Page 87 - When surgery alone won’t cut it - Valerie Maureen Monpellier
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INTRODUCTION
The positive effects of bariatric surgery (BS), including significant weight loss and res- olution of comorbidities, have been well established 1, 2. However, the massive weight loss can lead to excess skin, which may negatively affect patients’ well-being by causing medical, functional and psychological problems 3-6. Body contouring surgery (BCS) is the only treatment for restoration of the contour of the body and is desired by a large part of the post-bariatric population 6-14. Yet, only a small portion (18-33%) of the post-bariatric patients actually undergoes BCS; the high costs of this procedures are considered a major reason for this reluctance 6,8,12,15.
After BCS, patients show an improved functional status, a better body image and a higher quality of life, both on the short and long term 12,16-26. More importantly, BCS patients have better weight loss maintenance than patients who do not undergo BCS after bariatric surgery 14, 21, 27. Why BCS results in better weight loss maintenance has never been studied.
Body weight and depression are strongly correlated in patients with obesity (higher weight indicating more depressive symptoms), and several studies found that this re- lationship is, at least partly, mediated by body image 28-33. In obese patients there are more depressive symptoms when body image satisfaction is low. Depressive symp- toms, in turn, are known to negatively affect body weight 14,21,28-31,34.
In post-bariatric patients extensive overhanging skin leads to a negative body image, and could thereby lead to (more) depressive symptoms. However, research regard- ing the relationship between body image and depressive symptoms in post-bariatric patients is scarce. One study assessed body image in post-bariatric patients with complaints of excess skin; it was found that a negative body image was related to more depressive symptoms and secondarily to weight regain 34. Although this study was carried out in a relatively small sample, it does show that body image might play an important role in the well-being of post-bariatric patients. It is unknown, though, whether this is true for all post-bariatric patients. Do patients who desire BCS differ from patients who have no desire for BCS with regard to body image? In addition, to the best of our knowledge, no studies have been conducted assessing the role of body image in the relationship between weight loss and depressive symptoms, in a post-bariatric population.
Therefore, the goal of this study is to evaluate body image, depressive symptoms and weight loss in a post-bariatric population, and to compare patients who had BCS with patients who desire BCS and patients who do not desire BCS on these variables. Secondly, we will study the mediating role of body image in the relationship between weight loss and depressive symptoms for these groups.
We hypothesized that the relationship between weight loss and depressive symp- toms would be partly mediated by body image in the population who has not under- gone BCS. This hypothesis was based on previous research in patients with obesity,
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