Overvaluation of Shape and Weight (Not BMI) Associated with Depressive Symptoms and Binge Eating Symptoms Pre- and Post-bariatric Surgery

Obes Surg. 2022 Jul;32(7):2272-2279. doi: 10.1007/s11695-022-06062-4. Epub 2022 Apr 24.


Purpose: Overvaluation of shape and weight (OSW) involves defining self-worth by body shape/weight. Among persons seeking bariatric surgery, cross-sectional studies have found associations between OSW, depressive symptoms, and disordered eating.

Materials and methods: Relationships among OSW, depressive symptoms, binge eating symptoms, and BMI were analyzed both cross-sectionally and over time among 145 adults who had bariatric surgery. Participants completed the following measures pre-surgery and 1.5 to 3 years post-surgery: Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale, Patient Health Questionnaire, and body weight and height. OSW was measured by averaging two items on the EDE-Q which ask participants to rate how much their weight/shape influences how they judge themselves as a person. Analyses included Wilcoxon signed-ranks, bootstrapped Pearson correlations, and bootstrapped hierarchical linear regressions.

Results: OSW was significantly associated with depressive symptoms and binge eating symptoms both pre- and post-surgery, but was not associated with BMI at either timepoint. Improvements in OSW were associated with concurrent changes in depression and binge eating; reductions in BMI were not significantly associated with changes in any of these variables.

Conclusions: Findings suggest that self-evaluation is more important in regard to changes in depressive and binge eating symptoms than is BMI (and vice versa), and support the importance of assessing and treating psychological considerations among persons seeking bariatric surgery.

Keywords: Bariatric Surgery; Binge eating; Obesity; Outcomes; body image; depression; overvaluation.

MeSH terms

  • Adult
  • Bariatric Surgery*
  • Binge-Eating Disorder* / psychology
  • Body Image / psychology
  • Bulimia* / complications
  • Cross-Sectional Studies
  • Depression / etiology
  • Depression / psychology
  • Humans
  • Obesity, Morbid* / surgery