*Article* **Generalized Anxiety as a Risk Factor for Dysfunctional Eating Behavior after Obesity Surgery during the COVID-19 Pandemic**

**Corinna Pfeiffer 1,\*, Adam Schweda 1, Lynik Chantal Schüren 2, Marco Niedergethmann 2, Jasmin Steinbach 1, Vanessa Rentrop 1, Anita Robitzsch 1, Nora Dörrie 1, Alexander Bäuerle 1, Martin Teufel 1, Eva-Maria Skoda 1,† and Benjamin Weismüller 1,†**

	- <sup>2</sup> Department of Surgery, Alfried-Krupp Hospital Essen, 45131 Essen, Germany; lynik.schueren@krupp-krankenhaus.de (L.C.S.); marco.niedergethmann@krupp-krankenhaus.de (M.N.)

**Citation:** Pfeiffer, C.; Schweda, A.; Schüren, L.C.; Niedergethmann, M.; Steinbach, J.; Rentrop, V.; Robitzsch, A.; Dörrie, N.; Bäuerle, A.; Teufel, M.; et al. Generalized Anxiety as a Risk Factor for Dysfunctional Eating Behavior after Obesity Surgery during the COVID-19 Pandemic. *Int. J. Environ. Res. Public Health* **2021**, *18*, 10890. https://doi.org/10.3390/ ijerph182010890

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 17 September 2021 Accepted: 11 October 2021 Published: 16 October 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

**Abstract: Purpose:** The present study investigates the impact of obesity surgery on mental health (i.e., eating behavior and distress) during the COVID-19 pandemic. **Methods:** Two hundred fiftyfour participants were recruited via social media. One hundred fourteen (44.53%) of them were surgery candidates (waiting for obesity surgery), while 142 (55.46%) had already undergone surgery. Participants who underwent surgery were compared to participants that did not yet undergo surgery in terms of mental burden (depression and anxiety), as well as safety and eating behavior. Further moderation analyses attempted to identify risk factors for increased COVID-19-related dysfunctional eating behavior after surgery. **Results:** Participants who underwent surgery showed generally lower levels of depression and general anxiety on a trend level. Moderation analyses suggested that people with high levels of generalized anxiety actually show more dysfunctional COVID-19-specific eating behavior after obesity surgery. **Conclusion:** On a trend level, obesity surgery appears to attenuate symptoms of generalized anxiety and depression. Yet, surgery patients with high levels of generalized anxiety exhibit even higher levels of dysfunctional eating during the COVID-19 pandemic. It is therefore particularly important to support people at risk.

**Keywords:** anxiety; obesity; eating disorder; obesity surgery; COVID-19; mental health
