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Bariatric surgery, body image and depression

Mon, 10/26/2020 - 18:11
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Body image is a mediating factor of depression in subgroup of laparoscopic sleeve gastrectomy (LSG) patients with poor psychological outcome, report researchers from the Medical University Hospital Tübingen, Tübingen and the University of Duisburg-Essen, Essen, Germany. They noted that the current preparation and aftercare regimes for patients that undergo bariatric surgery often focus on nutrition and physical activity, but hardly target psychological components, and interventions to improve body image should be incorporated into aftercare regimes. The study, ‘Effects of Bariatric Surgery on Depression: Role of Body Image’, was published in Obesity Surgery.

The authors noted that previous studies have found psychosocial functioning improves after bariatric surgery. However, some patients have poor psychological outcomes and the researchers hypothesised that body image could play an import role in a patient’s self-esteem and depression. Therefore, they conducted a mediation analysis in longitudinal data from 52 patients who underwent LSG and they were assessed before and 21–80 months after surgery.

A minority of the patients (44.2%) were male, had a mean age of 44.3 (SD 11.5) and 36.5% of the sample had a clinical diagnosis of depression when they underwent surgery. The mean follow-up was 48.5 (SD 12.9) months, and time since surgery was a significant but in terms of effect size negligible predictor of % excess weight loss (R2 = 0.08; F(1,50) = 4.61, p<0.05).

The investigators assessed body image using the Body Image Questionnaire (BIQ-20), which is comprises of 20 items and assesses body image on the two subscales: negative evaluation of the body (NEB) that assesses a negative attitude towards the own body and a perceived lack of sense of coherence with the own body, and perception of body dynamics (PBD) that assesses feelings of power and health as well as interest in bodily activities such as sexuality or dancing.  A high score on NEB suggests a lack of well-being with the own body, while PBD is inversely scored and high values reflect a positive body image. In addition, depression was assessed using the depression section of the Patient Health Questionnaire (PHQ-9), that looks at depressive symptoms according to ICD-10 criteria over the last two weeks with nine items.


The outcomes revealed that PHQ-9 scores significantly decreased from 9.3 to 6.9 (p<0.01) and BIQ-20 NEB significantly decreased from 38.8 to 27.3 (p<0.001), whilst BIQ-20 PBD improved from 24.3 to 27.4 (p<0.01).

In summary, they reported that %EWL was not related to a reduction in depressive symptoms in PHQ-9 or BIQ-20 PBD, but was with BIQ-20 NEB. A similar finding was seen for percentage total weight loss. However, PHQ-9 change was moderately associated with changes in BIQ-20 NEB and BIQ-20 PBD.

Moreover, the total effects model for %EWL predicting PHQ-9 change was not significant (p<0.79), but the mediation model that included BIQ-20 NEB change as a mediator was overall significant with 14% of the variance in PHQ-9 change explained (p<0.05). The influence of %EWL on PHQ-9 change mediated by BIQ-20 NEB change was also significant, this indicates that higher %EWL could reduce depressive symptoms, mediated through reduced negative evaluation of the body.

For BIQ-20 PBD (n=49), %EWL predicting PHQ-9 change was not significant (p<0.88). However, when BIQ-20 PBD change was included there was a significant 16% of the variance in PHQ-9 change (p<0.05). However, the indirect effect that depicts the influence of %EWL on PHQ-9 change mediated by BIQ-20 PBD change was not significant.

Interestingly, the authors suggest that bariatric surgery appears to trigger complex behavioural, physiological and cognitive changes involving body image that in sum improve both health and psychosocial outcomes.

“Based on our observations, we suggest incorporating interventions to improve body image into aftercare regimes. This may be specifically relevant for patients with eating disorders or a desire for additional body contouring surgery,” the researchers concluded. “Further, we propose that future studies should target individual perspectives on obesity causes and consequences in the evaluation of treatment outcome.”

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