Background

An “obesity-hunger paradox” is characterized by a cycle of food hunger with food scarcity, followed by maladaptive eating when food is in surplus. Food insecurity is prevalent in up to 29% of patients interested in weight loss treatments and is a component of the social determinants of health, which are known to affect bariatric surgery outcomes. This study determines the prevalence of food insecurity in weight loss surgery applicants.

Methods

Between October 2017 and December 2019, adults >18 years completed the six-item USDA Household Food Security Module prior to initial appointment for bariatric surgery at a single academic center. Using standardized scoring procedures, patients were categorized as food secure (FS) (0-1) or food insecure (FI) (2-6), which included low food security (2-4) and very low food security (5-6). Surgeons were blinded to food security status. Comparisons were made between FS and FI.

Results

Of the 2,517 completed surveys, 582 (23.1%) underwent bariatric surgery. FS was present in 480 (82.5%), while 102 (17.5%) were FI. The most common procedure was Roux-en-Y gastric bypass (RYGB) (276, 47.4%), followed by sleeve gastrectomy (SG) (178, 30.6%), biliopancreatic diversion with duodenal switch (BPDDS) (91, 15.6%), and revisional bariatric surgery (37, 6.4%). Of those with FI, 54 (53%) underwent RYGB, 23 (22.5%) LSG, 18 (17.6%) BPDDS and 7 (6.9%) revisional surgery (p = 0.29) (Figure1).

Conclusions

Food insecurity is prevalent among patients undergoing bariatric surgery. Further research is needed to understand the impact of food insecurity on decision making and surgical outcomes.