Body image concerns in obese women seeking bariatric surgery

A moving target: Ideal body size following weight loss surgery

Weight-loss surgery (WLS) patients often experience changes in body image post-surgery, but the nature of this relationship has been unclear. The current study longitudinally assessed the discrepancy between perceived current and ideal body size before participants underwent WLS and at multiple time points during the first 2 years following surgery. As hypothesized, a mixed models analysis (N = 327) revealed that as participants' perceived current body size decreased following surgery in conjunction with weight loss, their ideal body size also decreased, resulting in a continued discrepancy between current and ideal body size. Thus, ideal body size may become a moving target post-WLS. Implications for WLS patients are discussed.

Understanding Uncontrolled Eating after Bariatric Surgery: The Role of Excessive Skin and Body Image Shame

Excess skin and disordered eating behaviors are referred to as some of the major negative consequences of bariatric surgery as well as body image shame. This study sought to explore how discomfort with excessive skin, body image shame, psychological distress, eating-related psychopathology, and negative urgency interact to understand uncontrolled eating among woman submitted to bariatric surgery. A cross-sectional sample of 137 women was evaluated postoperatively through self-report questionnaires assessing discomfort with excess skin, body image shame, eating-related psychopathology, negative urgency, and uncontrolled eating in a hospital center in the north of Portugal. Pearson correlations and Structural Equation Modeling (SEM) were performed. Body image shame mediated the relationship between discomfort with excess skin and eating-related psychopathology. In turn, the relationship between eating-related psychopathology and uncontrolled eating was mediated by negative urgency. This study highlights the impact of excess skin and body image shame on eating behavior post-bariatric-surgery. Considering the proven impact of uncontrolled eating on weight-loss results post-surgery, understanding the mechanisms underlying this problem is highly important. Our findings provide helpful insight for multidisciplinary teams committed to providing care to bariatric patients struggling with body image and eating difficulties.

Body Image Disturbances and Weight Bias After Obesity Surgery: Semantic and Visual Evaluation in a Controlled Study, Findings from the BodyTalk Project

Purpose

Body image has a significant impact on the outcome of obesity surgery. This study aims to perform a semantic evaluation of body shapes in obesity surgery patients and a group of controls.

Materials and Methods

Thirty-four obesity surgery (OS) subjects, stable after weight loss (average 48.03 ± 18.60 kg), and 35 overweight/obese controls (MC), were enrolled in this study. Body dissatisfaction, self-esteem, and body perception were evaluated with self-reported tests, and semantic evaluation of body shapes was performed with three specific tasks constructed with realistic human body stimuli.

Results

The OS showed a more positive body image compared to HC (p < 0.001), higher levels of depression (p < 0.019), and lower self-esteem (p < 0.000). OS patients and HC showed no difference in weight bias, but OS used a higher BMI than HC in the visualization of positive adjectives (p = 0.011). Both groups showed a mental underestimation of their body shapes.

Conclusion

OS patients are more psychologically burdened and have more difficulties in judging their bodies than overweight/obese peers. Their mental body representations seem not to be linked to their own BMI. Our findings provide helpful insight for the design of specific interventions in body image in obese and overweight people, as well as in OS.

'Shopping for a new body': descriptions of bariatric post-operative adjustment

PURPOSE

Co-morbid conditions resulting from obesity cause 3.4 million deaths per year. Bariatric surgery has become a solution for obesity. Post-operative psychosocial changes can be problematic and must not be neglected. Up to 74% of people with overweight or obesity have body image distortion or dissatisfaction, which may persist even after surgery and weight loss. The questions addressed by this research were: (a) what are the categories of open-ended responses from bariatric surgery patients about their experiences of post-operative adjustment? (b) Do the categories of response support previous quantitative findings of a retained obese identity after surgery?

METHODS

Herman's Dialogical Self Theory provides the basis for understanding the post-operative transition from "I-obese" to "I-ex-obese". Fifty-five bariatric surgery patients (18-30 months post-op) were asked to tell the investigator about their adjustment after surgery. Their open-ended responses were written down and analyzed using content analysis.

RESULTS

Individual responses were analyzed and divided into four dominant categories: (a) shopping for a new body; (b) relationship transitions; (c) focus on the new body; and (d) cheating on the fat person inside.

