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Psychological risk factors predict body image dissatisfaction after bariatric surgery

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August 29, 2017

Adults with obesity who report symptoms of depression, anxiety, disordered eating and negative body image often continue to struggle with body image dissatisfaction in the months after undergoing bariatric surgery, study data show.

Previous research has yielded a large effect size for the relationship between obesity and body image dissatisfaction, Ashleigh A. Pona, MA, of the department of psychology at the University of Missouri Kansas, and colleagues wrote in the study background. However, there is substantial body image heterogeneity within populations with obesity, and not all individuals with obesity are equally susceptible to body image dissatisfaction, they noted.

“Although postoperative weight loss has been linked to improvement in [body image dissatisfaction], this improvement might not reach normative levels for all patients, and there are some individuals who continue to experience [body image dissatisfaction] after bariatric surgery,” the researchers wrote. For example, excess skin after surgery is a common source of body image dissatisfaction, they wrote, and it is possible such concerns become more prominent in later postoperative months.

In a retrospective chart review, Pona and colleagues analyzed data from 444 patients who underwent bariatric surgery and completed a semi-structured preoperative interview (including the 338-item Minnesota Multiphasic Personality Inventory-2 Restructured Form, or MMPI-2-RF) and postoperative psychology appointments 3 and 6 months after surgery (74.48% women; 63% white; mean age, 47 years; presurgery BMI, 50.56 kg/m²). Presurgery interview included self-reported body image, coded by psychologists as distorted, dissatisfied, within normal limits or positive and collapsed into two groups: dissatisfied and positive. The Psychology Postoperative Questionnaire assessed common medical complications, psychological complications (including body image problems), behavioral adherence items, benefits of surgery and future goals. Researchers calculated the percentage of patients endorsing body image dissatisfaction at each time point and reviewed medical records for demographic information and current psychiatric diagnoses.

Within the cohort, 80% underwent Roux-en-Y gastric bypass; 8.1% underwent gastric banding; 9.9% underwent sleeve gastrectomy. At 3 months, 48.43% of patients completed follow-up assessments; only 4.38% of patients completed the 6-month assessment.

Researchers found that preoperative body image dissatisfaction was associated with higher scores on MMPI-2-RF scales of emotional/internalizing dysfunction, demoralization, low positive emotions, dysfunctional negative emotions, self-doubt, inefficacy, anxiety and negative emotionality/neuroticism, in addition to a diagnosis of depression and eating disorder not otherwise specified.

Patients who reported body image dissatisfaction at 3 months after surgery scored higher on MMPI-2-RF scales of emotional/internalizing dysfunction, demoralization, ideas of persecution, dysfunctional negative emotions, self-doubt, inefficacy, and negative emotionality/neuroticism, and were more likely to have depression or anxiety.

“An important finding from our study was that men and women did not differ in their endorsement of [body image dissatisfaction] at any of the three time points,” the researchers wrote. “These rates are mostly consistent with national prevalence studies that report estimates ranging from 11% to 72% for women and 8% to 61% for men, and survey results ranging from 13% to 32% for women and 9% to 28% for men. Furthermore, these results indicate that men are at risk for experiencing [body image dissatisfaction], which is consistent with previous findings, as well as suggest that men experience [body image dissatisfaction] at equal proportions to women both before and after bariatric surgery.”

Psychiatric diagnoses or MMPI-2-RF scores were not predictive of body image dissatisfaction at 6 months after bariatric surgery, according to researchers. – by Regina Schaffer

Disclosures:The authors report no relevant financial disclosures.