Body image concerns amongst massive weight loss patients

Impact of bariatric surgery on premenopausal women's womanliness: A qualitative systematic review and meta-synthesis

INTRODUCTION

Obesity is associated with several co-morbidities in women, including disturbed sex hormone regulation with menstrual disturbances, subfertility, hirsutism, and central fat dispersion, all with an impact on sexual function and quality of life. There are few investigations regarding women's experiences of obesity-related altered sex hormone regulation and resolution after bariatric surgery.

OBJECTIVES

This systematic review and interpretive meta-synthesis aim to identify the current qualitative knowledge base concerning women undergoing bariatric surgery and experiences of changes after weight loss, emphasising aspects of womanliness.

METHODS

A systematic review and qualitative meta-synthesis was conducted to gain a deeper and broader understanding of the available knowledge about premenopausal women's experienced changes after bariatric surgery. Relevant papers were identified by systematically searching PubMed, CINAHL, Embase, PsycInfo, PsycArticles, Scopus, Cochrane Library, Web of Science and Open Grey. The quality of the included studies was assessed, and the data was interpreted and synthesised using Gadamer's hermeneutics. The review protocol was registered on PROSPERO (CRD42023394225).

RESULTS

A total of 10 studies were considered relevant and included in the qualitative meta-synthesis. Three fusions were identified and interpreted as: "Womanliness," "A healthy and functioning body," and "Mind and Body Connection." Women experienced a return to womanliness after undergoing bariatric surgery with restored menstruation cycles, improved fertility and changed hair and fat dispersion signalling restored sex hormones. Women value a return to a healthy and functioning body that improves their experience of life and ability to take part in it. However, women experienced difficulties in adapting mentally to the drastic physical changes that occur after undergoing surgery.

CONCLUSIONS

Women that have undergone bariatric surgery report several benefits to their health and well-being, although difficulties in adapting mentally to changes in outer appearance need to be managed in order to successfully move forward with a new life after surgery.

Impact of body image and perceived stigmatization on the psychological wellbeing of obese women in Kumasi metropolis, Ghana

Obesity is found to have a significant impact on body image perception and overall well-being. This study examines the impact of body image and perceived stigmatization on the psychological wellbeing of obese women in Kumasi metropolis, Ghana. A sample of 231 obese women was selected from health shops and some fitness centers using snowballing technique (purposive, snowballing technique and convenience). The study employed the descriptive survey design and made use of both descriptive and inferential data analysis approaches. The body shape questionnaire BSQ-34, the inventory of the Stigmatization Situation (SSI) and finally, the psychological well-being tools were used. Also, frequency distributions mean, and standard deviation, Pearson correlation coefficient and simple linear regression analysis were employed using SPSS version 23. Our findings indicated that obese women in the Kumasi metropolis were significantly satisfied with their body image. This is a true reflection of their higher self-esteem and standard of living. The body image and perceived stigmatization on the psychological wellbeing of the obese do have some counselling implications. Counselors, nutritionists, and clinical psychologists address specific schemes such as binge eating, dieting, and exercising to build the self-esteem of obese women.

Women's lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study

OBJECTIVES

The study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels.

DESIGN

A qualitative interview study with transcribed text analysis based on Gadamer's hermeneutics.

SETTING

Regional hospital and outpatient bariatric clinic in central Sweden.

PARTICIPANTS

Ten women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed.

RESULTS

The transcribed interviews were analysed according to Gadamer's hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions 'Recognition of unhealthy body weight', 'Dealing with other people's opinions and society's norms', 'Life has changed in a positive way' and 'Accepting inner self and bodily changes'.

CONCLUSION

Women highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

The Influence of Weight-Related Self-Esteem and Symptoms of Depression on Shape and Weight Concerns and Weight-Loss 12 Months After Bariatric Surgery

INTRODUCTION

While body image can improve following bariatric surgery, a portion of patients continue to experience concerns about weight and shape regardless of weight lost. Research is needed to identify risk factors for post-surgical weight and shape concerns given that body dissatisfaction may contribute to poor outcomes.

AIMS

To evaluate whether (1) change in weight-related self-esteem and symptoms of depression from pre- to 12-month post-surgery were associated with change in weight and shape concerns independent of weight-loss; (2) improvement in weight and shape concerns, symptoms of depression, and/or weight-related self-esteem predict greater weight-loss 12 months after bariatric surgery; and (3) improvements in weight-related self-esteem, symptoms of depression, weight concerns, or shape concerns predict weight loss.

