An Explorative Cross-Sectional Study Using Patient-Reported Outcome Measures to Assess How Food Insecurity Impacts Eating-Related Behavior,Distress,and Symptoms for Patients Considering Metabolic and Bariatric Surgery

Abstract

Background: Food insecurity is defined as having limited availability of food and/or being unable to acquire food. In patients with obesity, the relationship between food insecurity and eating-related (ER) experiences is poorly described. We hypothesized that patients who are considering metabolic and bariatric surgery (MBS) and are experiencing food insecurity would report worse ER behavior, distress, and symptoms. Methods: All patients who presented for evaluation for MBS were given the food insecurity screen and BODY-Q ER modules. The validated two-question food insecurity screen was used to dichotomize the presence or absence of food insecurity over the prior 12 months. The BODY-Q module is a validated questionnaire to assess ER behavior (eg, feeling out of control), distress (eg, feeling embarrassed), and symptoms (eg, feeling pain or bloating) on a scale of 0-100 with 100 being optimal health. Average BODY-Q scores were compared using independent sample t-tests with a P < 0.05 considered significant. Results: Overall, 818 surveys were completed with an 80% compliance rate (818 completed/1022 total). A total of 174 surveys (21.3%) were positive for food insecurity. ER behavior did not differ, but patients with food insecurity reported significantly worse ER distress and ER symptoms (P < 0.01, respectively). Discussion: In patients considering MBS, 21% suffer from food insecurity which is associated with worse ER distress and ER symptoms. These findings suggest that food insecurity screening is a valuable tool for identifying patients with a high risk of ER emotional distress and negative symptoms. Pre-emptive diet-related and psychological interventions may benefit high-risk patients.