patients with and without ADHD did not differ significantly with respect to age, sex distribution, baseline BMI, or maximum lifetime BMI (all p > .05). In contrast, participants with ADHD demonstrated a markedly higher psychiatric burden. The prevalence of depressive disorders, anxiety disorders, and personality disorders was significantly higher in the ADHD group compared with participants without ADHD, with medium to large effect sizes (all p < .05). Consistently, patients with ADHD reported significantly higher levels of depressive symptoms, anxiety symptoms, and impulsivity, as measured by the BDI-II, BAI, and BIS-11, respectively (all p .05). However, at the 12-month follow-up, individuals with ADHD achieved significantly poorer postoperative outcomes. Specifically, %TWL, as well as normalized weight-loss indices (%EWL and %EBMIL), were significantly lower in the ADHD group compared with the non-ADHD group, with large effect sizes (all p ≤ .01) (Table 1 ). Table 1 Baseline characteristics and comprehensive 12-month weight-loss outcomes by ADHD status. Variable Total (n = 80) ADHD: Yes (n = 14) ADHD: No (n = 66) p-value Effect size Demographic and anthropometric data (baseline) Age (years) 39.24 ± 8.48 38.93 ± 8.01 39.30 ± 8.63 .882 d = 0.04 Sex (female), n (%) 67 (83.8%) 11 (78.6%) 56 (84.8%) .568 φ = 0.06 BMI I at baseline (kg/m²) 40.82 ± 5.04 40.41 ± 3.86 40.91 ± 5.27 .742 d = 0.11 BMI max (kg/m²) 43.74 ± 4.53 42.92 ± 4.71 43.91 ± 4.51 .461 d = 0.22 Psychological and clinical variables (baseline) Depressive disorders, n (%) 33 (41.3%) 11 (78.6%) 22 (33.3%) .002 φ = 0.35 Anxiety disorders, n (%) 37 (46.3%) 11 (78.6%) 26 (39.4%) .007 φ = 0.31 Binge Eating Disorder (BED), n (%) 10 (12.5%) 3 (18.8%) 7 (10.9%) .401 φ = 0.09 Any personality disorder (SCID-5-PD), n (%) 34 (42.5%) 10 (71.4%) 24 (36.4%) .016 φ = 0.27 Depressive symptoms (BDI-II), score 11.26 ± 9.02 16.93 ± 5.86 10.06 ± 9.14 .009 d = 0.79 Anxiety symptoms (BAI), score 18.84 ± 12.81 27.43 ± 10.16 17.02 ± 12.63 .005 d = 0.87 Impulsivity (BIS-11), score 36.44 ± 11.13 42.14 ± 5.42 35.23 ± 11.66 .034 d = 0.63 12-month follow-up outcomes – absolute changes BMI at 12 months (kg/m²) 28.70 ± 4.48 30.87 ± 3.50 28.24 ± 4.55 .045 d = 0.60 Preoperative weight – loss outcomes % Total weight loss – preoperative (%TWL) 6.78 ± 4.96 5.64 ± 3.35 7.02 ± 5.23 .347 d = 0.31 % Excess weight loss – preoperative (%EWL) 16.40 ± 12.92 13.18 ± 7.73 17.09 ± 13.72 .307 d = 0.33 % Excess BMI loss – preoperative (%EBMIL) 16.40 ± 12.92 13.18 ± 7.73 17.09 ± 13.72 .307 d = 0.33 Postoperative weight – loss outcomes (12 months, from preoperative values) % Total weight loss – 12 months (%TWL) 29.60 ± 7.63 23.61 ± 4.67 30.87 ± 7.55 < .001 d = 1.06 % Excess weight loss – 12 months (%EWL) 81.71 ± 28.82 63.93 ± 15.16 85.48 ± 29.68 .010 d = 0.85 % Excess BMI loss – 12 months (%EBMIL) 81.71 ± 28.82 63.93 ± 15.16 85.48 ± 29.68 .010 d = 0.85 Footnote Continuous variables are presented as mean ± SD or median (IQR), as appropriate. Categorical variables are reported as n (%). Between-group comparisons used t/Welch or Mann–Whitney tests for continuous variables and χ² or Fisher’s exact tests for categorical variables. Effect sizes are reported as Cohen’s d and Cramér’s V/φ. %TWL was the primary descriptive outcome, and %EBMIL the primary outcome in regression analyses. When analyses were stratified by personality disorder status, patients with a personality disorder did not differ from those without in age or sex distribution. Nevertheless, the personality disorder group presented with significantly higher baseline obesity severity, reflected by higher BMI values and maximum lifetime BMI (p = .002). As expected, patients with personality disorders exhibited significantly higher rates of depressive and anxiety disorders and higher levels of depressive symptoms, anxiety symptoms, and impulsivity (all p ≤ .01). Binge eating disorder was also significantly more prevalent among patients with personality disorders compared with those without personality pathology (p < .01). Despite these baseline differences, postoperative weight-loss outcomes at 12 months did not differ significantly between patients with and without personality disorders, including %TWL, %EWL, and %EBMIL (all p > .05) (Table 2 ). Table 2 Baseline characteristics and comprehensive 12-month weight-loss outcomes by personality disorder status. Variable Total (n = 80) Personality disorder: Yes (n = 34) Personality disorder: No (n = 46) p-value Effect size Demographic and anthropometric data (baseline) Age (years) 39.24 ± 8.48 38.29 ± 10.15 39.93 ± 7.03 .396 d = 0.11 Sex (female), n (%) 67 (83.8%) 29 (85.3%) 38 (82.6%) .748 φ = 0.04 BMI at baseline (kg/m²) 40.82 ± 5.04 42.78 ± 5.42 39.37 ± 4.23 .002 d = 0.71 BMI max (kg/m²) 43.74 ± 4.53 45.52 ± 4.79 42.42 ± 3.87 .002 d = 0.58 Psychological and clinical variables (baseline) Depressive disorders, n (%) 33 (41.3%) 26 (76.5%) 7 (15.2%) < 0.001 φ = 0.62 Anxiety disorders, n (%) 37 (46.2%) 21 (61.8%) 16 (34.8%) .017 φ = 0.62 Binge Eating Disorder (BED), n (%) 10 (12.5%) 8 (23.5%) 2 (4.3%) .005 φ = 0.34 ADHD, n (%) 14 (17.5%) 10 (29.4%) 4 (8.7%) .016 φ = 0.27 Depressive symptoms (BDI-II), score 11.26 ± 9.02 18.18 ± 7.84 6.15 ± 5.91 < 0.001 d = 1.76 Anxiety symptoms (BAI), score 18.84 ± 12.81 23.91 ± 11.44 15.09 ± 12.58 .002 d = 0.72 Impulsivity (BIS-11), score 36.44 ± 11.13 41.00 ± 6.20 33.07 ± 12.72 .001 d = 0.77 12-month follow-up outcomes – absolute changes BMI at 12 months (kg/m²) 28.70 ± 4.48 30.14 ± 4.79 27.63 ± 3.95 .012 d = 0.58 Preoperative weight – loss outcomes % Total weight loss – preoperative (%TWL) 6.78 ± 4.96 6.27 ± 3.87 7.16 ± 5.65 .429 d = 0.17 % Excess weight loss – preoperative (%EWL) 16.40 ± 12.92 14.62 ± 9.71 17.72 ± 14.83 .291 d = 0.29 % Excess BMI loss – preoperative (%EBMIL) 16.40 ± 12.92 14.62 ± 9.71 17.72 ± 14.83 .291 d = 0.29 Postoperative weight – loss outcomes (12 months, from preoperative values) % Total weight loss – 12 months (%TWL) 29.60 ± 7.63 29.57 ± 6.46 29.63 ± 8.46 .971 d = 0.10 % Excess weight loss – 12 months (%EWL) 81.71 ± 28.82 75.04 ± 20.98 86.64 ± 32.82 .075 d = 0.41 % Excess BMI loss – 12 months (%EBMIL) 81.71 ± 28.82 75.04 ± 20.98 86.64 ± 32.82 .075 d = 0.41 Footnote Continuous variables are presented as mean ± SD or median (IQR), as appropriate. Categorical variables are reported as n (%). Between-group comparisons used t/Welch or Mann–Whitney tests for continuous variables and χ² or Fisher’s exact tests for categorical variables. Effect sizes are reported as Cohen’s d and Cramér’s V/φ. %TWL was the primary descriptive outcome, and %EBMIL the primary outcome in regression analyses. To examine independent predictors of postoperative weight loss, a multiple linear regression model was fitted with %EBMIL at 12-month follow-up as the dependent variable. The overall model was statistically significant, explaining approximately one quarter of the variance in postoperative weight loss (R² = 0.255; adjusted R² = 0.183; F(7,72) = 3.52; p = .0026). After adjustment for age, sex, personality disorder status, depressive symptoms, anxiety symptoms, and impulsivity, ADHD diagnosis emerged as an independent negative predictor of %EBMIL ( p = .015). In contrast, higher anxiety symptom severity was independently associated with greater postoperative weight loss ( p = .025). No independent associations were observed for age, sex, depressive symptoms, impulsivity, or personality disorder status (all p > .05) (Table 3 ). Table 3 Multiple linear regression analysis predicting postoperative %EBMIL. Dependent variable: %EBMIL from preoperative baseline Predictor B SE β t p 95% CI Intercept 89.54 23.47 — 3.81 < 0.001 42.75–136.34 Age −0.52 0.36 −0.15 −1.43 0.157 −1.20–0.20 Sex 18.07 9.47 0.23 1.91 0.060 −0.81–36.94 ADHD (yes) −20.83 