METHODS

Fifty adults approved to receive bariatric surgery self-reported body mass index and completed validated measures of weight-related self-esteem, symptoms of depression, and weight and shape concerns pre- and 12-month post-surgery.

RESULTS

Improvements were observed for weight-related self-esteem, concerns over shape and weight, symptoms of depression, and body mass index from pre- to 12-month post-surgery. Improvement in weight-related self-esteem was associated with concomitant improvements in concerns over shape and weight, independent of weight loss. Improvement in symptoms of depression was associated with improvement in concerns over weight, but not shape. Finally, exploratory analyses indicated that improvements in weight-related self-esteem, and concerns over shape and weight, but not symptoms of depression were associated with improvement in weight-loss.

CONCLUSIONS

Weight-related self-esteem may represent an overlooked and important target throughout the bariatric surgery process that could enhance surgical outcomes.

Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients

OBJECTIVE

Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC).

METHODS

BSC recruited from a surgical clinic (N = 213, 82.2% women, 43  [SD 12] years, mean BMI: 49  [SD 9] kg/m² ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms.

RESULTS

After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion.

CONCLUSIONS

The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.

The PRS Rainbow Classification for Assessing Postbariatric Contour Deformities

Supplemental Digital Content is available in the text.

Background:

There is a need for a reliable classification system to grade contour deformities and to inform reimbursement of body contouring surgery after massive weight loss. We developed the PRS Rainbow Classification, which uses select photographs to provide standardized references for evaluating patient photographs, to classify contour deformities in postbariatric patients. To assess the reliability of the PRS Rainbow Classification to classify contour deformities in massive weight loss patients.

Methods:

Ten independent experienced plastic surgeons, 7 experienced medical advisors of the healthcare insurance company, and 10 laypersons evaluated 50 photographs per anatomical region (arms, breast, abdomen, and medial thighs). Each participant rated the patient photographs on a scale of 1–3 in an online survey. The inter-observer and the intra-observer reliabilities were determined using intra-class correlation coefficients (ICCs). The ICC analyses were performed for each anatomical region.

Results:

Inter-observer reliability was moderate to good in the body regions “arms,” “abdomen,” “medial thighs,” with mean ICC values of 0.678 [95% confidence interval (CI), 0.591–0.768], 0.685 (95% CI, 0.599–0.773), and 0.658 (95% CI, 0.569–0.751), respectively. Inter-observer reliability was comparable within the 3 different professional groups. Intra-observer reliability (test–retest reliability) was moderate to good, with a mean overall ICC value of 0.723 (95% CI, 0.572–0.874) for all groups and all 4 body regions.

Conclusions:

The moderate to good reliability found in this study validates the use of the PRS Rainbow Classification as a reproducible and reliable classification system to assess contour deformities after massive weight loss. It holds promise as a key part of instruments to classify body contour deformities and to assess reimbursement of body contouring surgery.

Eating attitudes, perceptions of body image and patient quality of life before and after bariatric surgery

AIM

This study examined eating attitudes, perceptions of body image and quality of life of patients before and after bariatric surgery.

METHODS

This prospective, descriptive study was conducted with fifty patients between April 23, 2018 and November 05, 2018. The data were collected by a survey form, the Three-Factor Eating Questionnaire, the Body Image Perception Questionnaire and SF-36 Quality of Life Questionnaire. The data collection instruments were applied before the surgery and at 1, 3 and 6 months following the surgery.

RESULTS

The mean age of the patients was 36.34 ± 10.89 years, 78% were females, 44% were university graduates, 80% were married, 78% had a child, 70% were employed, 80% were morbidly obese before the surgery, and 36% were morbidly obese at the first month following the surgery. It was also determined that there was no morbid obesity among the patients, and 84% of the patients were obese at the third month following the surgery. At the sixth postoperative month, 24% of the patients were found to be obese, and 8% had normal weight. It was determined that the patients' eating attitudes and behaviours changed significantly after the surgery in comparison to their pre-surgery values (p = 0.001). The body image perceptions and quality of life of the patients during the postoperative period were found to be significantly higher in comparison to their preoperative values (p = 0.001).

