Page 96 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 5
patients who have a desire for BCS the association between %TWL and depressive symptoms is indeed partially mediated by body image: a higher weight loss was re- lated to less depressive symptoms via a more positive body image. This was inde- pendent of gender and BMI before bariatric surgery. These results show the close relationship between body weight, negative affect and body image. This is the first step into analyzing the pathways by which patients who undergo BCS might have better weight loss maintenance.
The three groups of patients had a similar follow-up time, and the number of patients who underwent RYGB was equal. But BMI before bariatric surgery was significantly different between the groups. Although this might have influenced preoperative body image and depressive symptoms, we cannot be certain about this, since preoperative data collection was not part of this study.
A weakness of the current study is its cross-sectional design, making it impossible to draw conclusions about the causal nature of the associations. As a consequence of the cross-sectional nature, we have no knowledge of the body image and depressive symptoms before bariatric surgery. In addition, it could be discussed that we did not assess the actual amount of overhanging skin. However, our goal was to show the differences in the psychological consequences of the experience of excess skin in the post-bariatric population. Moreover, research has shown that estimating excess skin is very difficult and does not correlate with the perception of the patient 46.
A strength is the large number of participants and the relatively high response rate of this nationwide post-bariatric population, with almost no differences between the included and excluded population.
CONCLUSION
This study shows that post-bariatric patients differ in general body satisfaction. It seems that some post-bariatric patients are rather satisfied with their bodies without BCS, while another group is not happy with their body and desires BCS. The study further shows that body image is an important indicator of a patient’s well-being af- ter bariatric surgery, independently of the desire for BCS. However, up to date body image has not been a standard part of outcome analysis in this population. And until recently there was no specific questionnaire to assess body image in the (post-)bar- iatric patient. It is therefore unknown whether patients with a pre-operative negative body image are also the patients who desire BCS the most and who will also benefit the most from it.
Body image should be considered an outcome parameter in assessing health-related quality of life in post-bariatric patients. Future research should focus on body im- age both before and after bariatric surgery, and study the pathway by which BCS
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