8.36 −0.28 −2.49 0.015 −37.50–−4.17 Personality disorder (yes) −9.03 8.05 −0.16 −1.12 0.266 −25.08–7.02 BDI score −0.37 0.51 −0.12 −0.73 0.468 −1.39–0.64 BAI score 0.62 0.27 0.27 2.30 0.025 0.08–1.15 BIS score −0.07 0.33 −0.03 −0.22 0.831 −0.74–0.59 Overall model statistics R = 0.505 F(7,72) = 3.52 R² = 0.255; adj. R² = 0.183; p = 0.0026 Overall, ADHD was associated with a significantly higher burden of baseline psychopathology and with poorer postoperative weight-loss outcomes at 12-month follow-up. Although patients with personality disorders presented with greater baseline obesity severity and more pronounced affective and impulsivity symptoms, personality disorder diagnosis alone was not associated with postoperative weight-loss indices. In multivariable analyses, ADHD diagnosis emerged as an independent negative predictor of postoperative %EBMIL, whereas higher anxiety symptom severity was independently associated with greater postoperative weight loss. Other psychological variables, including depressive symptoms, impulsivity, and personality disorder status, were not independently associated with postoperative weight-loss outcomes. Discussion The present study investigated the role of ADHD, affective symptoms, impulsivity, and personality pathology in predicting postoperative weight-loss outcomes 12 months after sleeve gastrectomy. Our findings indicate that ADHD is associated with a substantially higher baseline psychopathological burden and poorer postoperative weight-loss outcomes, while personality disorder diagnosis alone does not independently predict surgical success. Importantly, ADHD diagnosis and anxiety symptom severity emerged as independent predictors of postoperative %EBMIL in multivariable analyses, whereas depressive symptoms, impulsivity, and personality disorder status did not. The association between ADHD and obesity has been well established, with accumulating evidence suggesting that ADHD-related deficits in executive functioning, impulse control, and reward processing contribute to maladaptive eating behaviors and difficulties with long-term weight regulation [ 4 , 14 , 21 ]. More recent studies have emphasized that ADHD represents a distinct neurobehavioral risk factor in bariatric populations, beyond traditional psychiatric comorbidities [ 20 , 10 ]. Our results extend these findings by demonstrating that ADHD independently predicts poorer postoperative weight loss at 12 months, even after controlling for affective symptoms, impulsivity, personality disorders, age, and sex. This aligns with recent cohort studies indicating that patients with ADHD may achieve comparable early postoperative weight loss but exhibit reduced adherence to dietary recommendations, follow-up visits, and lifestyle changes, ultimately resulting in less favorable outcomes [ 12 , 23 , 2 ]. The present findings underscore the clinical relevance of formally diagnosing ADHD using structured interviews rather than relying solely on symptom screening instruments, as categorical diagnosis appears to capture clinically meaningful variance in postoperative outcomes. Consistent with prior research, patients with personality disorders exhibited significantly higher baseline BMI and greater severity of depressive symptoms, anxiety symptoms, and impulsivity [ 1 , 16 , 19 ]. In addition, binge eating disorder was significantly more prevalent among patients with personality disorders, indicating greater baseline vulnerability related to disordered eating patterns. However, personality disorder diagnosis was not independently associated with postoperative weight-loss outcomes in the present study. This finding is in line with recent systematic reviews suggesting that while personality pathology is associated with psychosocial impairment and greater treatment complexity, it does not necessarily predict poorer short-term bariatric outcomes when adequate perioperative support is provided [ 13 , 15 , 10 ]. One possible explanation is that the restrictive and physiological effects of sleeve gastrectomy may temporarily mitigate behavioral vulnerabilities associated with personality pathology during the first postoperative year. Additionally, the substantial overlap between personality disorders, ADHD, and affective symptoms may limit the independent predictive value of categorical personality diagnoses once these factors are modeled simultaneously. A notable finding of the present study is the independent positive association between anxiety symptom severity and postoperative %EBMIL. Although anxiety symptoms were more prevalent among patients with ADHD and personality disorders, higher anxiety scores predicted greater weight loss after controlling for overlapping psychopathology. Similar findings have been reported in recent bariatric and non-bariatric medical populations, where moderate anxiety has been associated with increased treatment engagement, vigilance, and adherence to medical recommendations [ 11 , 17 ]. In the context of bariatric surgery, heightened anxiety may reflect increased concern about surgical outcomes, fear of complications, and greater attentiveness to dietary rules and behavioral restrictions during the early postoperative period. Importantly, this effect should not be interpreted as anxiety being protective or desirable, but rather as an indicator of behavioral regulation in the absence of pronounced impulsivity or executive dysfunction. This interpretation is supported by recent work emphasizing the heterogeneous functional role of anxiety across clinical contexts [ 7 , 22 ]. The absence of an independent association between depressive symptom severity and postoperative weight loss in the present study further supports recent evidence suggesting that depression may exert its influence primarily through motivational and energy-related pathways, which may be less relevant during the highly structured early postoperative period following bariatric surgery [ 15 , 10 , 19 ]. The present findings have several important clinical implications. First, systematic screening and diagnostic assessment for ADHD should be considered an integral component of preoperative psychological evaluation in bariatric surgery candidates. Identification of ADHD may allow for targeted interventions, including psychoeducation, behavioral coaching, and pharmacological treatment, which have been shown to improve executive functioning and self-regulation in adults with ADHD [ 6 , 24 ]. Second, the results caution against the exclusion of patients with personality disorders from bariatric surgery solely on the basis of diagnosis. Instead, individualized assessment focusing on functional impairment, comorbid ADHD, and affective symptom profiles may provide more clinically useful guidance. Finally, the observed role of anxiety highlights the importance of differentiating affective symptom profiles rather than treating psychopathology as a homogeneous risk factor. Future research should examine the longitudinal trajectory of anxiety symptoms and their interaction with ADHD and impulsivity across longer follow-up periods, particularly with respect to weight regain. Several limitations should be acknowledged. The sample size was moderate, and follow-up was limited to 12 months postoperatively. Longer-term studies are needed to determine whether ADHD and anxiety continue to influence outcomes beyond the first postoperative year. Additionally, anxiety was assessed using a self-report measure, and specific anxiety disorder subtypes were not examined separately. Future research should employ longitudinal designs and investigate whether treatment of ADHD and anxiety prior to surgery improves long-term bariatric outcomes. Strength and limits The strengths of this study include the use of structured