CONCLUSION

This study showed that multidimensional evaluation of patients and implementation of nursing interventions contributed positively to individuals undergoing bariatric surgery based on healthy lifestyle behaviours.

Risk factors and complications after body-contouring surgery and the amount of stromal vascular fraction cells found in subcutaneous tissue

Body contouring surgery following massive weight loss is often prone to complications. Subcutaneous adipose tissue is a rich source of stromal vascular fraction (SVF) cells, and moreover it plays an important role in the pathophysiology of obesity, metabolic syndrome, and wound healing. In this retrospective, single-centred appraisal, complications are examined and correlated with individual SVF numbers in abdominal subcutaneous fat tissue. We analysed whether the weight loss method affected complications. Eighty seven massive weight loss patients undergoing body contouring surgery between 2010 and 2017 were included in the study. In total, 57 cases with at least one complication were recorded (65.5%). Maximum lifetime weight was 109.6 kg (range 48-184 kg). Half of the complications (50.8%) were minor complications without the need for surgical revision. The mean number of SVF found in the resected tissue was 714 997.63 cells/g fat tissue. We found no statistical difference in complication rates dependent on cell numbers. Smoking (P = .049) and a high BMI at the time point of surgery (P = .031) led to significantly more complications. Also, a high resection weight (P = .057) showed a tendency for impaired wound healing. However, there was no difference in complication rates following body contouring procedures attributable to the method of weight loss in this study.

Complications after lower body contouring surgery due to massive weight loss unaffected by weight loss method

Body contouring surgery following massive weight loss positively affects a patient's quality of life. However, the procedure is prone to complications. Herein, we stratified complications timewise. Furthermore, we examined whether the weight loss method - bariatric surgery or lifestyle changes - affected the frequency or severity of complications. In this single-centre retrospective analysis, we included 158 patients with massive weight loss undergoing body contouring surgery between 2009 and 2015. We recorded 96 complications in 80 patients, with an overall rate of 51%. Most complications (80.2%) were minor (Clavien-Dindo grades 1 and 2) and superficial wound infections. Immediate complications (0-24 hours post-operation) affected 8.3% of patients, with early complications (1-7 post-operative days) affecting 16.7% of them and late complications (8-30 post-operative days) affecting 58.3% of them. We found no statistical difference in complication rates when comparing bariatric and non-bariatric patients. Older age (p = 0.042) at operation is associated with an increased risk for immediate haematoma or bleeding requiring surgery. Among early complications, a high maximum weight (p = 0.035) and a high preoperative weight (p = 0.0053) significantly correlated with a haematoma or bleeding requiring surgery. For late complications, seroma correlated with older age (p = 0.0061). Complications are primarily minor and non-life threatening after body contouring surgery because of frequent massive weight loss. Here, no particular subgroup of massive weight loss patients appeared more prone to complications. Thus, for each patient, the risks associated with body contouring surgery following massive weight loss should be considered individually.

A Concept Analysis of Disturbed Body Image in Bariatric Surgery Patients

PURPOSE

This article describes the concept of disturbed body image in bariatric surgery patients.

METHOD

Walker and Avant's (2011) method of concept analysis is used in this study.

FINDINGS

After bariatric surgery, the patient's body may change more rapidly than their allocentric ("inside, lived") view of themselves, leading to physical and psychosocial sequelae.

CONCLUSION

If not prepared physically and psychologically for body image challenges after bariatric surgery, patients may experience disturbed body image in the postoperative phase.

IMPLICATIONS FOR NURSING PRACTICE

Understanding the concept of disturbed body image in postoperative bariatric surgery patients may allow health providers to provide preoperative teaching and preparation, as well as postoperative interventions to create congruence between the patient's internal and external selves.

Self-image after bariatric surgery and its relationship to gender, excess skin and health-related quality of life

Introduction: There is limited knowledge about self-image in relation to excess skin after bariatric surgery. The aim of this study was therefore to explore self-image after massive weight loss and its relationship to gender, weight loss, discomfort regarding excess skin and health-related quality of life. Methods: Eighteen months after obesity surgery, 131 patients filled in questionnaires about self-image (Som jag ser mig själv), excess skin (Sahlgrenska Excess Skin Questionnaire, SESQ) and quality of life (EQ-5D and SF-36). In addition, maximal ptosis was measured on their abdomen, arms and thighs. Results: There were no differences in self-image or quality of life between the genders. Participants who scored low discomfort on SESQ had a significantly better overall self-image, in all subscales, compared to those with high discomfort scores (p < .05). They also had a significantly higher quality of life on the EQ-5D VAS (p = .045). Correlations were low, if any, between self-image, excess skin, quality of life and ptosis. There were moderate correlations between the SESQ score and the self-image subscore 'physical well-being', and in self-image and quality-of-life scores. Conclusions: Self-image is lower among those who experience a high degree of discomfort of excess skin after bariatric surgery. Its correlation to weight loss, measured excess skin and quality of life is weak.

