Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2020; 26(20): 2632-2644
Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2632
Anhedonia and functional dyspepsia in obese patients: Relationship with binge eating behaviour
Antonella Santonicola, Mario Gagliardi, Giovanni Asparago, Luna Carpinelli, Luigi Angrisani, Paola Iovino
Antonella Santonicola, Mario Gagliardi, Giovanni Asparago, Luna Carpinelli, Paola Iovino, Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
Luigi Angrisani, General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples 80100, Italy
Author contributions: Santonicola A and Iovino P designed research; Asparago G, Carpinelli L, Angrisani L collected the data and revised the paper. Santonicola A and Iovino P analyzed data; Santonicola A, Iovino P and Gagliardi M wrote the paper.
Institutional review board statement: The study received Ethics Committee approval and was conducted in accordance with the principles of the Declaration of Helsinki and good clinical practice.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Paola Iovino, MD, Associate Professor, Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, S Allende, Baronissi 84081, Salerno, Italy.
Received: December 31, 2019
Peer-review started: December 31, 2019
First decision: April 25, 2020
Revised: May 9, 2020
Accepted: May 16, 2020
Article in press: May 16, 2020
Published online: May 28, 2020

Obese patients (Ob) with a binge eating disorders (BED) behavior pattern have a higher prevalence of postprandial distress syndrome (PDS) compared to Ob without a BED behavior pattern, while an increase of PDS has been described in Ob after sleeve gastrectomy (SG). Hedonic response to a meal is dissociable from satiation in healthy subjects. Anhedonia is the lowered ability to experience pleasure. There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms.


To assess the relationship among anhedonia, BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG.


Eighty-one Ob without SG, 45 Ob with SG and 55 healthy controls (HC) were studied. All subjects fulfilled the binge eating scale (BES) to investigate BED, the validated 14 items Snaith-Hamilton pleasure scale (SHAPS) to assess Anhedonia as well as the Beck Depression Inventory-II (BDI II) and State Trait Anxiety Inventory (STAI) questionnaires to screen for depression and anxiety. All patients underwent a standardized questionnaire investigating the intensity-frequency scores (0-6) of upper gastrointestinal symptoms and were diagnosed for the presence of functional dyspepsia (FD) and its subtypes according to ROME IV criteria.


Ob without SG who were positive for BED had a 4.7 higher risk of FD compared to Ob without SG who were negative for BED (OR: 4.7; 95.0%CI 1.23-18.24; P = 0.02). STAI-Y2 scores were significantly higher in Ob without SG positive for BED (42.2 ± 1.5 vs Ob negative for BED: 39.6 ± 1 .0, P = 0.04), while SHAPS scores and BDI II did not differ in the two groups (1.16 ± 1.30 vs 0.89 ± 1.02, P = 0.49). A lower prevalence of BED (BES > 17: 11.4% vs 40.7%, P = 0.001) and BDI-II (6.8 ± 1.2 vs 13.8 ± 1.9, P = 0.005) was reported in Ob with SG than Ob without SG, on the contrary total mean scores of STAI-Y1 and STAI-Y2 were significantly higher in Ob with SG than Ob without SG. Thirty-five percent of Ob with SG fulfilled the diagnosis of FD. SHAPS mean scores and the prevalence of anhedonia did not differ among the two groups (18.2 vs 8.1%, P = 0.2). Fifty-four percent of Ob with SG achieved surgical success excess weight loss > 50%. Excess weight loss was negatively related to SHAPS total mean scores [adjusted B: -7. 099 (95%CI: -13.91 to -0.29), P = 0.04].


Ob without SG showed a higher prevalence of PDS, mood disorders and anxiety when positive for BE behavior compared to those negative for BE behavior, whereas no differences were found in SHAPS score. Ob with SG showed a higher prevalence of PDS compared to Ob without SG. Concerning psychological aspect, BED and depression are less frequent in the Ob with SG, while both state and trait anxiety are significantly higher. Moreover, the more an Ob with SG is anhedonic, less surgical success was achieved.

Keywords: Morbid obesity, Functional dyspepsia, Postprandial distress syndrome, Epigastric pain syndrome, Anhedonia, Binge eating disorders, Sleeve gastrectomy

Core tip: Binge eating disorders (BED) co-occur with mood disorders and anxiety, whereas the relationship with anhedonia in obese patients undergoing sleeve gastrectomy (SG) is not known. We studied two group of morbidly obese patients with and without SG to assess the relationships among anhedonia, BED and functional dyspepsia. Our results suggest that a more regular screening for functional dyspepsia in SG candidates might help to disclose the presence of BED that may jeopardize postsurgical outcomes. Although anhedonia was not associated with BED in this study, worse surgical outcome was observed in patients with anhedonia independent of early satiety and postprandial fullness.