Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Body Image and Quality of Life: Changes with Gastric Bypass Surgery and Body Contouring
Nirav B. Patel, MD, MS, JD1, Sven Gunther, AS, BS2, Ping Song, BA3, Chin-Shang Li, PhD4, Nathan A. Kludt, MD5, Carolyn Y.G. Lee, RN, MSN, ANP-C, PSN1, Shannon M. Hearney, BS candidate6, Kamlesh B. Patel, MD7, Mohamed R. Ali, MD8, Michael S. Wong, MD1.
1UC Davis Medical Center, Division of Plastic Surgery, Sacramento, CA, USA, 2UC Davis School of Medicine, Sacramento, CA, USA, 3Virginia Commonwealth University School of Medicine, Richmond, VA, USA, 4UC Davis School of Medicine, Division of Biostatistics, Sacramento, CA, USA, 5Joseph R. Burlin, MD, Inc., Stockton, CA, USA, 6University of California, Davis, Davis, CA, USA, 7Washington University School of Medicine, St. Louis, MO, USA, 8UC Davis Medical Center, Division of Bariatric Surgery, Sacramento, CA, USA.

PURPOSE:
Bariatric surgery leads to massive weight loss changes that patients may not anticipate and can affect expectations. Studies are lacking that evaluate patients’ body image and quality of life as they undergo bariatric surgery and subsequent body contouring.
We sought to examine effects of bariatric surgery on patients’ body image and quality of life, as well as the durability of those effects.
METHODS:
A prospective, two year experience followed patients who underwent bariatric surgery. Patients were given questionnaires pre-operatively and at 6, 12, and 24 months post-operatively.
The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is a 34-item inventory of body image. Sub-scores include Appearance Evaluation (‘AE’), Appearance Orientation (‘AO’), Body Area Satisfaction (‘BASS’), Overweight Preoccupation (‘OP’), and Self-classified Weight (‘SW’). High scores for AE and BASS indicated satisfaction with one’s appearance. Higher scorers in AO placed more importance on their appearance. High scores for OP reflected greater anxiety and attention to weight loss. A high SW reflected greater perception and self-labeling as overweight.
To assess quality of life, we employed the RAND Corporation’s Short Form 36 (SF-36).
Repeated analyses of variance (ANOVA) F-tests were used to evaluate mean SF-36 score, AO, AE, BASS, OP, and SW. All analyses were completed with Statistical Analysis Software version 9.4. A 95% confidence interval was utilized with a p-value < 0.05 considered statistically significant.
RESULTS:
A total of 121 patients were surveyed prior to bariatric surgery, with 8 patients surveyed at their 6 month follow up, 16 patients at 12 months, and 4 patients at 24 months.
Pre-operative AE improved at all three time-points following bariatric surgery (p = 0.007) [Table 1]. AO score improvements, by contrast, approached but did not reach statistical significance (p = 0.058).
BASS demonstrated significant improvements in the follow-up period as well (p = 0.020).
There was no discernable decrease in OP scores after bariatric surgery (p = 0.809). However, SW scores decreased from pre-operative levels at all three time points following surgery (p = 0.001).
Lastly, the composite SF-36 scores for patients increased following bariatric surgery (p = 0.002) [Table 2].
CONCLUSION:
The MBSRQ, applied to bariatric surgery patients, demonstrates body image improvements and reduced perception of being overweight. The SF-36 inventory similarly demonstrates durable quality of life improvements.
Understanding the evolution of body satisfaction as patients proceed from bariatric to body contouring surgery will assist clinicians in providing guidance and facilitating optimal outcomes such as stable weight loss and aesthetics.
Future work will evaluate both bariatric and body contouring cohorts for trends in demographics, outcomes, and complications.
Table 1. MBSRQ Sub-Scores
Pre-opPostop 6 mo.Postop 12 mo.Postop 24 mo.
Appearance Evaluation (AE)2.12
[2.01, 2.23]
2.50
[1.87, 3.31]
2.90
[2.43, 3.38]
2.82
[1.59, 4.05]
Appearance Orientation (AO)3.40
[3.29, 3.51]
3.30
[3.00, 3.61]
3.77
[3.47, 4.08]
4.04
[3.52, 4.56]
Body Area Satisfaction (BASS)2.40
[2.32, 2.47]
2.85
[2.39, 3.30]
2.73
[2.35, 3.11]
2.75
[1.75, 3.75]
Overweight Preoccupation (OP)3.26
[3.13, 3.39]
3.22
[2.72, 3.71]
3.16
[2.84, 3.47]
3.00
[2.00, 4.00]
Self-classified Weight (SW)4.70
[4.57, 4.83]
3.69
[3.10, 4.27]
3.84
[3.60, 4.09]
3.63
[2.54, 4.71]

Table 2. SF-36 Quality of Life (QOL) Scores
Pre-op (%)Postop 6 mo. (%)Postop 12 mo. (%)Postop 24 mo. (%)
QOL Score54.5
[51.3, 57.7]
74.8
[66.5, 83.2]
75.3
[64.1, 86.5]
76.7
[61.7, 91.7]


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