Body Image and Mental Health Outcomes in Bariatric Patients by Body Contouring Surgery Status

Overview

This 5-year prospective study evaluated body image and mental health in bariatric surgery patients who either underwent body contouring surgery (BCS), desired but did not undergo BCS, or had no desire for BCS. Results showed that patients who underwent BCS reported better body satisfaction and mental health outcomes compared to those desiring but not undergoing BCS, who exhibited greater body dissatisfaction and depressive symptoms.

Background

Bariatric surgery leads to significant weight loss and psychosocial benefits, but many patients experience excessive skin, which can negatively affect body image and mental health. Although a majority desire body contouring surgery (BCS) post-bariatric surgery, only a minority undergo it. Prior research indicates that BCS may improve body satisfaction and mental health, but the subgroup desiring BCS without undergoing it has been understudied, especially in prospective designs. This study aimed to fill that gap by examining body image and mental health trajectories over five years post-bariatric surgery.

Data Highlights

Key Findings

• Patients who underwent BCS reported significantly higher body satisfaction at 5 years post-surgery compared to those desiring but not undergoing BCS.
• The group desiring BCS without undergoing it exhibited greater body dissatisfaction and more depressive symptoms than both the BCS and no desire groups.
• Baseline resilience scores were higher in patients who eventually underwent BCS, suggesting a protective psychological factor.
• Adjusting for BMI and percent total weight loss did not eliminate group differences in body image and mental health outcomes.
• Over the 5-year period, body satisfaction improved in the BCS group but remained lower or worsened in the desire group.
• Employment status at baseline predicted attrition, with unemployed patients more likely to drop out by 5 years.

Clinical Implications

Clinicians should recognize that patients desiring but not undergoing body contouring surgery after bariatric surgery are at risk for poorer body image and mental health outcomes. Screening for body dissatisfaction and depressive symptoms in this subgroup is important. Enhancing resilience and providing psychological support may improve long-term psychosocial adjustment. Facilitating access to body contouring surgery when appropriate could contribute to better maintenance of mental health and body satisfaction.

Conclusion

This study highlights the significant psychosocial benefits of undergoing body contouring surgery after bariatric surgery and identifies a vulnerable group of patients who desire but do not receive BCS, exhibiting worse body image and mental health outcomes. Addressing these disparities is essential for optimizing long-term patient well-being.

References

1. Oslo Bariatric Surgery Study, 2011-2013 -- Prospective cohort data on bariatric patients
2. Hospital Anxiety and Depression Scale (HADS) -- Zigmond & Snaith, 1983
3. Multidimensional Body Self Relations Questionnaire -- Cash, 1990
4. Resilience Scale for Adults -- Friborg et al., 2003