Prevalence and associated factors of eating disorders among metabolic bariatric surgery patients in Egypt

Obesity is a growing global epidemic associated with significant morbidity and mortality. Metabolic
bariatric surgery (MBS) is an effective intervention for obesity and its associated medical problems. However, eating disorders (EDs) are prevalent among MBS patients and may influence postoperative weight loss outcomes. 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 remain scarce. This study aims to determine the prevalence of EDs and identify their associated factors in a large cohort of Egyptian MBS patients.

A cross-sectional study was 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 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 E.Ds.

The overall prevalence of EDs in the study cohort was 47.8%, with BED being the most common disorder (36.1%), followed by NES (22.8%) and BN (2.1%). Female gender was significantly associated with a higher risk of BED OR 1.68, 95% CI: 1.38–2.04, p < 0.001). Heavy smoking was associated with significantly lower odds of BED compared to non-smoking (OR = 0.44, 95% CI: 0.30–0.63, p < 0.001), suggesting a potential protective association, but increased associated with NES (OR = 2.04, 95% CI: 1.42–2.90, p < 0.001). Psychiatric in associated medical problems, particularly depressive disorders (OR = 1.74 for BED, OR = 1.35 for NES, p < 0.05) and borderline personality disorder (OR = 1.56 for BED, OR = 1.91 for NES, p < 0.05), were significantly associated with increased ED risk.

EDs are highly prevalent among MBS patients in Egypt, with BED being the most common. Female
gender, younger age, psychiatric disorders, and smoking habits are key predictors of E.Ds. Given the potential impact of EDs on postoperative outcomes, routine psychiatric screening is essential for preoperative assessment. Future research should explore the long-term effects of EDs on weight loss and surgical outcomes.