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A Longitudinal Analysis of Variation in Psychological Well-being and Body Image in Patients Before and After Bariatric Surgery

deMeireles, Alirio J. BA*; Carlin, Arthur M. MD; Bonham, Aaron J. MS*,‡; Cassidy, Ruth MS; Ross, Rachel RN, MS; Stricklen, Amanda RN, MS; Finks, Jonathan MD*,‡; Ghaferi, Amir A. MD, MS*,‡

doi: 10.1097/SLA.0000000000003146
Original Article: PDF Only

Mini In this multicenter, prospective cohort study we conducted a longitudinal assessment of a bariatric-specific, patient-reported outcome instrument. We assessed psychological well-being and satisfaction with body image before and after bariatric surgery, and its association with clinical outcomes.

Objective: We sought to use a bariatric-tailored patient-reported outcome (PRO) instrument to assess psychological well-being and satisfaction with body image before and after bariatric surgery, and its association with clinical outcomes.

Background: Weight loss after bariatric surgery has the potential to improve body image and psychological well-being. Traditional instruments used to measure these PROs have, however, not been tailored to patients who have undergone bariatric surgery.

Methods: In this multicenter, prospective, longitudinal cohort study we administered the Body-Q survey (a validated, customized PRO instrument) to patients in the Michigan Bariatric Surgery Collaborative just before bariatric surgery and at 1-year postoperatively. We linked the survey data to prospectively collected clinical outcome data to assess associations between body image or psychological well-being and patient characteristics and clinical outcomes (ie, percent excess body weight loss and complications).

Results: The preoperative and postoperative surveys were completed by 4068 patients for body image and 4062 patients for psychological well-being. Overall mean scores for body image and psychological well-being improved significantly from 26.2 ± 21.4 and 70.8 ± 20.1, respectively, before surgery to 57.7 ± 21.1 and 78.1 ± 22.1 after surgery. For both body image and psychological well-being, we found several patient-level factors such as sex, race, income level, and baseline body mass index that were statistically significant predictors of increases in scores. All P values less than 0.05.

Conclusions: Psychological well-being and body image vary widely across patients before bariatric surgery with significant increases in both measures 1 year postoperatively. Some patient populations do not experience the same increases at 1 year. Recognition of these differences and factors contributing to lower reported levels of psychological well-being and body image may help providers provide appropriate counseling in the postoperative period.

*Department of Surgery, University of Michigan, Ann Arbor, MI

Department of Surgery, Henry Ford Health System, Detroit, MI

Michigan Bariatric Surgery Collaborative, Ann Arbor, MI.

Reprints: Amir A. Ghaferi, MD, MS, Institute for Healthcare Policy and Innovation University of Michigan, 2800 Plymouth Ave, Bldg 16, Rm 140-E Ann Arbor, MI 48109-2800. E-mail:

Disclosure: A.A.G. is supported through grants from the Agency for Healthcare Research and Quality (K08HS02362 and P30HS024403) and a Patient-Centered Outcomes Research Institute Award (CE-1304-6596).

A.A.G. receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative. The remaining authors report no conflicts of interest.

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