Table 2.
Summary of articles reporting body image results among bariatric surgery patients before or after body contouring surgery
| Study (ref) by Design and Year |
Study Design Timeframe Group Description (if indicated) |
Sample Characteristics Gender: n or % Race: n or % Age: Mean±SD years Post-WLS BMI: Mean±SD kg/m2 |
WLS typea
· n included if > 1 procedure BCS type |
Body Image Measures ·Subscales |
Summary of Relevant Body Image Findings Response Rate (cross-sectional design) or Retention Rate (longitudinal design) |
|---|---|---|---|---|---|
| Pavan (2013) | Cross-sectional · Time since WLS: NI 2 groups: 1. Post-WLS seeking BCS 2. Control (matched BMI and demo-graphics) |
N=35 1. n=35 2. n=33 Gender: 1. Female: 30; 2. Female: 23 1. Male: 5; 2. Male: 10 Race: NI Age: 1. 45.51±11; 2. 41.51±9.1 Post-WLS BMI: 1. 30.17±3.37 |
Bariatric restrictive procedures | BSQ | WLS group had higher BSQ scores than controls. A significantly higher number of WLS patients had moderate or high concerns with shape than the control group. Response rate: 50% |
| Pavan (2017) | Cross-sectional · Time since WLS: NI 2 groups: 1. Post-WLS seeking BCS 2. Control (matched BMI and demo-graphics) |
N=36 1. n=36 2. n=21 Gender: 1. Female: 28; 2. Female: 14 1. Male: 8; 2. Male: 7 Race: NI Age: 1. 42.44±10.6; 2. 40.76±13.73 Post-WLS BMI: 1. 28.77±3.05 |
Sleeve: · 52.78% Band: · 22.22% |
BUT: Italian version |
BCS group reported more past plastic surgeries than controls (36.1% vs. 9.5%) BCS group reported significantly higher scores on Weight Phobia, Body Image Concerns, Avoidance, Depersonalization, Global Severity Index, and Positive Symptom Distress Index Global Severity Index was suggestive for “disease” (>1.2) for BCS group, but not for controls (<1.2). Response rate: NI |
| Menderes (2003) | Cross-sectional · Time since WLS: 27.2 months |
N=11 Gender: Female: 7 Male: 4 Race: NI Age: 37.4 Post-WLS BMI: 34.4 |
Vertical banded gastroplasty Abdominoplasty=11 Reduction mammoplasty=3 Lateral thigh lift=2 Gynecomastia=3 Medial thigh lift=1 Liposuction=3 |
DAS | Of 38 post-WLS patients, 11 patients underwent 23 different plastic surgery interventions. The most frequently performed operation was abdominoplasty. Body image improved after BCS. Response rate: 90.9% |
| Pecori (2007) | Cross-sectional 4 groups: 1. Pre-WLS 2. >2 years post-WLS 3. >2 years post-WLS seeking BCS 4. >2 years Post-WLS and >1 year post-BCS |
N=60 1. n=20 2. n=20 3. n=10 4. n=10 Gender: Female=60 Male=0 Race: NI Age: Overall NI Post-WLS BMI: Overall NI. Post-WLS BMI by groups ranged from 28.2±1.7 (post-BCS) to 31.2±4.5 (post-WLS) |
Biliopancreatic diversion Leg or arm lift=8 Abdominoplasty=7 Mastoplasty=5 Torsoplasty=2 |
BUT | BUT scores were lower post-WLS. Post-WLS patients requesting cosmetic surgery had similar BUT scores to pre-WLS patients and had higher body uneasiness than post-WLS who did not seek cosmetic surgery. Those who had cosmetic surgery had lower body uneasiness scores than pre-WLS patients and post-WLS patients seeking cosmetic surgery. Response rate: NI |
| de Zwaan (2014) | Cross-sectional 3 groups: 1. Pre-WLS 2. Post-WLS, but no BCS 3. Post-WLS and BCS · Time since WLS: 37.8-49.8 months |
N=393 1. n=79 2. n=252 3. n=62 Gender: Overall NI Race: Overall NI Age: Overall NI Age by groups ranged from 41.63±10.40 to 47.97±9.93 Post-WLS BMI: Overall NI Post-WLS BMI by groups ranged from 32.46±6.07 to 34.46±7.31 |
Bypass · n=175 Sleeve gastrectomy · n=71 Band · n=63 Other WLS · n=4 Abdominoplasty=55 Thigh lift=15 Breast lift=10 Lower back=7 Arms=6 Buttocks=4 Upper back=1 |
MBSRQ: German version · 10 subscales |
