Skip to main content

Advertisement

SpringerLink
Log in

The role of body image in obese identity changes post bariatric surgery

  • Review
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery.

Methods

We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed.

Results

According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown.

Conclusion

Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing.

Level I

Evidence obtained from: systematic reviews of experimental studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pokrajac Bulian A, Živčić Bećirević I (2005) Locus of control and selfesteem as correlates of body dissatisfaction in Croatian university students. Eur Eat Disord Rev 13(1):54–60. https://doi.org/10.1002/erv.606

    Article  Google Scholar 

  2. de Meireles AJ, Carlin, AM, Bonham AJ et al (2019) A longitudinal analysis of variation in psychological well-being and body image in patients before and after bariatric surgery. Ann Surg 271(5):885–890

  3. Cash TF, Melnyk SE, Hrabosky JI (2004) The assessment of body image investment: an extensive revision of the Appearance Schemas Inventory. Int J Eat Disord 35(3):305–316. https://doi.org/10.1002/eat.10264

    Article  PubMed  Google Scholar 

  4. Hrabosky JI, Masheb RM, White MA, Grilo CM (2007) Overvaluation of shape and weight in binge eating disorder. J Consult Clin Psychol 75(1):175. https://doi.org/10.1037/0022-006X.75.1.175

    Article  PubMed  Google Scholar 

  5. Gardner RM, Brown DL (2011) Method of presentation and sex differences when using a revised figural drawing scale to measure body size estimation and dissatisfaction. Percept Motor Skills 113(3):739–750. https://doi.org/10.2466/07.17.27.PMS.113.6.739-750

    Article  PubMed  Google Scholar 

  6. Halliwell E, Dittmar H (2006) Associations between appearance-related self-discrepancies and young 51 women’s and men’s affect, body satisfaction, and emotional eating: a comparison of fixed-item and participant 52 generated self-discrepancies. Personal Soc Psychol Bull 32(4):447–458. https://doi.org/10.1777/0146167205284005

    Article  Google Scholar 

  7. Geller S, Levy S, Goldzweig G et al (2019) Psychological distress among bariatric surgery candidates: the roles of body image and emotional eating. Clin Obes 9(2):9. https://doi.org/10.1111/cob.12298

    Article  Google Scholar 

  8. Grogan S (2016) Body image: understanding body dissatisfaction in men, women and children. Taylor & Francis

    Book  Google Scholar 

  9. Segura-García C, Papaianni MC, Rizza P, Flora S, De Fazio P (2012) The development and validation of the Body Image Dimensional Assessment (BIDA). Eat Weight Disord Stud Anorex Bulim Obes 17(3):e219–e225. https://doi.org/10.3275/8271

    Article  Google Scholar 

  10. Naliato E, Pinho M (2019) SAT-115 body image dissatisfaction and distortion in bariatric patients. J Endocr Soc 3(Supplement_1):SAT-115

    Article  Google Scholar 

  11. Schilder P, Cremante R, Poli M (1973) Immagine di sé e schema corporeo. Franco Angeli

  12. Nickel F, Schmidt L, Bruckner T et al (2017) Influence of bariatric surgery on quality of life, body image, and general self-efficacy within 6 and 24 months—a prospective cohort study. Surg Obes Relat Dis 13(2):313–319. https://doi.org/10.1016/j.soard.2016.08.017

    Article  PubMed  Google Scholar 

  13. Mento C, Le Donne M, Crisafulli S et al (2017) BMI at early puerperium: body image, eating attitudes and mood states. J Obstetr Gynaecol 37(4):428–434. https://doi.org/10.1080/01443615.2016.1250727

    Article  Google Scholar 

  14. Slade PD (1994) What is body image? Behav Res Ther 32(5):497–502

  15. Pona AA, Heinberg LJ, Lavery M et al (2016) Psychological predictors of body image concerns 3 months 26 after bariatric surgery. Surg Obes Relat Dis 12(1):188–193. https://doi.org/10.1016/j.soard.2015.05.008

