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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
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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: aghaferi@umich.edu.

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

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