Body Image as a Potential Motivator for Bariatric Surgery: a Case-Control Study

BACKGROUND

Not every eligible person opts for bariatric surgery. Body image concerns might be a reason to choose surgery. This case-control study evaluated differences in body image between a pre-bariatric surgery population and a weight-matched control group from the general population. We hypothesized that the pre-bariatric group would show less satisfaction with appearance, defined as a discrepancy between evaluating one's appearance as less attractive while attaching more importance to appearance.

METHODS

Data from 125 pre-bariatric patients were compared with 125 body weight-matched controls from the general population. The Multidimensional Body-Self Relations Questionnaire-Appearance Scales was used to assess appearance evaluation (AE), appearance orientation (AO), and their discrepancy score. Both groups were compared with norms from the non-body weight-matched general population.

RESULTS

The pre-bariatric group had lower AE scores (mean 2.23 ± 0.65 vs. mean 2.54 ± 1.06) and higher AO scores (mean 3.33 ± 0.69 vs. mean 3.04 ± 0.90) than the control group. The discrepancy between AE and AO was larger in the pre-bariatric group (p < 0.001). Compared with the general population, both groups showed lower AE scores (d = - 1.43 and d = - 1.12, p < 0.001) and lower AO scores (d = - 0.23 and d = - 0.58, p < 0.001).

CONCLUSIONS

People with morbid obesity have on average less body image satisfaction. The results indicate that part of the motivation of people that choose bariatric surgery may be due to relatively low global appearance evaluation combined with considering appearance more important. Knowledge about motivations can be used to communicate realistic expectations regarding treatment outcome.

The BAPRAS screening tool for reimbursement in a postbariatric population

INTRODUCTION

Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool.

METHODS

In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes.

RESULTS

Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m² versus 30.4 kg/m², p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales.

CONCLUSIONS

Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS.