Body image ‘multidimensional construct’ for adults undergoing bariatric surgery
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Body image concerns and internalized weight bias play a large role in the psychosocial thought process of people undergoing bariatric surgery, and perceptions can lead to different surgical outcomes, according to study findings.
“The current research adds to the growing body of literature examining body image in patients presenting for bariatric surgery,” Melissa Butt, MPH, a research project manager and public health doctoral student at the Penn State College of Medicine in Hershey, Pennsylvania, and colleagues wrote in a study published in Bariatric Surgical Practice and Patient Care. “The totality of the research thus far clearly marks this as a complex and multidimensional construct for which it is crucial to understand variations among populations. The differences between the ways in which pre- and postsurgical patients spoke about their experiences in their bodies speak directly to the importance of this, as well as to the potential need for nuanced conversations to prepare patients for surgery and ongoing support postsurgically.”
Researchers recruited adults who were preparing for bariatric surgery (n = 13) or who already had bariatric surgery (n = 11) from an academic medical center’s surgical weight-loss clinic in 2019. All participants were adults aged 18 years or older with a presurgical BMI of at least 40 kg/m2 or a presurgical BMI of at least 35 kg/m2 and a diagnosed comorbidity. Participants attended 60-minute focus group sessions based on their surgical status. Interviews were semi-structured and included questions about weight bias, body image concerns, functional impairment and perceived social support.
Body image concerns before surgery
In the presurgical group, participants primarily focused on body image concerns, internalized weight bias and the use of social media as a form of support. All of the focus groups included participants discussing hopeful expectations relating to physical changes in their body that would affect their life after surgery. Most participants said they had negative feelings about their body image or size and discussed instances of internalized weight bias. Participants in nearly all focus groups described instances of body focus and, to a lesser degree, acknowledged body checking. Although some discussed using social media to make comparisons due to weight differences or social pressure, some identified positive social media influences that served as motivation for change.
Postsurgical body perceptions
Adults who already had bariatric surgery presented some similar concerns. After surgery, participants discussed substantial changes in their social interactions. Similar to those in the presurgical subgroup, participants discussed comparing their bodies with others and increased social pressure after surgery. For body image, participants said they faced barriers to change and experienced some body avoidance, body checking and dissatisfaction, and confidence compared with before surgery. A subgroup had an increased awareness of positive and negative changes and desired additional mental health support to navigate the changes. However, they also reported a disconnect between their physical shape and internal perceptions, indicating a struggle of body acceptance.
Awareness of health and physical changes varied based on presurgical expectations. Most adults said their expectations before surgery did not align with reality, and many were frustrated they did not meet personal goals. Some people experienced health challenges both from surgery and comorbidities. Participants also described behavioral changes that occurred in relation to their lifestyle and their relationship to food.
“The number and depth of the themes established in the current research underscores the need for future research to examine body image as a multidimensional construct in bariatric patients,” the researchers wrote. “To ask the question ‘does body image improve postsurgically?’ would be to miss the nuance and depth of these patients’ experiences in their bodies, as well as the fluctuations that appear to occur postsurgically. Future clinical care would benefit from longitudinal research that captures the full spectrum of how body image changes before and after surgery, as time frame for capturing data appears to impact the picture seen.”
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