Post-WLS groups reported better MBSRQ scores on 8/10 subscales than the pre-WLS group. BCS group reported better MBSRQ Appearance Evaluation (AE), Body Areas Satisfaction (BAS), and lower Self-Classified Weight (SCW) than post-WLS group without BCS, despite similar BMI; but no differences for 7/10 subscales. Compared post-abdominoplasty to non-BCS post-WLS group who were dissatisfied with abdomen. · After abdominoplasty, BCS group reported better MBSRQ AE, BAS, and SCW. Post-BCS, scores on MBSRQ-AE, Health Evaluation, Illness Orientation, BAS, Overweight Preoccupation, and SCW did not reach norms, but AO, Fitness Evaluation, Fitness Orientation, and Health Orientation did reach norms. Response rate: NI |
| Al-Hadithy (2014) | Cross-sectional 2 groups: 1. Post-WLS · Time since WLS: M=19.6 months 2. Post-BCS Time since WLS: M=38.7 months |
N=68 1. n=48 2. n=20 Gender: Female=44 Male=24 Race: NI Age: Age: 51 Post-WLS BMI: Overall NI Post-WLS BMI by groups ranged from 31.40 to 36.71 |
Restrictive WLS · n=38 Malabsorptive WLS · n=30 Abdominoplasty=24% Brachioplasty=19% Mastopexy=19% Interim abdominoplasty=9% Fleur-de-lys abdominoplasty=9% Lower body lift=5% Thigh lift=5% Mammaplasty=5% Neck reduction=5% |
DAS | Best results were observed in patients who had undergone BCS following restrictive WLS. The authors reported statistically significant improvement in DAS scores, although did not report description of body image analyses or statistical values. Response rate: 90.7% |
| Song (2006) | Longitudinal Pre-BCS: · Baseline Post-BCS: · 3 months · 6 months · Time since WLS: M:20.5 months |
N=18 Gender: Female=16 Male=2 Race: NI Age: 46±10 Post-WLS BMI: 29.4 |
WLS Type NI Abdominal contouring of panniculectomy or cosmetic abdominoplasty=18 Additional BCS=11 |
BISA CBIA PBIA PBSQOL |
Body image improved following BCS. Body image satisfaction improved in only areas that underwent BCS, and this change resulted in increased overall body satisfaction. Self-perception based on current body image silhouettes changes post-BCS. Self-perception of appearance did not change. Retention: 3 months: 100%, 6 months: 72% |
| Stuerz (2008) | Longitudinal Pre-BCS: · Baseline Post-BCS: · 3 months · 12 months · Time since WLS: NI |
N=34 Control group: Post-WLS without BCS: n=26 Gender: Female: 30 Male: 4 Race: NI Age: 37.1±9.3 Post-WLS BCS BMI: 27.1±5.1 Post-WLS Control BMI: 27.9±3.7 |
Band Abdominoplasty |
BPQ · Attractiveness Strauss and Appelts’ Questionnaire for Assessing One’s Body |
Compared to the control group, the post-BCS group reported significant improvements in the body image attractiveness/self-esteem subscale. At 12 months post-BCS, 8 (23.5%) had a second BCS procedure. Retention: 91.2% |
| Bracaglia (2011) | Longitudinal Pre-WLS: · Baseline Post-WLS: · 24 months Post-BCS: · 6 months |
N=47 Gender: Female: 40 Male: 7 Race: NI Age: 41.55±9.48 BMI post-WLS: 31.28±9.35 |
Biliopancreatic diversion Abdominoplasty=11 Abdominoplasty & mastopexy=7 Arm lift=7 Abdominoplasty & arm lift=6 Mastopexy & arm lift=6 Mastopexy=5 Abdominoplasty, mastopexy, & thigh contouring=5 |
BAT | High BAT body dissatisfaction scores pre-WLS. Post-BCS, body image improved but did not reach norms. Post-BCS, only patients experiencing mastopexy, alone or with arm lift, scored within normal range for BAT scores. When three or more plastic surgery procedures were performed, all patients showed BAT scores within the normal range. Retention: NI |
| Koller (2013) | Longitudinal Pre-BCS: · Baseline Post-BCS: · 6 months |
N=27 Gender: Females=25 Males= 2 Race: NI Age: 39.9±10.9 Post-WLS BMI: NI |
Bypass · n=16 Band · n=11 Circumferential body lift |
FBeK | Post-BCS, FBeK subscales attractiveness and self-confidence, as well as insecurity and uneasiness, improved significantly, while accentuation of one’s body and sensibility remained unchanged. Retention: NI |
| Grieco (2016) | Longitudinal Pre-BCS: · Baseline Post-BCS: · 3 months |
N=30 Gender: Females: 22 Male: 8 Race: NI Age: 50.5 Post-WLS BMI: 31.6 |
