Food security and its impact on patient-reported outcome measures (PROMs) in patients seeking evaluation for metabolic and bariatric surgery.

Abstract

Background: Food insecurity (FI) places patients seeking metabolic and bariatric surgery (MBS) evaluation at a disadvantage, as it is associated with worse patient-reported outcome measures (PROMs). However, of the further granularity impact of FI levels on PROMs is needed. We sought to investigate the impact of food insecurity levels on BODY-Q ER (eating-related) behavior, distress, symptoms, and physical function in preoperative MBS patients.

Methods: Patients who underwent preoperative assessment for MBS (Feb 2024-2025) and completed the validated 6-item FI questionnaire and BODY-Q ER modules (scale of 0-100; 0 being worse health and 100 being optimal health) were included. Patients were divided into food security levels (high, low, and very low). Median Rasch scores (0-100, higher signifies better health) of BODY-Q ER behavior, distress, symptoms, and physical function were compared between food security levels using the Kruskal-Wallis test (p < 0.05).

Results: From the 614 patients, 76% had high food security, 14.7% had low food security, and 9.9% had very low food security. Median Rasch scores from all four BODY-Q surveys (eating-related behavior, eating-related distress, eating-related symptoms, and physical function) were statistically different by food security level (p < 0.001). Higher median Rasch scores were seen in patients with high food security in all BODY-Q surveys compared to low food security and very low food security.

Conclusions: Food security levels directly correlate with BODY-Q PROMs scores: lower food security is associated with worse eating-related behavior, distress, symptoms, and physical function. The 6-item FI questionnaire helped identify individuals at highest risk. Presurgical planning should involve goal-directed interventions to optimize these patients and correlate with surgical outcomes.