diagnostic interviews for ADHD (DIVA-5) and personality disorders (SCID-5-PD), allowing for categorical diagnoses rather than reliance solely on self-report symptom measures. The comprehensive assessment of multiple psychological domains and the use of multivariable regression modelling enabled the identification of independent predictors of postoperative weight-loss outcomes while accounting for substantial psychopathological overlap. Additionally, the focus on normalized weight-loss indices enhances the clinical relevance of the findings. Several limitations should be acknowledged. The sample size was moderate and follow-up was limited to 12 months after surgery, precluding conclusions regarding long-term weight maintenance or regain. Anxiety and depressive symptoms were assessed using self-report instruments, and specific diagnostic subtypes of anxiety disorders were not examined. Finally, the single-center design may limit generalizability to other bariatric settings and healthcare systems. What is already known on this subject? ADHD, affective symptoms, impulsivity, and personality pathology are highly prevalent among bariatric surgery candidates and are associated with obesity severity and psychosocial impairment. Previous studies examining their impact on postoperative weight-loss outcomes have yielded inconsistent results and often relied on self-report measures or univariate analyses, without formal diagnostic assessment or multivariable modelling. What this study adds? This study demonstrates that formally diagnosed ADHD independently predicts poorer postoperative weight-loss outcomes 12 months after sleeve gastrectomy, even after controlling for affective symptoms, impulsivity, personality disorders, age, and sex. In contrast, personality disorder diagnosis alone was not associated with postoperative weight loss, while higher anxiety symptom severity independently predicted greater weight loss. These findings highlight the importance of targeted preoperative psychological assessment, particularly for ADHD and anxiety profiles, to inform individualized bariatric care. Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. This study was performed in accordance with the Declaration of Helsinki and was approved by the Bioethics Committee of the Jagiellonian University Medical College (decision no. 118.6120.108.2023). Written informed consent was obtained from all individual participants included in the study. Consent for publication is not applicable. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. AR conceived the study and performed data collection, analysis, and manuscript drafting. MW and AB contributed to surgical data and clinical interpretation. ASF and BBK contributed to psychological assessment and interpretation of findings. All authors critically revised the manuscript and approved the final version. Funding: Not applicable. References Aloi, M. et al. The role of personality disorders in bariatric surgery outcomes: A systematic review. Eating and Weight Disorders – Studies on Anorexia. 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Long-term outcomes after bariatric surgery: Behavioral and psychiatric predictors. Ann. Surg. 278 , 112–120. https://doi.org/10.1097/SLA.0000000000005753 (2023). Young, S. et al. Improving outcomes in adults with ADHD: Clinical implications for multidisciplinary care. Lancet Psychiatry . 11 , 52–63. https://doi.org/10.1016/S2215-0366(23)00345-1 (2024). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9290663","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":621461590,"identity":"9595d8bd-61e9-4fc7-84cd-2597b38548de","order_by":0,"name":"Anna Rajtar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYBADZiBmfMDAA6QOAPEDYrQAFTMbwLUkEGMNUDGbBJhFSAv/7N6DHxj32LHbs599Vs0jwyDHdyOB7QE+LRJ3ziVLMDxLZubhSTe7zcPDYCx5I4HdAK/DbuQYSDAcYAb6JY0NpCVxA9AWCXxa5G/kGP9gOFDPzMP/jK0YqKWeoBaDGzlmQFsOM/NIpLEBXceQYEBIiyFQi0XCgePMPDeeMUvO4ZEwnHnmYTtev8gBHXbjw4HqZPb+NMYPb3ts5PmOJx978AGPFjAAmpkMZjD2gKKGsY2QBjCwg1A/wCQbUVpGwSgYBaNgxAAAIlBEf+GhwfIAAAAASUVORK5CYII=","orcid":"","institution":"Jagiellonian University Medical College","correspondingAuthor":true,"prefix":"","firstName":"Anna","middleName":"","lastName":"Rajtar","suffix":""},{"id":621461592,"identity":"8856c003-c16a-4f4f-98b5-d4fe12e1d942","order_by":1,"name":"Michał Wysocki","email":"","orcid":"","institution":"Ludwik Rydygier Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michał","middleName":"","lastName":"Wysocki","suffix":""},{"id":621461594,"identity":"c5e46d27-215c-4dd0-9d4b-d23389290465","order_by":2,"name":"Anna Starowicz-Filip","email":"","orcid":"","institution":"Jagiellonian University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Starowicz-Filip","suffix":""},{"id":621461595,"identity":"104c18c5-b97a-4828-8523-fdce5e80bfd3","order_by":3,"name":"Barbara Bętkowska-Korpała","email":"","orcid":"","institution":"Jagiellonian University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Bętkowska-Korpała","suffix":""},{"id":621461596,"identity":"e3169c89-9a9e-4e59-830d-745408a24108","order_by":4,"name":"Andrzej Budzyński","email":"","orcid":"","institution":"Ludwik Rydygier Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Andrzej","middleName":"","lastName":"Budzyński","suffix":""}],"badges":[],"createdAt":"2026-04-01 10:50:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9290663/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9290663/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106771664,"identity":"b479e959-f3b7-456b-970e-4569abe8459c","added_by":"auto","created_at":"2026-04-13 10:13:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1097153,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9290663/v1/c824b614-9097-4a48-b8f7-7c5161f7665a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity represents a major global health burden and is associated with increased morbidity, mortality, and reduced quality of life. Bariatric surgery is currently the most effective treatment for severe obesity, leading to substantial and sustained weight loss as well as improvements in metabolic and cardiovascular outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Despite the overall effectiveness of bariatric procedures, considerable interindividual variability in postoperative weight-loss outcomes persists, suggesting that factors beyond surgical technique and baseline anthropometrics may play an important role [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Psychological and psychiatric factors have increasingly been recognised as relevant contributors to bariatric surgery outcomes. Depression, anxiety, disordered eating, impulsivity, and personality pathology are highly prevalent among bariatric surgery candidates and have been linked to poorer adherence to postoperative recommendations and long-term weight regain in some studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, findings remain inconsistent, and many studies rely on self-report symptom measures without formal diagnostic assessment or multivariable modelling.