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Moro O, Albert U, De Caro EF, Palmisano S, Mastronardi M, Di Blas L. Pre-operative body shape concerns moderate excess weight loss trajectory in bariatric surgery patients: a 2-year longitudinal study. Eat Weight Disord 2024; 29:30. [PMID: 38653913 DOI: 10.1007/s40519-024-01660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE The main research aim was to inspect whether pre-operative body shape concerns and discomfort as Body Shape Questionnaire (BSQ) scores moderate post-operative weight loss trajectory in bariatric patients. METHODS Two studies were conducted. Study 1 analyzed cross-sectional data and verified the structural validity of the 34-item BSQ questionnaire on a sample of 327 candidates for bariatric surgery. Study 2 examined longitudinal data, with objective Body Mass Index (BMI) recorded every 6 months, from surgery intervention on, with 5 measurement occasions, from 111 patients who initially completed BSQ as bariatric surgery candidates and then underwent periodic medical post-operative follow-ups, over 2 years. RESULTS In Study 1, confirmatory factor analysis of a single-dimension model yielded acceptable fit indices and high internal consistency levels. Study 2 showed that post-operative excess BMI reduction trend was not linear and pre-operative BSQ scores moderated it, with a higher risk of weight regain in patients who initially were less concerned with their body shape. CONCLUSIONS The present findings support the structural validity of the BSQ questionnaire in bariatric candidates and call attention on the role of pre-operative body shape concerns on post-operative weight loss trajectories over 2 years, in accordance with a pathoplasty model. They suggest the need for systematic attention on perceived body image and psychological paths aimed to help bariatric patients regain positive attitudes towards their own body. Level of evidence III, well-designed cohort.
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Affiliation(s)
- Oriana Moro
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Umberto Albert
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Mental Health, ASUGI, Trieste, Italy
| | | | - Silvia Palmisano
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Manuela Mastronardi
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Lisa Di Blas
- Department of Life Sciences, University of Trieste, Trieste, Italy.
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Granero-Molina J, Jiménez-Lasserrotte MDM, Arias Hoyos C, Sánchez MJT, Fernández-Sola C, Ruiz-Fernández MD. Sexuality and self-concept of morbidly obese women who are sexually attracted to men after bariatric surgery: a phenomenological study. BMC Womens Health 2024; 24:174. [PMID: 38481251 PMCID: PMC10936016 DOI: 10.1186/s12905-024-03014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Morbid Obesity (MO) is a public health problem that affects a person's physical, psychological and sexual well-being. Women with MO are affected by their body image and self-concept, and obesity stigma may affect women in social and sexual relationships. OBJECTIVE To describe and understand the experiences of morbidly obese heterosexual women (who are sexually attracted to men) in relation to their body image and sexuality after bariatric surgery. METHODOLOGY Qualitative study using Merleau-Ponty's hermeneutic phenomenology as a philosophical framework. Data collection took place between 2020 and 2021 in a southern Spanish province. A total of 22 in-depth interviews were conducted using open-ended questions until data saturation was reached. RESULTS Two main themes were identified: (1) "Escaping from a cruel environment": weight loss to increase self-esteem; with the sub-themes: 'I love myself now', and 'Body image and social relationships; a vicious circle; (2) "Now, I am truly me": accepting my body to reclaim my sexuality, with the sub-themes: 'The body as the focal point of sexuality', and 'When regaining your sex drive reignites your sex life and relationship'. CONCLUSION Weight loss and body acceptance radically change morbidly obese women's sex lives after bariatric surgery. They rediscover their bodies, have increased self-esteem, and see improvements in their social relationships and sexuality. These women feel seen, loved and desired, and now value their body image and femininity. As they go through continuous improvements following bariatric surgery, they gradually regain self-esteem, acceptance of their bodies and control over their sex life. Even though the women's partners benefit from these improvements, they seem to be afraid of being left.
