Problematic eating behaviors among bariatric surgical candidates: A psychometric investigation and factor analytic approach

• The Weight and Lifestyle Inventory Section-H was demonstrated to be comprised of three factors
• Eating in response to negative affect is a key problematic among bariatric patients
• Eating in response to positive affect is an unhealthy behavior that warrants more research
• Multiple comorbidities do not influence unhealthy eating behaviors more than single comorbidity
• Pre-surgical bariatric assessments should query behavioral as well as psychological factors

Psychological factors (e.g., anxiety, depression) are routinely assessed in bariatric pre-surgical programs, as high levels of psychopathology are consistently related to poor program outcomes (e.g., failure to lose significant weight pre-surgery, weight regain post-surgery). Behavioral factors related to poor program outcomes and ways in which behavioral and psychological factors interact, have received little attention in bariatric research and practice. Potentially problematic behavioral factors are queried by Section H of the Weight and Lifestyle Inventory (WALI-H), in which respondents indicate the relevance of certain eating behaviors to obesity. A factor analytic investigation of the WALI-H serves to improve the way in which this assessment tool is interpreted and used among bariatric surgical candidates, and subsequent moderation analyses serve to demonstrate potential compounding influences of psychopathology on eating behavior factors. Bariatric surgical candidates (n = 362) completed several measures of psychopathology and the WALI-H. Item responses from the WALI-H were subjected to principal axis factoring with oblique rotation. Results revealed a three-factor model including: (1) eating in response to negative affect, (2) overeating/desirability of food, and (3) eating in response to positive affect/social cues. All three behavioral factors of the WALI-H were significantly associated with measures of depression and anxiety. Moderation analyses revealed that depression did not moderate the relationship between anxiety and any eating behavior factor. Although single forms of psychopathology are related to eating behaviors, the combination of psychopathology does not appear to influence these problematic behaviors. Recommendations for pre-surgical assessment and treatment of bariatric surgical candidates are discussed.