\u003c/p\u003e \u003cp\u003eAttention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity, and impulsivity, frequently persisting into adulthood. Epidemiological studies indicate that ADHD is associated with an increased risk of overweight and obesity, with adults with ADHD showing higher body mass index (BMI) and greater difficulty with weight regulation compared to individuals without ADHD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In clinical obesity samples, the prevalence of ADHD appears substantially higher than in the general population [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Several mechanisms have been proposed to explain the association between ADHD and obesity, including impaired inhibitory control, altered reward processing, emotional dysregulation, and difficulties maintaining structured eating and physical activity routines [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Adults with ADHD also exhibit higher rates of comorbid affective disorders and personality pathology, which may further complicate postoperative adjustment following bariatric surgery [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite growing interest in ADHD within bariatric populations, its impact on postoperative weight-loss outcomes remains unclear. Some observational studies suggest that ADHD symptoms may be associated with poorer long-term weight-loss maintenance and reduced adherence to follow-up after bariatric surgery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In contrast, other studies have reported no significant differences in short-term postoperative weight loss between patients with and without ADHD, particularly during the first postoperative year when the restrictive and physiological effects of surgery are strongest [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These mixed findings highlight the need for studies that combine formal ADHD diagnosis with comprehensive psychological assessment and multivariable statistical approaches.\u003c/p\u003e \u003cp\u003eBeyond ADHD, affective symptoms such as depression and anxiety have been extensively examined in bariatric populations, though their independent predictive value remains debated. While some studies report that higher levels of depressive or anxiety symptoms predict poorer postoperative outcomes, others fail to find significant effects after adjusting for demographic and clinical covariates [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Personality disorders and impulsivity have also been associated with maladaptive eating behaviours and psychosocial impairment, yet their unique contribution to weight-loss outcomes following bariatric surgery remains insufficiently established [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Importantly, many previous studies have examined these psychological factors in isolation, without accounting for their substantial overlap and comorbidity. In particular, it remains unclear whether ADHD exerts an independent effect on postoperative weight loss beyond co-occurring affective symptoms, impulsivity, and personality pathology.\u003c/p\u003e \u003cp\u003eTherefore, the aim of the present study was to investigate the associations between ADHD diagnosis, affective symptoms (depression and anxiety), personality disorders, and impulsivity with weight-loss outcomes 12 months after sleeve gastrectomy. Using structured diagnostic interviews and validated self-report measures, we sought to identify independent psychological predictors of postoperative weight loss in a multivariable regression model. We hypothesised that ADHD diagnosis and anxiety severity would be independently associated with postoperative weight-loss outcomes after controlling for demographic variables and co-occurring psychopathology.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis observational cohort study was conducted at an academic hospital in Poland between May 2024 and October 2025 as part of the routine multidisciplinary qualification process for bariatric surgery. Adult patients with obesity referred for surgical evaluation were consecutively recruited during standard preoperative psychological assessment. Eligibility criteria included age\u0026thinsp;\u0026ge;\u0026thinsp;18 years and qualification for bariatric surgery according to national and international guidelines. Patients with severe cognitive impairment or acute psychiatric decompensation preventing valid assessment were excluded. All participants underwent a comprehensive preoperative psychological evaluation conducted by trained clinical neuropsychologists and clinical psychologists. Written informed consent was obtained from all participants prior to inclusion. The study protocol was approved by the Bioethics Committee of the Jagiellonian University Medical College (decision no. 118.6120.108.2023) and was carried out in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eAttention-deficit/hyperactivity disorder (ADHD) was diagnosed using the Diagnostic Interview for ADHD in Adults, version 5 (DIVA-5), a structured clinical interview based on DSM-5 criteria assessing childhood and adulthood symptoms of inattention and hyperactivity/impulsivity as well as associated functional impairment. Depressive symptom severity was assessed with the Beck Depression Inventory\u0026ndash;II (BDI-II), and anxiety symptom severity with the Beck Anxiety Inventory (BAI). Trait impulsivity was measured using the Barratt Impulsiveness Scale\u0026ndash;11 (BIS-11). All instruments have well-established psychometric properties and are widely used in clinical and bariatric populations. Anthropometric data, including body mass index (BMI), were obtained from medical records at baseline and at postoperative follow-up. Weight-loss outcomes were calculated at 12 months after surgery and expressed as percentage total weight loss (%TWL), percentage excess weight loss (%EWL), and percentage excess BMI loss (%EBMIL) relative to preoperative baseline values. %TWL was treated as the primary descriptive outcome, while %EBMIL served as the primary dependent variable in regression analyses due to its clinical relevance and normalization for baseline BMI. Descriptive statistics were calculated for demographic, clinical, psychological, and weight-loss variables. Continuous variables are presented as means and standard deviations, and categorical variables as frequencies and percentages. Between-group comparisons were conducted using independent-samples t-tests or Mann\u0026ndash;Whitney U tests for continuous variables and χ\u0026sup2; or Fisher\u0026rsquo;s exact tests for categorical variables, as appropriate. Effect sizes were reported as Cohen\u0026rsquo;s d or Cram\u0026eacute;r\u0026rsquo;s V/φ.\u003c/p\u003e \u003cp\u003eTo examine independent predictors of postoperative weight-loss outcomes, multiple linear regression analysis was performed with %EBMIL at 12-month follow-up as the dependent variable. Predictor variables entered simultaneously into the model included age, sex, ADHD diagnosis (yes/no), presence of any personality disorder, depressive symptom severity (BDI-II score), anxiety symptom severity (BAI score), and trait impulsivity (BIS-11 total score). Regression assumptions were verified by inspection of residuals, and multicollinearity was assessed using variance inflation factors (all VIF values\u0026thinsp;\u0026lt;\u0026thinsp;2.5). Model fit was evaluated using R, R\u0026sup2;, adjusted R\u0026sup2;, and the F statistic. All statistical analyses were performed using Statistica version 13.3 (TIBCO Software Inc.), with two-tailed tests and a significance threshold of \u003cem\u003ep\u003c/em\u003e \u0026lt; .05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study sample comprised 80 adults undergoing sleeve gastrectomy, predominantly female, with a mean age of approximately 39 years. ADHD was diagnosed in 17.5% of participants, while any personality disorder was identified in 42.5% of the sample.