Monday, September 22, 2008

Psychological Considerations of the Bariatric Surgery Patient Undergoing Body Contouring Surgery--An Article Review

Earlier this month I reviewed an article on nutritional deficienciess in the post-surgery bariatric patient. Today I'd like to review an article on some of the psychological considerations of that same patient population. The article is the first one listed below in references.

They begins by stating their intentions:

This article discusses the psychological considerations of bariatric surgery patients who elect to undergo subsequent body contouring. Drawing from several recent comprehensive reviews, the article begins with a brief discussion of the psychosocial and physical functioning of persons with extreme obesity. Of particular interest is research on the relationship between obesity and body image. Dissatisfaction with one’s body image is believed to play a central role in the decision to seek plastic surgery, and the empirical studies of this relationship are reviewed. The article concludes with a discussion of future research priorities and suggestions for the plastic surgeon on the psychosocial assessment and management of these patients.


I'm not sure that the article lives up to the stated intentions, but they did have some salient points. Mostly, for me, they managed to point out that most studies only follow these patients for 1-2 years post-surgery or post-weight loss, so true long-term satisfaction/maintenance is unknown.

No study, however, has followed patients for more than 2 years postoperatively. As a result, it is unclear whether cosmetic surgery leads to longer lasting improvements in body image.


The best part of the article for me was the reminder that not all post-bariatric surgery patients (post-massive weight loss patients) are appropriate candidates for surgery. Their reasons for wanting surgery should be accessed as all cosmetic/reconstructive patients are to be sure their expectations are realistic and obtainable. (bold type emphasis is mine)

Many post– bariatric surgery patients are probably highly motivated to undergo body contouring. High levels of motivation, however, may not equate with psychological appropriateness. Patients may hold unrealistic expectations about the postoperative results, perhaps inaccurately gleaned from the mass media and “reality-based” television shows that have featured body contouring. Some may incorrectly anticipate that body contouring surgery will result in a total body transformation that makes their bodies comparable to persons who never experienced excessive body weight. At the same time, patients may have little appreciation of the fact that body contouring surgery often produces large, visible scars, skin irregularities, and residual deformities in body shape. Thus, patients should be reminded, on several occasions, that although surgery may improve body contour, it will not result in a “perfect” body shape.


This following list of questions is a from the article. I have altered their layout (not content) for easier reading/presentation.

Preoperative Psychological Assessment of the Body Contouring Patient

Motivations and expectations*

  • Why are you interested in body contouring surgery now?
  • How do you anticipate your life will be different following surgery?
  • How will you know if you are happy with the postoperative results?

Physical appearance and body image concerns†

  • What, specifically, do you dislike about the appearance of your body?
  • How unhappy do you become when you think about your appearance?
  • When does your body’s appearance bother you the most?
  • Do you ever think you spend too much time thinking about your body?
  • Do your feelings about your body ever keep you from doing certain activities?

Psychiatric history and status:

  • Have you ever had any significant problems with depression or anxiety?
  • Have you ever, or are you currently, under the care of a mental health professional?
  • Have you ever, or are you currently, taken a psychiatric medication?
  • If yes, who is prescribing this medication?

To further assess for depressive symptoms‡:

  • How is your mood?
  • Are you having difficulties falling asleep, staying asleep, or waking up prematurely?
  • Have you noticed any changes in your appetite?
  • How is your concentration?
  • Are you crying more than usual?
  • Are you more irritable than usual?
  • Are you interacting with family and friends?
  • Do you feel hopeless or helpless?
  • Do you have any thoughts about hurting yourself or ending your life?

*Patients should express that their motivations for surgery are internal (i.e., that they are having surgery for improvements in their body image and self-esteem) rather than external (i.e., that they are having surgery to please a spouse or romantic partner).

Their postoperative expectations should be realistic in terms of both the improvements in their appearance and the impact of these improvements on their overall quality of life (which may be modest or minimal).

†Patients should be able to articulate specific appearance concerns that are readily visible to the surgeon. This dissatisfaction, however, should not be accompanied by significant emotional upset (i.e., reports of daily sadness or tearfulness or excessive crying during the consultation) or reports of significant behavioral avoidance (i.e., reluctance to leave the house to work or socialize).
‡Patients who report excessive sadness, present with a flat or blunted affect, and who endorse the neurovegetative symptoms of depression (changes in sleep, appetite, and concentration) should be asked about other symptoms of depression. Those who endorse five or more symptoms may be suffering from a major depressive episode and should undergo a mental health evaluation before surgery.



A related blog post of mine on this subject is Suitability.



Psychological Considerations of the Bariatric Surgery Patient Undergoing Body Contouring Surgery; Plastic & Reconstructive Surgery. 121(6):423e-434e, June 2008; Sarwer, David B. Ph.D.; Thompson, J Kevin Ph.D.; Mitchell, James E. M.D.; Rubin, J Peter M.D.

Maintenance of Weight Loss after Body Contouring Surgery for Massive Weight Loss; Plastic & Reconstructive Surgery. 121(6):2114-2119, June 2008; Shermak, Michele A. M.D.; Bluebond-Langner, Rachel M.D.; Chang, David Ph.D., M.P.H., M.B.A.


Robin said...

This seems to apply a whole lot to the (former) Cushing's patient who has lost a lot of weight, too.


Anonymous said...

I worked in pre-op intake and management of bariatric surgery patients. Sadly, most Medicare patients who qualified for the surgery (and were thrilled that they did) had no understanding that massive weight loss would like result in a need for plastic surgery, which is only covered by Medicare for medical, not aesthetic, reasons. Our wealthier/self-pay patients already had the body contouring surgeon lined up. We tried to inform all equally, but most people insisted that their skin would stretch back.

I've also seen a tragic couple of end results: post-plastic, post-bariatric patients who regained the weight after contouring. They look something like a Michelin man.

Anonymous said...

Bariatric surgery though helps one to loose weight but it also give rise to another problem like loose flabby skin. Besides looking horrible, all this extra skin can also cause hygiene problems, skin irritation, infections, etc. Instead of giving psychological satisfaction it gives rise to another surgery. C­o­sm­etic­ su­rgery­ after a bariatric surgery c­an be a go­o­d­ w­ay­ to­ h­el­p­ b­ariatric p­atients­ to­ f­eel their v­ery­ b­es­t. Many things are to be considered before opting for a weight loss surgery as it changes ones life forever. one need to have realistic expectations .

Unknown said...

A common misunderstanding is that the majority of people undergo bariatric surgery for MEDICAL, and not COSMETIC, purposes. While there are some patients and physicians who may perform the surgery strictly for cosmetic reasons, the vast majority of these patients are morbidly obese with multiple significant co-morbidities. The overall purpose of the surgery is to reduce or eliminate the co-morbidities that are associated with morbid obesity. Weight loss and improved self/body image are side effects of the procedure.

bariatric surgery said...

Nice and useful blog.I am very impressed from your blog.I will share your blog with my friends .Thanks for sharing and keep it up.