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Affiliation(s)
- José Granero-Molina
- Physiotheraphy and Medicine Department, University of Almería, Almería, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile, Santiago, 7500000, Spain
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Parzer V, Taube M, Ludvik B, Peltonen M, Svensson PA, Brix JM, Sjöholm K. Perceived Body Size in Relation to 10-Year Weight Change in the Swedish Obese Subjects Intervention Study. Obes Facts 2023; 17:81-89. [PMID: 38035550 PMCID: PMC10836937 DOI: 10.1159/000535489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Body size underestimation in patients with obesity may be associated with long-term weight increase. In the current report, we analyse changes in body size perception in patients with obesity undergoing either bariatric surgery or usual obesity care, and in subgroups of patients who gain weight or maintain their body weight over 10 years. MATERIALS AND METHODS A total of 2,504 patients with obesity from the prospective, controlled Swedish Obese Subjects (SOS) intervention study were included in this report, 1,370 patients underwent bariatric surgery and 1,134 patients were usual care controls. Weight was measured and body size was self-estimated using the Stunkard's figure rating scale at baseline and after 0.5, 1, 2, 3, 4, 6, 8 and 10 years of follow-up. A body perception index (BPI) was calculated as estimated/measured BMI. Weight (re)gain was defined as ≥10% increase between 1 and 10 years of follow-up. RESULTS Body size was underestimated by 12% in the surgery and 14% in the control group (i.e., >5 BMI units) at baseline and underestimation largely persisted over 10 years in both intervention groups. When stratified by long-term weight development, weight regainers from the surgery group underestimated their body size to a larger degree compared to weight maintainers (12 vs. 9%, p < 0.001) after 10 years. Likewise weight gainers in the control group also underestimated their body size to a larger degree (17% vs. 13%, p < 0.001). In both groups, the change in BPI was significantly different between weight regainers and maintainers during follow-up (time-BPI interactions both p < 0.001). CONCLUSION Patients with obesity underestimate their body size and this underestimation remains long-term even after major weight loss induced by bariatric surgery. In patients with obesity who maintain their weight, regardless of treatment, underestimation of body size persists but body size perception is slightly more accurate compared to patients who gain or regain weight long-term.
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Affiliation(s)
- Verena Parzer
- Department of Medicine, Clinic Landstrasse, Vienna, Austria
| | - Magdalena Taube
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bernhard Ludvik
- Department of Medicine, Clinic Landstrasse, Vienna, Austria
- Karl Landsteiner Institute for Obesity and Metabolic Disorders, Vienna, Austria
| | | | - Per-Arne Svensson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johanna Maria Brix
- Department of Medicine, Clinic Landstrasse, Vienna, Austria
- Karl Landsteiner Institute for Obesity and Metabolic Disorders, Vienna, Austria
| | - Kajsa Sjöholm
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Makarawung DJS, Dijkhorst PJ, de Vries CEE, Monpellier VM, Wiezer MJ, van Veen RN, Geenen R, Mink van der Molen AB. Body Image and Weight Loss Outcome After Bariatric Metabolic Surgery: a Mixed Model Analysis. Obes Surg 2023; 33:2396-2404. [PMID: 37354307 DOI: 10.1007/s11695-023-06690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE As in nonsurgical weight loss populations, body image may partly explain differences in weight loss outcomes after surgery. The aim of this study was to determine the prospective association between body image and weight loss in a longitudinal cohort of patients up to 3 years after bariatric metabolic surgery. MATERIALS AND METHODS The BODY-Q self-report questionnaire was used to assess body image. Linear mixed models evaluated associations of baseline body image with weight loss in the first year as well as associations of body image at 12 months and first-year change in body image with weight loss 12 to 36 months after surgery. RESULTS Available body image data included 400 (100%), 371 (93%), 306 (77%), 289 (72%), and 218 (55%) patients at baseline and 4, 12, 24, and 36 months, respectively. Body image scores improved significantly until 12 months, followed by a gradual decline. Scores remained improved in comparison to baseline (β = 31.49, 95% CI [27.8, 35.2], p < .001). Higher baseline body image was associated with less weight loss during the first year, and the effect size was trivial (ß = -0.05, 95% CI [-0.09, -0.01], p = .009). Body image and change in body image were not associated with weight loss 12 to 36 months after surgery. CONCLUSION Body image improved after bariatric metabolic surgery. Although no clinically relevant associations of body image with weight loss were demonstrated, the gradual decline in body image scores underlines the importance of long-term follow-up with regular assessment of this aspect of quality of life.
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Affiliation(s)
- Dennis J S Makarawung
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands.
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
| | - Phillip J Dijkhorst
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Claire E E de Vries
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Valerie M Monpellier
- Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), Amersfoortseweg 43, 3712 BA, Huis ter Heide, the Netherlands
| | - M J Wiezer
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, the Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Aebele B Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
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