\u003c/p\u003e \u003cp\u003eAt baseline, patients with and without ADHD did not differ significantly with respect to age, sex distribution, baseline BMI, or maximum lifetime BMI (all \u003cem\u003ep\u003c/em\u003e \u0026gt; .05). In contrast, participants with ADHD demonstrated a markedly higher psychiatric burden. The prevalence of depressive disorders, anxiety disorders, and personality disorders was significantly higher in the ADHD group compared with participants without ADHD, with medium to large effect sizes (all \u003cem\u003ep\u003c/em\u003e \u0026lt; .05). Consistently, patients with ADHD reported significantly higher levels of depressive symptoms, anxiety symptoms, and impulsivity, as measured by the BDI-II, BAI, and BIS-11, respectively (all \u003cem\u003ep\u003c/em\u003e \u0026lt; .05), indicating substantial baseline psychological differences between groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Preoperative weight-loss indices did not differ between patients with and without ADHD (all \u003cem\u003ep\u003c/em\u003e \u0026gt; .05). However, at the 12-month follow-up, individuals with ADHD achieved significantly poorer postoperative outcomes. Specifically, %TWL, as well as normalized weight-loss indices (%EWL and %EBMIL), were significantly lower in the ADHD group compared with the non-ADHD group, with large effect sizes (all \u003cem\u003ep\u003c/em\u003e \u0026le; .01) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics and comprehensive 12-month weight-loss outcomes by ADHD status.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eADHD: Yes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eADHD: No (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eDemographic and anthropometric data (baseline)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\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/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\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/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39.30\u0026thinsp;\u0026plusmn;\u0026thinsp;8.63\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/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e.882\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/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.04\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/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (female), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (83.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI I at baseline (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.82\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.41\u0026thinsp;\u0026plusmn;\u0026thinsp;3.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI max (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychological and clinical variables (baseline)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepressive disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBinge Eating Disorder (BED), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny personality disorder (SCID-5-PD), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepressive symptoms (BDI-II), score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.26\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.06\u0026thinsp;\u0026plusmn;\u0026thinsp;9.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety symptoms (BAI), score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.84\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.43\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.02\u0026thinsp;\u0026plusmn;\u0026thinsp;12.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpulsivity (BIS-11), score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.44\u0026thinsp;\u0026plusmn;\u0026thinsp;11.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.14\u0026thinsp;\u0026plusmn;\u0026thinsp;5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.23\u0026thinsp;\u0026plusmn;\u0026thinsp;11.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12-month follow-up outcomes \u0026ndash; absolute changes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI at 12 months (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative weight \u0026ndash; loss outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Total weight loss \u0026ndash; preoperative (%TWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess weight loss \u0026ndash; preoperative (%EWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess BMI loss \u0026ndash; preoperative (%EBMIL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative weight \u0026ndash; loss outcomes (12 months, from preoperative values)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Total weight loss \u0026ndash; 12 months (%TWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess weight loss \u0026ndash; 12 months (%EWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.71\u0026thinsp;\u0026plusmn;\u0026thinsp;28.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.93\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.48\u0026thinsp;\u0026plusmn;\u0026thinsp;29.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess BMI loss \u0026ndash; 12 months (%EBMIL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.71\u0026thinsp;\u0026plusmn;\u0026thinsp;28.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.93\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.48\u0026thinsp;\u0026plusmn;\u0026thinsp;29.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFootnote\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eContinuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (IQR), as appropriate. Categorical variables are reported as n (%). Between-group comparisons used t/Welch or Mann\u0026ndash;Whitney tests for continuous variables and χ\u0026sup2; or Fisher\u0026rsquo;s exact tests for categorical variables. Effect sizes are reported as Cohen\u0026rsquo;s d and Cram\u0026eacute;r\u0026rsquo;s V/φ. %TWL was the primary descriptive outcome, and %EBMIL the primary outcome in regression analyses.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen analyses were stratified by personality disorder status, patients with a personality disorder did not differ from those without in age or sex distribution. Nevertheless, the personality disorder group presented with significantly higher baseline obesity severity, reflected by higher BMI values and maximum lifetime BMI (p = .002). As expected, patients with personality disorders exhibited significantly higher rates of depressive and anxiety disorders and higher levels of depressive symptoms, anxiety symptoms, and impulsivity (all p \u0026le; .01). Binge eating disorder was also significantly more prevalent among patients with personality disorders compared with those without personality pathology (p \u0026lt; .01). Despite these baseline differences, postoperative weight-loss outcomes at 12 months did not differ significantly between patients with and without personality disorders, including %TWL, %EWL, and %EBMIL (all p \u0026gt; .05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics and comprehensive 12-month weight-loss outcomes by personality disorder status.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePersonality disorder: Yes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePersonality disorder: No\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eDemographic and anthropometric data (baseline)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.48\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/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38.29\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\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/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39.93\u0026thinsp;\u0026plusmn;\u0026thinsp;7.03\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/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e.396\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/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.11\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/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (female), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (83.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (85.