Obesity
Conditions
Keywords
Bariatric Surgery, Intetoception
Brief summary
Obesity is associated with alterations in the perception and interpretation of internal bodily signals (interoception), which may influence eating behaviors, emotional regulation, and long-term weight outcomes. Bariatric surgery induces profound physiological and neurohormonal changes that may affect interoceptive awareness and illness perception, potentially impacting the risk of disordered eating behaviors after surgery. This observational study aims to evaluate longitudinal changes in interoceptive awareness and illness perception in adults with severe obesity undergoing bariatric surgery, from the pre-operative phase to long-term follow-up. The study also explores the relationship between these psychological constructs and clinical and behavioral outcomes over time.
Detailed description
Interoception refers to the ability to perceive, interpret, and integrate internal bodily signals and plays a key role in appetite regulation, emotional processing, and eating behavior. Altered interoceptive processing has been associated with obesity, disordered eating behaviors, and psychological distress. In individuals with severe obesity, bariatric surgery represents the most effective treatment for weight reduction; however, the persistence or recurrence of maladaptive eating behaviors after surgery remains a relevant clinical concern. Bariatric surgery leads to marked modifications in the gut-brain axis, neuroendocrine signaling, and central processing of internal bodily signals. These changes may influence interoceptive awareness and illness perception, which in turn could affect long-term behavioral, psychological, and clinical outcomes. Despite increasing interest in these mechanisms, longitudinal evidence on subjective interoceptive changes and illness perception before and after bariatric surgery remains limited. This monocentric, longitudinal, ambispective observational study is conducted in adults with severe obesity evaluated for bariatric surgery at a tertiary referral center. Psychological and clinical data are collected during the pre-operative assessment and during post-surgical follow-up, allowing the evaluation of changes over time in interoceptive awareness, illness perception, psychological functioning, and weight-related outcomes. The study includes both a retrospective component, based on existing clinical data, and a prospective component with repeated assessments over long-term follow-up. By characterizing trajectories of interoceptive awareness and illness perception before and after bariatric surgery, this study aims to improve the understanding of psychological and behavioral factors involved in post-surgical outcomes and to support the development of more personalized multidisciplinary care pathways for patients with severe obesity.
Interventions
None listed
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older. * Diagnosis of severe or morbid obesity (body mass index ≥35 kg/m² with obesity-related comorbidities or ≥40 kg/m²). * Undergoing multidisciplinary evaluation with indication for bariatric surgery. * Ability to provide informed consent and complete self-administered questionnaires.
Exclusion criteria
* Age younger than 18 years. * Presence of neurological disorders associated with cognitive impairment that may interfere with questionnaire completion. * Pregnancy or breastfeeding at the time of enrollment. * Inability to complete study assessments due to language barriers or other conditions limiting participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in interoceptive awareness measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA) | Baseline to 24 months after bariatric surgery | Change from baseline to 24 months in MAIA subscale scores. The MAIA is a validated 32-item self-report questionnaire assessing interoceptive awareness across 8 dimensions. Each item is rated on a Likert scale, and subscale scores are calculated as the mean of corresponding items. Higher scores indicate greater interoceptive awareness. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in illness perception measured by the Illness Perception Questionnaire-Revised (IPQ-R) | Baseline to 24 months after bariatric surgery | Change from baseline to 24 months in cognitive and emotional domains of the IPQ-R. The IPQ-R includes multiple domains assessing illness representations using Likert scales. Higher scores indicate stronger endorsement of the measured dimension (interpretation depends on domain). |
| Anthropometrics | Baseline, 12 months, and 24 months after bariatric surgery | Change in body weight from baseline to 12 and 24 months after bariatric surgery. |
| Changes in Depression | Baseline, 12 months, and 24 months after bariatric surgery | Change in depressive symptoms assessed by the Patient Health Questionnaire-9 (PHQ-9)from baseline to follow-up. |
| Changes in Disordered Eating Behaviors | Baseline, 12 months, and 24 months after bariatric surgery | Change in disordered eating behaviors assessed by the Eating Disorder Examination Questionnaire 6.0 (EDE-Q6) |
| Changes in Psychological Functioning | Baseline, 12 months, and 24 months after bariatric surgery | Change in general psychological functioning assessed by the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). |
| Changes in Health-Related Quality of Life | Baseline, 12 months, and 24 months after bariatric surgery | Change in health-related quality of life assessed by the Short Form-36 Health Survey (SF-36). |
| Changes Anxiety Symptoms | Baseline, 12 months, and 24 months after bariatric surgery | Change in depressive symptoms assessed by the anxiety symptoms assessed by the Generalized Anxiety Disorder-7 (GAD-7) from baseline to follow-up. |
| Changes in Disordered Eating Behaviors 1 | Baseline, 12 months, and 24 months after bariatric surgery | Change in disordered eating behaviors assessed by the Binge Eating Scale (BES). |
| Changes in Disordered Eating Behaviors 2 | Baseline, 12 months, and 24 months after bariatric surgery | Change in disordered eating behaviors assessed by the Clinical Impairment Assessment (CIA). |
Countries
Italy
Contacts
CONTACTMaria Rosaria Magurano, PC
PRINCIPAL_INVESTIGATORMaria Rosaria Magurano
Fondazione Policlinico A. Gemelli IRCCS
Outcome results
None listed