Body image of patients with morbid obesity before and after bariatric surgery

Abstract

Morbid obesity can have severe psychological impact and is a major risk factor for health issues (Schwartz & Brownell, 2004), such as type 2 diabetes, hypertension and sleep apnea (Gilmartin, Long & Soldin, 2013), higher levels of stress, anxiety, depression, food craving and binge eating disorder (BED) symptoms (Abilés, Rodríguez-Ruiz, Abilés, Mellado, García, Pérez de la Cruz, Fernández-Santaella, 2010) and impairments in quality of life (Sarwer, Lavery & Spitzer, 2012). Understanding body image in relation to obesity may contribute to comprehension of the etiology and maintenance of obesity and may help in improving care. The current study examines the level of body image of patients with morbid obesity before and after bariatric surgery in comparison with the general population, the factors associated with body image before and after bariatric surgery, and the relation of body image with weight-loss outcome. Body image of 379 patients with morbid obesity was compared to a matched control group of 1517 people from the general population. Body image was measured with a shortened Dutch version of the Multidimensional Body-Self Relations Questionnaire (MBSRQ; Cash, 2000) and Self-Esteem was measured with the Dutch version of the Rosenberg Self-esteem Scale (Rosenberg, 1965; Woertman, 1994). Patients who underwent surgery scored better in terms of appearance evaluation than patients before surgery, but there was still a large difference with the general population. Preoperative patients judged their appearance worse than postoperative patients but attached less importance to their appearance than postoperative patients. Appearance evaluation was shown to be independently predicted by self-esteem indicating lower levels of appearance evaluation in patients with low self-esteem. Moreover, appearance orientation before surgery was shown to be independently predicted by gender, indicating lower levels of appearance orientation in male patients. After surgery, gender and middle education were significant predictors of appearance orientation. Neither body image nor other variables could predict weight-loss. For clinical practice, this study underlines the existence of a subgroup of patients experiencing problems with their body image. Female patients and patients with low self-esteem need extra attention when it comes to body image. Future research, mostly longitudinal, is needed.