Personality Traits Predict Weight Loss Following Endoscopic Sleeve Gastroplasty: A Cohort Study with External Validation

Endoscopic sleeve gastroplasty (ESG) is a safe and effective treatment for obesity, but weight loss varies widely among patients. Personality traits may influence behavioral adherence after bariatric interventions. We evaluated whether Big Five personality traits predict weight loss after ESG and validated findings across two demographically distinct cohorts. Two retrospective cohorts were analyzed. The primary cohort included self-pay patients who underwent ESG at a tertiary center in New York (2013–2019). The external cohort included predominantly uninsured or underinsured patients treated at a New Jersey academic/safety-net hospital (2021–2024). Patients completed the Ten-Item Personality Inventory (TIPI). Weight loss was measured as percent total body weight loss (%TBWL). Associations between personality traits and %TBWL were assessed using multilevel mixed-effects linear regression. Primary cohort: Thirty-four patients (83% female, mean age 48±13; baseline BMI 36±4 kg/m²) completed TIPI with median follow-up of 24 months. Mean %TBWL was 15.7±6.2% (Table 1). Emotional stability was significantly associated with greater %TBWL, with each one-point increase corresponding to 1.9% higher TBWL (95% CI 0.2–3.5%; p=0.026). The association persisted after adjusting for baseline BMI and follow-up compliance (β=1.9; 95% CI 0.4–3.3%; p=0.017). No other traits were significant predictors (Table 2). External validation cohort: Twenty-three patients (74% female, mean age 47±14; baseline BMI 44±4 kg/m²) completed TIPI with median follow-up of 17 months. Mean %TBWL was 12.6±12.2% (Table 1). Emotional stability again predicted%TBWL, with each one-point increase associated with 3.4% greater TBWL (95% CI 0.1–6.5%; p=0.042). No other traits were significant predictors (Table 2). Across two demographically and socioeconomically distinct cohorts, emotional stability was the only personality trait consistently associated with weight loss after ESG. This trait—reflecting resilience to stress and effective emotional regulation—may support long-term adherence to post-ESG behavioral changes. The TIPI enables rapid, point-of-care personality assessment and can facilitate personalized, risk-stratified counseling. Patients with lower emotional stability may benefit from enhanced behavioral or psychological support. Further prospective studies are needed to clarify causal mechanisms and optimize pre-procedural risk stratification.