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (82.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI at baseline (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.82\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI max (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychological and clinical variables (baseline)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepressive disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (76.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety disorders, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBinge Eating Disorder (BED), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eφ\u0026thinsp;=\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepressive symptoms (BDI-II), score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.26\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety symptoms (BAI), score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.84\u0026thinsp;\u0026plusmn;\u0026thinsp;12.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.91\u0026thinsp;\u0026plusmn;\u0026thinsp;11.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.09\u0026thinsp;\u0026plusmn;\u0026thinsp;12.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpulsivity (BIS-11), score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.44\u0026thinsp;\u0026plusmn;\u0026thinsp;11.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.07\u0026thinsp;\u0026plusmn;\u0026thinsp;12.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e12-month follow-up outcomes \u0026ndash; absolute changes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI at 12 months (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.70\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative weight \u0026ndash; loss outcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Total weight loss \u0026ndash; preoperative (%TWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess weight loss \u0026ndash; preoperative (%EWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.72\u0026thinsp;\u0026plusmn;\u0026thinsp;14.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess BMI loss \u0026ndash; preoperative (%EBMIL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;12.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.72\u0026thinsp;\u0026plusmn;\u0026thinsp;14.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative weight \u0026ndash; loss outcomes (12 months, from preoperative values)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Total weight loss \u0026ndash; 12 months (%TWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.60\u0026thinsp;\u0026plusmn;\u0026thinsp;7.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.63\u0026thinsp;\u0026plusmn;\u0026thinsp;8.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess weight loss \u0026ndash; 12 months (%EWL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.71\u0026thinsp;\u0026plusmn;\u0026thinsp;28.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.04\u0026thinsp;\u0026plusmn;\u0026thinsp;20.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.64\u0026thinsp;\u0026plusmn;\u0026thinsp;32.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Excess BMI loss \u0026ndash; 12 months (%EBMIL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.71\u0026thinsp;\u0026plusmn;\u0026thinsp;28.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.04\u0026thinsp;\u0026plusmn;\u0026thinsp;20.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.64\u0026thinsp;\u0026plusmn;\u0026thinsp;32.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFootnote\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eContinuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (IQR), as appropriate. Categorical variables are reported as n (%). Between-group comparisons used t/Welch or Mann\u0026ndash;Whitney tests for continuous variables and χ\u0026sup2; or Fisher\u0026rsquo;s exact tests for categorical variables. Effect sizes are reported as Cohen\u0026rsquo;s d and Cram\u0026eacute;r\u0026rsquo;s V/φ. %TWL was the primary descriptive outcome, and %EBMIL the primary outcome in regression analyses.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo examine independent predictors of postoperative weight loss, a multiple linear regression model was fitted with %EBMIL at 12-month follow-up as the dependent variable. The overall model was statistically significant, explaining approximately one quarter of the variance in postoperative weight loss (R\u0026sup2; = 0.255; adjusted R\u0026sup2; = 0.183; F(7,72)\u0026thinsp;=\u0026thinsp;3.52; \u003cem\u003ep\u003c/em\u003e = .0026). After adjustment for age, sex, personality disorder status, depressive symptoms, anxiety symptoms, and impulsivity, ADHD diagnosis emerged as an independent negative predictor of %EBMIL (\u003cem\u003ep\u003c/em\u003e = .015). In contrast, higher anxiety symptom severity was independently associated with greater postoperative weight loss (\u003cem\u003ep\u003c/em\u003e = .025). No independent associations were observed for age, sex, depressive symptoms, impulsivity, or personality disorder status (all \u003cem\u003ep\u003c/em\u003e \u0026gt; .05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis predicting postoperative %EBMIL.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eDependent variable: %EBMIL from preoperative baseline\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntercept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.75\u0026ndash;136.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;1.20\u0026ndash;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.81\u0026ndash;36.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;20.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;37.50\u0026ndash;\u0026minus;4.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonality disorder (yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;9.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;25.08\u0026ndash;7.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBDI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;1.39\u0026ndash;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBAI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.08\u0026ndash;1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;0.74\u0026ndash;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall model statistics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eR\u0026thinsp;=\u0026thinsp;0.505\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eF(7,72)\u0026thinsp;=\u0026thinsp;3.52\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eR\u0026sup2; = 0.255; adj. R\u0026sup2; = 0.183; p\u0026thinsp;=\u0026thinsp;0.0026\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 \u003cp\u003eOverall, ADHD was associated with a significantly higher burden of baseline psychopathology and with poorer postoperative weight-loss outcomes at 12-month follow-up. Although patients with personality disorders presented with greater baseline obesity severity and more pronounced affective and impulsivity symptoms, personality disorder diagnosis alone was not associated with postoperative weight-loss indices. In multivariable analyses, ADHD diagnosis emerged as an independent negative predictor of postoperative %EBMIL, whereas higher anxiety symptom severity was independently associated with greater postoperative weight loss. Other psychological variables, including depressive symptoms, impulsivity, and personality disorder status, were not independently associated with postoperative weight-loss outcomes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated the role of ADHD, affective symptoms, impulsivity, and personality pathology in predicting postoperative weight-loss outcomes 12 months after sleeve gastrectomy. Our findings indicate that ADHD is associated with a substantially higher baseline psychopathological burden and poorer postoperative weight-loss outcomes, while personality disorder diagnosis alone does not independently predict surgical success. Importantly, ADHD diagnosis and anxiety symptom severity emerged as independent predictors of postoperative %EBMIL in multivariable analyses, whereas depressive symptoms, impulsivity, and personality disorder status did not.