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

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.