Body consciousness of people with intestinal stomach: A phenomenological study

ABSTRACT Objective: to describe the bodily awareness of people with stomies. Method: a descriptive study with a qualitative approach, carried out in the Ostomized Association of the State of Ceará, through semi-structured interviews with ten people with intestinal stomies, according to Merleau-Ponty's phenomenological thinking. Results: two categories of analysis emerged: The body that I have, in which the sensations of deficiency, imperfection and bad odor add to the feeling of strangeness towards one's own body, affecting the way of being in the world of each deponent; and The body that others perceive, in which the stoma is seen as an embarrassing and complex experience, since it hampers daily activities and conviviality with other people. Final considerations: The corporeal consciousness of Being-Stomp-in-the-world requires the movement to reconstruct the senses of the body from the body I have and from that which others perceive.

Conceptualization of body image in the bariatric surgery patient

Bariatric (weight loss) surgery is more popular than ever. The American Society for Metabolic and Bariatric Surgery in 2016 reported that 216,000 bariatric procedures were performed in the United States. Bariatric surgery has major physiological benefits; its use is expected to increase globally. However, patients may not anticipate the profound impact that rapid and massive weight loss may have on their body image after bariatric surgery. The construct of body image in this population needs to be explicated to facilitate continued research regarding this increasingly prevalent healthcare procedure. This article describes the formulation of a model of relevant concepts and dimensions within the construct of body image in the bariatric surgery patient. In the process of creating the model, we identified many factors influencing body image in patients before and after bariatric surgery, summarized eight measures, and developed a new definition based on prior work. Theoretical considerations are discussed. The long-term objective of this model building approach is to encourage researchers and clinicians to test the feasibility of systematic clinical measurement of body image at office visits before as well as multiple times after bariatric surgery.

Integrative Literature Review on Shame

Shame is a universal living experience that is just beginning to be explored within the discipline of nursing. Development of a broad understanding of shame is needed to aid nurse researchers in clarifying this phenomenon from a nursing perspective. Pursuant to this goal, the author in this article reviews the extant literature on shame from the disciplines of nursing, psychology, sociology, philosophy, and theology. Three themes that emerged from the scholarly literature were (a) shame propels miring in paralysis, (b) shame captures the illusionary seen-unseen, and

Surgical weight loss as a life-changing transition: The impact of interpersonal relationships on post bariatric women

Surgical Weight Loss as A Life-changing Transition: The Impact of Interpersonal Relationships on Post-Bariatric Women BACKGROUND: Although women account for 80% of patients having bariatric surgery (BS), the complex psychosocial mechanisms that accompany this transformation process have not been well established.

PURPOSE

The purpose of this study is to explore the lived experience of women transitioning in their interpersonal relationships post BS.

METHODS

A semi-structured interview with four questions was used. Six women, from six to 12 months post BS, were interviewed. The interviews were recorded, transcribed and analyzed using thematic analysis.

MAIN FINDINGS

By seeking support systems prior to undergoing BS, adequate social support was received during their recovery period. Attending bariatric support group meetings and using social media were significant to these women's satisfactory recovery. Relationship adjustments were sometimes needed, but overall these women established fulfilling social lives. Within the first year post bariatric surgery, women began to gain emotional strength and inspire others to lose weight as well.

CONCLUSIONS

By inquiring about the psychosocial concerns of women who have undergone BS, healthcare providers can provide a more practical wellness plan.

