Eating disorders are highly prevalent among Egyptian MBS patients

Eating disorders (EDs) are highly prevalent among metabolic bariatric surgery (MBS) patients, with binge eating disorder (BED) being the most common, according to a study by researchers from Medical Research Institute, Alexandria University, Alexandria, Egypt. They found that female gender, younger age, psychiatric disorders and smoking habits were key predictors of EDs.

The researchers noted that despite the well-documented impact of EDs in Western populations, data on their prevalence and associated factors among MBS patients in the Middle East and North Africa (MENA) region are limited. Therefore, they designed a study to determine the prevalence of EDs and identify their associated factors in a large cohort of Egyptian MBS patients.

This cross-sectional study, conducted at the Bariatric Surgery Center of Madina Women’s Hospital in Alexandria, Egypt, including all adult patients for MBS from August 2022 to November 2024 (n=3,240). A psychiatrist conducted structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria using the Structured Clinical Interview for DSM-5 (SCID-5-RV) to diagnose EDs, including binge eating disorder (BED), bulimia nervosa (BN) and night eating syndrome (NES). Logistic regression analyses were performed to assess factors associated with EDs.

Outcomes

The study cohort consisted mostly of female patients (76.6%), the mean age was 36.8 ± 11.6 years and most patients were married (65.6%). The mean body mass index (BMI) of the cohort was 45.2 ± 8.2 kg/m². Non-smoking was in 89.1% of patients, while 5.4% reported heavy smoking. The patients presented with a high burden of obesity-related comorbidities, with obstructive sleep apnoea being the most prevalent condition affecting nearly 60% of patients (n=1,940, 59.9%).

Eating disorders were identified in 47.8% of the patients and the most prevalent disorder was BED with 36.1% of the patients. Night eating syndrome (NES) was observed in 22.8% of patients, while bulimia nervosa (BN) had the lowest prevalence at 2.1%.

Psychiatric comorbidities were present in a substantial portion of the study population, with depressive disorders being the most prevalent mental health condition affecting 12.8% of patients (n=416). Personality disorders, specifically borderline personality disorder, were diagnosed in 5.1% of the cohort (n=164), while anxiety disorders affected 4.7% of patients (n=151). Antidepressants being the most frequently prescribed psychiatric medication, used by 8.7% of patients (n=282).

Increasing age was associated with lower odds of BED (p<0.001), meaning younger patients had relatively higher odds of experiencing BED. Females had significantly higher odds than males (p<0.001). Heavy smoking was associated with significantly lower odds of BED compared to non-smoking (p<0.001), suggesting a potential protective association. Psychiatric factors such as depressive disorder (p<0.001), anxiety disorder (p=0.020) and borderline personality disorder (p<0.001) were also associated.

In the adjusted analysis, these associations were largely consistent with age (p=0.009), heavy smoking (p<0.001), substance use (p=0.006) and depressive disorder (p=0.020) maintaining their significance, while the association with marital status was attenuated.

“These findings emphasise the need for routine psychiatric screening using validated assessment methods like the SCID-V to identify and support patients in an attempt to prevent recurrent weight gain and better understand the mechanism of potential suboptimal weight loss,” the researchers concluded.

The findings were featured in the paper, 'Prevalence and associated factors of eating disorders among metabolic bariatric surgery patients in Egypt', published in the Journal of Eating Disorders. To access this paper, please click here