Person factors in bariatric surgery: Moving beyond weight loss

Abstract

Obesity is one of the greatest global contemporary challenges to public health. It is associated with an increased risk of numerous health problems including metabolic syndrome as well as several types of cancer. In addition, obesity is related to psychopathology and socioeconomic disadvantages, and it may impair health-related quality of life (HRQL). Of the various treatments available including lifestyle modifications and pharmacotherapy, bariatric metabolic surgery is considered the most effective treatment for individuals with severe obesity. Effects are observed regarding long-term weight loss, reduction in associated medical problems and improvement in HRQL. This thesis focuses on HRQL, with a particular emphasis on body image, which describes the perception of individuals regarding their own bodies. Body image is influenced by various factors, including body size, shape, reactions from others, and the presence of excess skin following surgery. The results of the first studies indicate that body image of women with obesity is significantly more negative compared to women of normal weight or underweight. This dissatisfaction with appearance may serve as motivation for individuals with severe obesity to opt for surgical treatment. The expectation that body image will improve after surgery is realistic, as there is generally an observed improvement in body image postoperatively. Various factors were related to postoperative HRQL. A lower BMI and greater weight loss were associated with a higher HRQL. Also, being employed and not having pre-existing medical conditions were related to a higher HRQL. Focusing specifically on factors associated with improvement in psychological well-being, individuals with (overly) high expectations regarding weight loss and those with psychiatric issues experienced less improvement after surgery. This thesis highlights the importance of regular assessment of body image and HRQL in patients undergoing bariatric metabolic surgery. It is recommended to use questionnaires that assess besides general HRQL, also topics important to this population. These insights may be used to increase a healthcare provider’s awareness of their patients HRQL, improve physician–patient communication, and enable identification of patients who may be at risk of a less favorable outcome. Moreover, these insights may be used to improve patient education and set realistic expectations for post-surgical outcomes. In conclusion, the findings of this thesis enhance our understanding of the consequences of obesity and the impact of surgical treatment on a person's life, which, in turn, enables developing a tailored approach in the treatment of severe obesity.