Stabilizing family life after gastric bypass surgery

Weight-loss surgery requires lifelong lifestyle modifications for the maintenance of weight loss and health effects, and can affect both the individual and family. Earlier research indicates that the quality of social relationships has positive and negative influences on wellbeing and health. There is little research on family-life after a member has undergone gastric bypass (GBP) against obesity. Thus, this study aimed to develop a classic grounded theory about families with a member treated with GBP against obesity. The study design used classic grounded theory and included data from 16 interviews. Families' shared a main concern of unexpected changes after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. The social process develops differently which entail families: attaining unity, returning to old patterns, or disconnecting to find stability, depending on the discrepancy in expectations and knowledge. This is affected by the overall life situation, life-stage and relationship quality. The theory highlights unexpected change as a potential challenge for the family, as well as how they resolve this. Hence, the theory can be applied in care strategies for families. Identification of families needing support to stabilize family life after GBP requires further research.

What Is Known About the Correlates and Impact of Excess Skin After Bariatric Surgery: a Scoping Review

Although bariatric surgery (BS) improves health among adults with severe obesity, it results in excess skin in more than 70% of adults. The purpose of this study was to synthesize current knowledge on (1) the impact of excess skin experienced by adults after BS and (2) the correlates of excess skin quantity and inconveniences. PubMed, PsyArticles, and CINAHL databases were searched in May 2016 for relevant studies. Titles, abstracts, and full texts of studies retrieved were screened independently by two reviewers against inclusion criteria: (1) peer-reviewed primary research studies, (2) samples with adults who underwent BS, and (3) studies reporting the impact of excess skin and/or excess skin correlates. Thirteen quantitative and eleven qualitative studies met inclusion criteria. Negative physical, psychosocial, and daily life impacts of excess skin were reported in 67, 75, and 83% of studies, respectively. Women reported more excess skin and greater inconveniences of excess skin than did men. Based on the quantitative studies, pre-BS BMI, time since BS, and type of BS were not significantly associated with inconveniences of excess skin; findings were inconclusive for other correlates found (e.g. age, weight loss, BMI). Excess skin may adversely impact adults' physical and psychosocial functioning, as well as their activities of daily life after BS. However, evidence is lacking to determine which adults may be at heightened risk of developing or being negatively impacted by excess skin. More research on correlates of excess skill is needed to inform the development of tailored interventions in those more vulnerable to developing excess skin after BS to mitigate adverse consequences.

Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis

Although bariatric surgery is the most effective treatment for severe and complex obesity, less is known about its psychosocial impact. This systematic review synthesizes qualitative studies investigating the patient perspective of living with the outcomes of surgery. A total of 2,604 records were screened, and 33 studies were included. Data extraction and thematic synthesis yielded three overarching themes: control, normality and ambivalence. These were evident across eight organizing sub-themes describing areas of life impacted by surgery: weight, activities of daily living, physical health, psychological health, social relations, sexual life, body image and eating behaviour and relationship with food. Throughout all these areas, patients were striving for control and normality. Many of the changes experienced were positive and led to feeling more in control and 'normal'. Negative changes were also experienced, as well as changes that were neither positive nor negative but were nonetheless challenging and required adaptation. Thus, participants continued to strive for control and normality in some aspects of their lives for a considerable time, contributing to a sense of ambivalence in accounts of life after surgery. These findings demonstrate the importance of long-term support, particularly psychological and dietary, to help people negotiate these challenges and maintain positive changes achieved after bariatric surgery.

Obesity, Body Image, Depression, and Weight-control Behaviour Among Female University Students in Korea

BACKGROUND

Obesity has become epidemic worldwide and 31.0% of Korean adults are obese. Obesity is the main cause of chronic diseases, such as diabetes, hypertension, cardiac disease, and cancer. The purpose of the study was to examine obesity, body image, depression, and weight-control behaviour among Korean female university students and investigate the differences in body image, depression, and weight-control behaviour with respect to obesity.

METHODS

This study examined obesity, body image, depression, and weight control in 700 female university students from 4 universities in South Korea. To evaluate obesity, both objective obesity (body mass index [BMI]) and subjective obesity (subjectively perceived) were measured.

RESULTS

There was a significant difference between objective and subjective obesity (χ(2) = 231.280, P < 0.001). In addition, the objective obesity group had the lowest body image score (F = 19.867, P < 0.001) and difference in weight-control behaviour (F = 3.145, P = 0.045). Further, the subjective obesity group had the lowest body image score (F = 58.281, P < 0.001). The results revealed a statistically significant difference in body image and weight-control behaviour with respect to objective obesity.

CONCLUSION

Objective and subjective obesity was negatively associated with body image, and no relationships between objective or subjective obesity and depression.