Background: Research exploring dietary quality patterns within bariatric populations is limited, despite the significance of eating behaviors for postoperative outcomes. Recent studies revealed associations between food insecurity and disordered eating behavior in bariatric patients; however, the relationship between food insecurity and dietary quality is not known. Objective: To examine the association between dietary quality and levels of food security within a sample of presurgical bariatric patients. Setting: One academic medical center in central Pennsylvania, United States of America. Methods: Patients completed three self-report measures as part of their presurgical psychological assessment process. Food security status was measured by the United States Department of Agriculture's Food Security Module, modified for self-reports. Participants also completed the Rapid Eating Assessment for Participants, short version, which is a measure of dietary quality with scores ranging from 13–39, and the Adult Eating Behavior Questionnaire. Hierarchical multiple regressions were used to assess relationships between dietary quality and food security levels, and mediation models were built to explore associations between variables. Results: Of the 197 participants, 35.5% reported high food security, while 35.0% and 29.5% reported marginal food security and food insecurity, respectively. Compared with patients with high food security, the dietary quality scores of food-insecure patients were 1.3 points lower (95% confidence interval [CI], −3.3 to. 7; P =. 2) of and marginally food-secure patients were 1.2 points lower (95% CI, −2.9 to. 5) than those reporting high food security (P =. 2). Conclusions: Our findings indicate a need for further exploration into the barriers that prebariatric patients may face when attempting to adhere to pre- and postoperative dietary requirements, particularly for those reporting marginal food security and food insecurity. Future research should target postoperative outcomes, including weight gain, weight regain, and dietary adherence, among the most economically vulnerable bariatric patients.
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