Attention-Deficit/Hyperactivity Disorder, Anxiety, and Weight Loss Outcomes After Sleeve Gastrectomy: A 12-Month Prospective Study

Purpose Attention-deficit/hyperactivity disorder (ADHD) and affective symptoms are highly prevalent among bariatric surgery candidates, yet their role in postoperative weight-loss outcomes remains insufficiently understood. Previous studies suggest that neurodevelopmental traits and emotional dysregulation may influence adherence and long-term outcomes after bariatric procedures. This study aimed to examine associations between ADHD, affective symptoms, personality pathology, and weight-loss outcomes 12 months after sleeve gastrectomy. Methods Eighty adults undergoing sleeve gastrectomy were assessed preoperatively using structured diagnostic interviews and standardized self-report measures. ADHD was diagnosed using the Diagnostic Interview for ADHD in Adults (DIVA-5), personality disorders with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), and depressive symptoms, anxiety symptoms, and impulsivity were assessed using the Beck Depression Inventory–II (BDI-II), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale–11 (BIS-11), respectively. Weight-loss outcomes (%TWL, %EWL, %EBMIL) were calculated 12 months postoperatively. Group comparisons and multiple linear regression analyses were conducted to identify independent psychological predictors of postoperative weight loss. Results Patients with ADHD exhibited significantly higher levels of depressive symptoms, anxiety symptoms, impulsivity, and a higher prevalence of personality disorders at baseline. At 12-month follow-up, patients with ADHD achieved significantly lower postoperative weight-loss outcomes compared with those without ADHD. In multivariable regression analyses predicting %EBMIL from preoperative baseline, ADHD diagnosis and anxiety symptom severity emerged as independent predictors of postoperative weight loss, whereas depressive symptoms, impulsivity, personality disorder diagnosis, age, and sex were not significant. Conclusion ADHD and anxiety symptoms independently predict weight-loss outcomes after sleeve gastrectomy, highlighting the clinical relevance of neurodevelopmental and affective factors in bariatric care. These findings support the inclusion of targeted psychological assessment and tailored interventions for patients with ADHD traits and elevated anxiety prior to bariatric surgery. Level of Evidence Level III, welldesigned cohort study.