A longitudinal investigation of eating behavior, attention-deficit/hyperactivity disorder, and weight loss outcomes following bariatric surgery.

BACKGROUND: Metabolic and bariatric surgery (MBS) is the most effective treatment for sustained weight loss, yet postoperative outcomes vary. Attention-deficit/hyperactivity disorder (ADHD) may influence eating behaviors and outcomes, but its role after MBS remains unclear. OBJECTIVES: To examine changes in eating behaviors and ADHD symptoms from before surgery to 4 and 12 months after surgery, compare baseline profiles by ADHD symptom level, and test whether ADHD symptoms moderate associations between eating behaviors and 12 months excess weight loss (EWL). SETTING: University hospital bariatric surgery center, Quebec City, Canada. METHODS: Seventy-five adults with severe obesity undergoing MBS were assessed at baseline and at 4 and 12 months postoperatively. Measures included the Three-Factor Eating Questionnaire, Adult ADHD Self-Report Scale, Beck Depression Inventory II, and anthropometric data. Repeated-measures analyses examined longitudinal changes, and multiple linear regression models tested moderation. RESULTS: Mean EWL was 46.8% at 4 months and 75.3% at 12 months. Dietary restraint increased from baseline to 4 months and remained stable at 12 months, whereas disinhibition decreased and remained low. ADHD symptoms remained stable across time. At baseline, participants who screened positive for ADHD (n = 6, 8.0%) showed distinct profiles, including higher dietary restraint, lower disinhibition, lower body mass index, and more depressive symptoms. ADHD symptoms did not moderate associations between eating behaviors and EWL. However, higher dietary restraint at baseline and 4 months predicted less 12-month EWL. CONCLUSIONS: ADHD symptoms were associated with distinct baseline psychobehavioral profiles but did not influence weight loss outcomes. Dietary restraint emerged as a clinically relevant predictor of poorer 12-month EWL after MBS.