Trajectories of Eating Behavior and Health-Related Quality of Life During the First Year After Metabolic Bariatric Surgery: A Longitudinal Study

Background: Metabolic bariatric surgery (MBS) yields significant but heterogeneous recovery patterns. The longitudinal interplay between evolving eating behaviors and health-related quality of life (HRQoL) remains insufficiently characterized. Objectives: To identify trajectories of eating behavior and HRQoL during the first postoperative year and examine their associations with 12-month outcomes. Methods: A total of 244 patients from two hospitals in Taiwan were followed for 12 months. Dutch Eating Behavior Questionnaire, and Impact of Weight on Quality of Life-Lite were assessed. Group-based trajectory modeling (GBTM) identified latent subgroups, and multiple regression analyzed associations with 12-month HRQoL, adjusting for clinical covariates. Results: GBTM identified two distinct trajectories for restrained, emotional, and external eating. For HRQoL, three trajectories emerged: high-start stable (45–50%), moderate-decline (30–35%), and low-start improving (~20%). In the regression model (R2 = 0.37, p < 0.001), eating behavior trajectories were not independently associated with total HRQoL at 12 months after adjusting for covariates, including baseline BMI and comorbidities. Specifically, restrained eating (β = −1.42, p = 0.502), emotional eating (β = −10.33, p = 0.110), and external eating (β = −5.33, p = 0.160) trajectories did not significantly predict global HRQoL scores. Conclusions: Postoperative adaptation is characterized by substantial heterogeneity, with a significant subgroup experiencing HRQoL decline despite surgery. While eating behavior trajectories align with domain-specific psychosocial trends, early postoperative clinical factors appear to exert a more dominant influence on total HRQoL during the first year. These findings suggest that multidisciplinary support should target specific vulnerable trajectories to optimize long-term outcomes.