Page 142 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 8 - Discussion
more preoccupied with overweight stigmata and they classified their weight higher; even though BMI was the same for both groups. In the group with a desire for BCS, body image partially mediated the relationship between weight loss and depressive symptoms. Thus, in this group the excess skin might, via a more negative body image, cause more depressive symptoms, like Friedman et al. found 1. These depressive symptoms may in turn because weight regain. Therefore, the patients with a desire for BCS might benefit most from BCS in terms of weight loss maintenance 45,46.
Satisfaction with one’s body and shape were significantly higher in the patients who already had BCS. Unexpectedly, they also scored quite high on overweight preoccu- pation, even though their BMI was quite low compared to the other groups. It seems that body image is a very broad construct in the bariatric population ranging from perception, and appearance, to perceived body size and space 47. Depending on the “type” of body image that is assessed, the effect or bariatric and/or body contouring surgery might differ. For instance, focus on appearance does not seem to change af- ter bariatric surgery, while satisfaction with appearance improves 48-50. And like in our population, even after BCS overweight pre-occupation and appearance orientation can be high (i.e. not improve), while appearance evaluation and self-classified weight did 51.
Appearance orientation and overweight preoccupation are developed in childhood and it is suggested that these parts of body image might be intrinsic to a person 33,49. This can explain why these constructs do not change easily after either bariatric or body contouring surgery and are comparable between the patients who already had BCS and patients who desire BCS. It would be interesting to see whether improve- ment of body image through interventions (in addition to bariatric surgery), will also improve these concepts of body image. And thereby, eventually, outcome after bar- iatric surgery.
Since body image seems to be an important parameter, more information about the change in body image after bariatric surgery and the influence on patient well-being and weight loss is essential. We need to know whether and how body image changes after bariatric and body contouring surgery. And also, if the relationship between body image and depressive symptoms is causal and can be improved via cognitive be- havioural therapy. Fortunate, there is currently more research directed at body image in the bariatric population. For example, body image is a standard part of assessment in the new PROM for the bariatric population, the BODY-Q, which we also used in chapter 7 of this thesis 52. Prospective trials with this new PROM might provide more information on the change of body image during the total weight loss journey.
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