Weight loss after weight-loss surgery: The mediating role of dichotomous thinking

Chloe Marshall, Robert Reay, Alan Robert Bowman

Research output: Contribution to journalArticlepeer-review


Purpose: Overly rigid forms of dietary restraint are associated with poorer weight loss outcomes. Dichotomous (“all or nothing”) thinking has been shown to mediate this relationship in non-clinical participants, but this finding has yet to be replicated in clinical samples of individuals who have had weight-loss surgery.

Materials and Methods: A cross-sectional design was used, adopting quantitative questionnaires with 129 individuals who had previously underwent bariatric surgery at least 12 months prior to participation. Bootstrapped mediation analysis was used to establish the mediating role of dichotomous thinking.

Results: Eating-specific dichotomous thinking was shown to fully mediate the relationship between dietary restraint and post-surgical weight loss. In contrast, no mediation effect was found for generalised dichotomous thinking.

Conclusion: Dichotomous thinking specifically about food/eating may play a central role in weight loss maintenance after weight-loss surgery. Pre-surgical assessment of dichotomous thinking, and provision of psychological therapy to think more flexibly about food, is suggested.
Original languageEnglish
JournalObesity Surgery
Publication statusPublished - 5 Mar 2024


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