Binge Eating, Depression and Anxiety Outcomes After Sleeve Gastrectomy Versus Gastric Bypass: A Cohort Study

This prospective cohort study compares two standard-of-care bariatric surgical procedures - laparoscopic sleeve gastrectomy (SG) and laparoscopic gastric bypass (Roux-en-Y or one-anastomosis) - with respect to postoperative changes in binge eating, depression, and anxiety. A total of 100 morbidly obese patients (50 per arm) aged 18-60 years with a body mass index ≥35 kg/m² (or ≥30 kg/m² with at least one obesity-related comorbidity) will be recruited from the General Surgery department at Kasr Alainy Teaching Hospital, Cairo University.

The choice of procedure is determined by a preoperative multidisciplinary evaluation considering baseline BMI, presence of gastroesophageal reflux disease, type 2 diabetes mellitus, and patient preference after detailed counseling. All operations are performed under general anesthesia; SG uses a 36-Fr bougie.

Validated Arabic versions of the following instruments are administered at baseline and at each postoperative visit (1 week, 2 weeks, 1 month, and monthly thereafter for 12 months):

Binge Eating Scale (BES) - primary outcome for binge eating

Beck Depression Inventory-II (BDI-II) - primary outcome for depression

Beck Anxiety Inventory (BAI) - primary outcome for anxiety

General Health Questionnaire-28 (GHQ-28)

Body Shape Questionnaire-14 (BSQ-14)

Eating Attitude Test-26 (EAT-26)

Secondary outcomes include changes in GHQ-28, BSQ-14, EAT-26 scores, and weight loss (absolute weight and BMI). Data will be analyzed using SPSS version 27, with appropriate parametric and non-parametric tests for between- and within-group comparisons. The significance level is set at p ≤ 0.05. The study is powered (80%, alpha 5%) to detect a difference in binge eating prevalence between SG (18.4%) and gastric bypass (1.3%) at one year, requiring 92 evaluable patients; 100 will be enrolled to accommodate potential loss to follow-up.

The study has been approved by the Cairo University Faculty of Medicine Research Ethics Committee (REC approval number N-64-2026, dated 7 March 2026). All participants provide written informed consent.

Inclusion criteria

• Age between 18 and 60 years
• Body Mass Index (BMI) ≥ 35 kg/m² without comorbidities, OR BMI ≥ 30 kg/m² with at least one obesity-related medical comorbidity (e.g., type 2 diabetes, hypertension, obstructive sleep apnea, dyslipidemia)
• Patient is generally fit for laparoscopic surgery and general anesthesia as determined by preoperative evaluation
• Patient agrees to comply with postoperative lifestyle changes (dietary modifications and follow-up schedule)
• Willing and able to provide written informed consent

Exclusion criteria

• Age < 18 years or > 60 years
• Inability or unwillingness to adhere to postoperative lifestyle changes
• Contraindication to surgery: American Society of Anesthesiologists (ASA) class IV or higher
• History of receiving radiotherapy or chemotherapy for cancer treatment
• Active substance use disorder or uncontrolled severe psychiatric illness that would impair ability to comply with study procedures (e.g., active psychosis, severe suicidal ideation)
• Pregnant or breastfeeding women (pregnancy test performed preoperatively per institutional protocol)
• Previous bariatric surgery (revisional surgery excluded)
• Untreated thyroid disorder (e.g., hypothyroidism or hyperthyroidism)