Bypass · n=13 Band · n=8 Sleeve gastrectomy · n=6 Other · n=3 Abdominoplasty |
BIA-O Figure Ratings: Evolution of the Standard Stimulating Figure Tests |
Post-BCS, patients reported slimmer body image perception based on the figure ratings. Retention: NI |
| Song (2016) | Longitudinal (2 cohorts) 1. Pre-WLS · Baseline Post-WLS · 6 months · 12 months · 24 months 2. Pre-BCS · Baseline Post-BCS · 6 months · 12 months |
N=216 1.WLS n=175 2.BCS n=41 Gender: NI Race: NI Age: NI Post-WLS BMI: NI |
Bypass Panniculectomy=32 Belt lipectomy=3 Lower body lift=2 Upper body lift=2 Breast reduction=2 |
MBSRQ | All MBSRQ subscales significantly improved after WLS except for Overweight Preoccupation; however, retention rates for the WLS group were extremely poor. After BCS, Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, and Self-Classified Weight improved significantly, but Overweight Preoccupation did not. Retention: 1. WLS: 6 months: 9.1% 12 months: 10.9% 24 months: 2.3% 2. BCS: 6 months: 75.6% 12 months: 65.9% |
| Vierhapper (2017) | Longitudinal Pre-BCS: · Baseline Post-BCS: · 32-83 months · Time since WLS: |
N=40 Gender: Female=40 Male=0 Race: NI Age: 40.9±10.3 Post-WLS BMI: 27.6±3.6 |
Bypass · n=32 Band · n=4 Lifestyle change · n=4 Lower body lift |
FBeK FKB-20 |
FBeK: Scores for attractiveness and self-confidence improved post-BCS, but did not reach norms. The other three subscales, accentuation of own body, insecurity and uneasiness, and sexual discomfort did not change post-BCS. FKB-20: “Dismissive Body Rating” improved significantly after BCS, but remained worse than normative data of healthy female students. FKB-20: 'Vital Body Dynamics' decreased significantly after BCS, signifying that realization of power, fitness, and health was worse after BCS and worse than data from healthy female students. Pre-operative problems like eczema, shame, and difficulties with sport activities and clothes fitting were significantly improved after BCS. 62% wished for further BCS Retention: 72.5% |
| Danilla (2016) | Scale Development | Phase 1: n=16 pre- and post-BCS Phase 2: 1) 1029 general population 2) cohort before BCS and 3 months after BCS 3) cohort 1 and 3 years post-BCS Phase 3: n=34 Test-retest 2-4 weeks after BCS All surgery demographics split by: - before surgery: n=55 - after surgery: n=37 - before and after surgery: n=17 |
NI Unclear whether all post-BCS patients had a history of WLS |
Phase 2 Body-QOL: 120 items · Satisfaction with body · Sex life · Self-esteem and social performance · Physical symptoms |
In surgical group, all scores improved significantly from pre-BCS to 3 months post-BCS. Patients who did not desire BCS scored better than patients who desired BCS. Patients with a history of BCS scored better than control group regardless of desire to have BCS. In WLS patients, pre- and post- scores were lower than in BCS patients, but the improvement before and after surgery was equal between groups. Post-WLS patients scored lower on all domains than BCS patients. Response Rate or Retention: NI for all phases |
| Klassen (2016) | Scale Development | 1. Both pre- and post-WLS asked to complete surveys at baseline, 1 week later, and 6 months later 2. Post-BCS patients 3. Exploring or seeking BCS and those who had BCS: Only those with history of WLS asked to complete Physical Scale and Symptoms checklist 4. Patients in weight loss program and collagen stimulation treatment Demographics by country |
NI | Body-Q · Appearance · Health-Related Quality of Life · Experience of healthcare |
The pre-WLS group reported lower (poorer) body image scores than the post-BCS group. Participants with greater excess skin reported lower (poorer) body image scores than participants with minimal excess skin. Response Rate or Retention: Overall NI |