\u003c/p\u003e \u003cp\u003eThe association between ADHD and obesity has been well established, with accumulating evidence suggesting that ADHD-related deficits in executive functioning, impulse control, and reward processing contribute to maladaptive eating behaviors and difficulties with long-term weight regulation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. More recent studies have emphasized that ADHD represents a distinct neurobehavioral risk factor in bariatric populations, beyond traditional psychiatric comorbidities [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Our results extend these findings by demonstrating that ADHD independently predicts poorer postoperative weight loss at 12 months, even after controlling for affective symptoms, impulsivity, personality disorders, age, and sex. This aligns with recent cohort studies indicating that patients with ADHD may achieve comparable early postoperative weight loss but exhibit reduced adherence to dietary recommendations, follow-up visits, and lifestyle changes, ultimately resulting in less favorable outcomes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The present findings underscore the clinical relevance of formally diagnosing ADHD using structured interviews rather than relying solely on symptom screening instruments, as categorical diagnosis appears to capture clinically meaningful variance in postoperative outcomes.\u003c/p\u003e \u003cp\u003eConsistent with prior research, patients with personality disorders exhibited significantly higher baseline BMI and greater severity of depressive symptoms, anxiety symptoms, and impulsivity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, binge eating disorder was significantly more prevalent among patients with personality disorders, indicating greater baseline vulnerability related to disordered eating patterns. However, personality disorder diagnosis was not independently associated with postoperative weight-loss outcomes in the present study. This finding is in line with recent systematic reviews suggesting that while personality pathology is associated with psychosocial impairment and greater treatment complexity, it does not necessarily predict poorer short-term bariatric outcomes when adequate perioperative support is provided [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. One possible explanation is that the restrictive and physiological effects of sleeve gastrectomy may temporarily mitigate behavioral vulnerabilities associated with personality pathology during the first postoperative year. Additionally, the substantial overlap between personality disorders, ADHD, and affective symptoms may limit the independent predictive value of categorical personality diagnoses once these factors are modeled simultaneously.\u003c/p\u003e \u003cp\u003eA notable finding of the present study is the independent positive association between anxiety symptom severity and postoperative %EBMIL. Although anxiety symptoms were more prevalent among patients with ADHD and personality disorders, higher anxiety scores predicted greater weight loss after controlling for overlapping psychopathology. Similar findings have been reported in recent bariatric and non-bariatric medical populations, where moderate anxiety has been associated with increased treatment engagement, vigilance, and adherence to medical recommendations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the context of bariatric surgery, heightened anxiety may reflect increased concern about surgical outcomes, fear of complications, and greater attentiveness to dietary rules and behavioral restrictions during the early postoperative period. Importantly, this effect should not be interpreted as anxiety being protective or desirable, but rather as an indicator of behavioral regulation in the absence of pronounced impulsivity or executive dysfunction. This interpretation is supported by recent work emphasizing the heterogeneous functional role of anxiety across clinical contexts [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The absence of an independent association between depressive symptom severity and postoperative weight loss in the present study further supports recent evidence suggesting that depression may exert its influence primarily through motivational and energy-related pathways, which may be less relevant during the highly structured early postoperative period following bariatric surgery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present findings have several important clinical implications. First, systematic screening and diagnostic assessment for ADHD should be considered an integral component of preoperative psychological evaluation in bariatric surgery candidates. Identification of ADHD may allow for targeted interventions, including psychoeducation, behavioral coaching, and pharmacological treatment, which have been shown to improve executive functioning and self-regulation in adults with ADHD [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Second, the results caution against the exclusion of patients with personality disorders from bariatric surgery solely on the basis of diagnosis. Instead, individualized assessment focusing on functional impairment, comorbid ADHD, and affective symptom profiles may provide more clinically useful guidance. Finally, the observed role of anxiety highlights the importance of differentiating affective symptom profiles rather than treating psychopathology as a homogeneous risk factor. Future research should examine the longitudinal trajectory of anxiety symptoms and their interaction with ADHD and impulsivity across longer follow-up periods, particularly with respect to weight regain.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. The sample size was moderate, and follow-up was limited to 12 months postoperatively. Longer-term studies are needed to determine whether ADHD and anxiety continue to influence outcomes beyond the first postoperative year. Additionally, anxiety was assessed using a self-report measure, and specific anxiety disorder subtypes were not examined separately. Future research should employ longitudinal designs and investigate whether treatment of ADHD and anxiety prior to surgery improves long-term bariatric outcomes.\u003c/p\u003e"},{"header":"Strength and limits","content":"\u003cp\u003eThe strengths of this study include the use of structured diagnostic interviews for ADHD (DIVA-5) and personality disorders (SCID-5-PD), allowing for categorical diagnoses rather than reliance solely on self-report symptom measures. The comprehensive assessment of multiple psychological domains and the use of multivariable regression modelling enabled the identification of independent predictors of postoperative weight-loss outcomes while accounting for substantial psychopathological overlap. Additionally, the focus on normalized weight-loss indices enhances the clinical relevance of the findings.\u003c/p\u003e \u003cp\u003eSeveral limitations should be acknowledged. The sample size was moderate and follow-up was limited to 12 months after surgery, precluding conclusions regarding long-term weight maintenance or regain. Anxiety and depressive symptoms were assessed using self-report instruments, and specific diagnostic subtypes of anxiety disorders were not examined. Finally, the single-center design may limit generalizability to other bariatric settings and healthcare systems.