CONCLUSION

This study presents an opportunity to gain perspective on the physical and psychosocial adjustment after bariatric surgery. The information can be used to guide pre-op and post-op education and counseling efforts for patients. Physical healing should be paired with healthy psychological adjustment to ensure a positive outcome.

LEVEL OF EVIDENCE

Level V, descriptive analysis of previous Level III research.

Sick but healthy: bariatric patients and the social construction of illness and disability

Bariatric (weight loss) surgery modifies the digestive system, which produces impairments and symptoms which might be considered illness or disability. Bariatric patients, however, do not view themselves as ill or disabled, but healthier than before surgery. For this study, 35 bariatric patients - from a clinic located in the Midwestern United States - were interviewed to investigate how moral and medical discourses surrounding obesity impact how patients experience their bodies after bariatric surgery. While previous literature on bariatric patients has explored discourses of medicine, stigma and discipline, fewer have analysed how patients interpret physiological symptoms. Patients often reduce or discontinue medications for chronic illness after bariatric surgery, then replace them with a strict regimen of dietary supplements. Even though these supplements are taken to manage an impaired digestive system, they do not carry the same moral weight as medications for chronic illness. Patients also experience painful and humiliating symptoms after bariatric surgery. Bariatric patients interpret symptoms not as illness, but as important disciplinary tools to lose weight. These findings have implications for the social construction and experience of illness and disability in the context of fat stigma, health morality and biomedicalisation.

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.

A Novel Technique for Improving Bodily Experience in a Non-operable Super-Super Obesity Case

INTRODUCTION

The available clinical guidelines for super-super obese patients (i.e., with body mass index (BMI) > 60 kg/m(2)) that are not suitable for bariatric surgery mandate a palliative multidisciplinary treatment (i.e., production and maintenance of weight loss) provided in a center of excellence. However, the modality and the impact of this approach are still controversial. Moreover, it is not able to address the high level of body dissatisfaction and body distortions that are common among these patients.

CLINICAL PRESENTATION

We report the case of a non-operable super-super obesity - a 37 year old woman with a BMI of 62 kg/m(2) - receiving a specialized treatment for her obstructive sleep apnea. She entered a multidisciplinary program that promoted healthy behaviors, including physical activities and psychological intervention. To improve body dissatisfaction, which was linked to a significant multisensory impairment of body perception, she also entered a virtual reality (VR) body-swapping illusion protocol. At the end of the current investigation, the patient continued her multidisciplinary program, reporting an increase in the motivation for undertaking healthy behavior and a decrease in the anxiety feelings associated with her clinical condition.

CONCLUSION

This case provides preliminary evidence that both body dissatisfaction and body-size distortions of non-operable super-super obesity patients could be addressed by a VR body-swapping protocol, which is important because the palliative multidisciplinary treatment recommended for these patients is not able to address them. Interestingly, the use of a VR body-swapping illusion protocol seems to be able to improve not only the experience of the body in these patients but their motivation for change, too.

Validation of the factor structure of the Greek adaptation of the Situational Inventory of Body-Image Dysphoria-Short Form (SIBID-S)

PURPOSE

Body image is a psychological construct that refers to one's perceptions, feelings, and thoughts towards one's body and appearance. The intensity and frequency of dysphoric body-image emotions depend upon situational events (i.e., situations involving body exposure, social comparisons, wearing certain clothing, looking in the mirror, and so forth). The Situational Inventory of Body-Image Dysphoria-Short Form (SIBID-S; Cash, Manual for the situational inventory of body-image dysphoria, 2000) was originally developed to assess one's negative body-image emotions in certain situational events. The current study aimed to confirm the factor structure and reliability of the newly translated Greek version of the SIBID-S.

METHODS

Participants consisted of a convenient sample of 2664 high school students (1119 males, 1545 females) who answered the measures of interest.

RESULTS

Results indicated that the original one-factor structure of the SIBID-S was retained and fitted very well with the original model for both males and females. In addition, the Greek version had satisfactory reliability and convergent validity coefficients. Gender differences were also noted.

CONCLUSION

The Greek SIBID-S has very good validity and reliability data and will serve as a useful measure of body-image dysphoria enabling research with the Greek-speaking population as well as cross-cultural research.