\u003c/p\u003e"},{"header":"What is already known on this subject?","content":"\u003cp\u003eADHD, affective symptoms, impulsivity, and personality pathology are highly prevalent among bariatric surgery candidates and are associated with obesity severity and psychosocial impairment. Previous studies examining their impact on postoperative weight-loss outcomes have yielded inconsistent results and often relied on self-report measures or univariate analyses, without formal diagnostic assessment or multivariable modelling.\u003c/p\u003e"},{"header":"What this study adds?","content":"\u003cp\u003eThis study demonstrates that formally diagnosed ADHD independently predicts poorer postoperative weight-loss outcomes 12 months after sleeve gastrectomy, even after controlling for affective symptoms, impulsivity, personality disorders, age, and sex. In contrast, personality disorder diagnosis alone was not associated with postoperative weight loss, while higher anxiety symptom severity independently predicted greater weight loss. These findings highlight the importance of targeted preoperative psychological assessment, particularly for ADHD and anxiety profiles, to inform individualized bariatric care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. This study was performed in accordance with the Declaration of Helsinki and was approved by the Bioethics Committee of the Jagiellonian University Medical College (decision no. 118.6120.108.2023). Written informed consent was obtained from all individual participants included in the study. Consent for publication is not applicable. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. AR conceived the study and performed data collection, analysis, and manuscript drafting. MW and AB contributed to surgical data and clinical interpretation. ASF and BBK contributed to psychological assessment and interpretation of findings. All authors critically revised the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003eFunding: Not applicable.\u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAloi, M. et al. The role of personality disorders in bariatric surgery outcomes: A systematic review. 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Improving outcomes in adults with ADHD: Clinical implications for multidisciplinary care. \u003cem\u003eLancet Psychiatry\u003c/em\u003e. \u003cb\u003e11\u003c/b\u003e, 52\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2215-0366(23)00345-1\u003c/span\u003e\u003cspan address=\"10.1016/S2215-0366(23)00345-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ADHD, bariatric surgery, sleeve gastrectomy, anxiety, weight loss, obesity","lastPublishedDoi":"10.21203/rs.3.rs-9290663/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9290663/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eAttention-deficit/hyperactivity disorder (ADHD) and affective symptoms are highly prevalent among bariatric surgery candidates, yet their role in postoperative weight-loss outcomes remains insufficiently understood. Previous studies suggest that neurodevelopmental traits and emotional dysregulation may influence adherence and long-term outcomes after bariatric procedures. This study aimed to examine associations between ADHD, affective symptoms, personality pathology, and weight-loss outcomes 12 months after sleeve gastrectomy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eEighty adults undergoing sleeve gastrectomy were assessed preoperatively using structured diagnostic interviews and standardized self-report measures. ADHD was diagnosed using the Diagnostic Interview for ADHD in Adults (DIVA-5), personality disorders with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), and depressive symptoms, anxiety symptoms, and impulsivity were assessed using the Beck Depression Inventory\u0026ndash;II (BDI-II), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale\u0026ndash;11 (BIS-11), respectively. Weight-loss outcomes (%TWL, %EWL, %EBMIL) were calculated 12 months postoperatively. Group comparisons and multiple linear regression analyses were conducted to identify independent psychological predictors of postoperative weight loss.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePatients with ADHD exhibited significantly higher levels of depressive symptoms, anxiety symptoms, impulsivity, and a higher prevalence of personality disorders at baseline. At 12-month follow-up, patients with ADHD achieved significantly lower postoperative weight-loss outcomes compared with those without ADHD. In multivariable regression analyses predicting %EBMIL from preoperative baseline, ADHD diagnosis and anxiety symptom severity emerged as independent predictors of postoperative weight loss, whereas depressive symptoms, impulsivity, personality disorder diagnosis, age, and sex were not significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eADHD and anxiety symptoms independently predict weight-loss outcomes after sleeve gastrectomy, highlighting the clinical relevance of neurodevelopmental and affective factors in bariatric care. These findings support the inclusion of targeted psychological assessment and tailored interventions for patients with ADHD traits and elevated anxiety prior to bariatric surgery.\u003c/p\u003e\u003ch2\u003eLevel of Evidence\u003c/h2\u003e \u003cp\u003eLevel III, welldesigned cohort study.\u003c/p\u003e","manuscriptTitle":"Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 10:12:36","doi":"10.21203/rs.3.rs-9290663/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-19T07:41:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T23:34:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T19:33:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T14:49:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73439963027147685958961520366467689753","date":"2026-04-27T18:15:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265643963964134004352450317210791715422","date":"2026-04-27T14:04:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T10:16:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234627568457823422428058548283411240601","date":"2026-04-26T09:07:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90097349995140350079038482273058875894","date":"2026-04-26T01:23:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177636324894011498940030806720689228315","date":"2026-04-13T06:46:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T12:42:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-07T12:03:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-04T05:03:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-04T05:03:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-04-01T10:21:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6de06f17-0fe9-42b9-bced-00451d44f630","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-19T07:41:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T23:34:55+00:00","index":39,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T19:33:44+00:00","index":38,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T14:49:19+00:00","index":37,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66138353,"name":"Health sciences/Diseases"},{"id":66138354,"name":"Health sciences/Medical research"},{"id":66138355,"name":"Biological sciences/Psychology"},{"id":66138356,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-19T13:53:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 10:12:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9290663","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9290663","identity":"rs-9290663","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}