    Article  PubMed  Google Scholar 

  16. Monpellier VM, Antoniou EE, Mulkens S et al (2018) Body image dissatisfaction and depression in 30 postbariatric patients is associated with less weight loss and a desire for body contouring surgery. Surg Obes Relat Dis 14(10):1507–1515. https://doi.org/10.1016/j.soard.2018.04.016

    Article  PubMed  Google Scholar 

  17. Phelan SM, Burgess DJ, Yeazel MW et al (2015) Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 16(4):319–326. https://doi.org/10.1111/obr.12266

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Perdue TO, Schreier A, Swanson M, Neil J, Carels R (2019) Majority of female bariatric patients retain an obese identity 18–30 months after surgery. Eat Weight Disord Stud Anorex Bulim Obes. https://doi.org/10.1007/s40519-018-0601-3

    Article  Google Scholar 

  19. Perdue TO, Schreier A, Swanson M et al (2018) Evolving self view and body image concerns in female 43 postoperative bariatric surgery patients. J Clin Nurs 27(21–22):4018–4027. https://doi.org/10.1111/jocn.14527

    Article  PubMed  Google Scholar 

  20. Pavan C, Marini M, De Antoni E et al (2017) Psychological and psychiatric traits in post-bariatric patients asking for body-contouring surgery. Aesthet Plast Surg 41(1):90–97–896. https://doi.org/10.1007/s00266-016-0752-4 ((49))

    Article  Google Scholar 

  21. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement (Chinese edition). J Chin Integr Med 7(9):889

  22. Alegrìa CA, Larsen B (2015) “That’s who I am: a fat person in a thin body”: Weight loss, negative selfevaluation, and mitigating strategies following weight loss surgery. J Am Assoc Nurse Pract 27:137–144

    Article  Google Scholar 

  23. Biörserud C, Shams K, Elander A et al (2018) Self-image after bariatric surgery and its relationship to gender, excess skin and health-related quality of life. J Plast Surg Hand Surg 52(5):288–293. https://doi.org/10.1080/2000656x.2018.1481860

    Article  PubMed  Google Scholar 

  24. Faccio E, Nardin A, Cipolletta S (2016) Becoming ex-obese: narrations about identity changes before and after the experience of the bariatric surgery. J Clin Nurs. https://doi.org/10.1111/jocn.13222

    Article  PubMed  Google Scholar 

  25. Fernandez L, Rubinstein M, Dumet N, Dargent L, Parrocchetti JP (2015) Obésité sévère, perte de poids et image du corps après la chirurgie bariatrique Severe obesity, weight loss and body image after bariatric surgery. Obésité 10:151–159

    Article  Google Scholar 

  26. Gilmartin J, Bath-Hextall F, Maclean J et al (2016) Quality of life among adults following bariatric and body contouring surgery: a systematic review. JBI Database System Rev Implement Rep 14(11):240–270

    Article  Google Scholar 

  27. Lacerda R, Resende M, Castanha CR et al (2018) Perception of body image by patients undergoing bariatric surgery. Rev Col Bras Cir. https://doi.org/10.1590/0100-6991e-20181793

    Article  PubMed  Google Scholar 

  28. Williams GA, Hudson DL, Whisenhunt BL et al (2018) Short-term changes in affective, behavioral, and cognitive components of body image after bariatric surgery. Surg Obes Relat Dis 14(4):521–526. https://doi.org/10.1016/j.soard.2017.12.026

    Article  PubMed  Google Scholar 

  29. Neven K, Dymek M, Maasdam H, Boogerd AC, Alverdy J (2002) The effects of Roux-en-Y gastric bypass surgery on body image. Obes Surg 12(2):265–269. https://doi.org/10.1381/096089202762552755

    Article  PubMed  Google Scholar 

  30. Adami GF, Meneghelli A, Bressani A, Scopinaro N (1999) Body image in obese patients before and after 26 stable weight reduction following bariatric surgery. J Psychosom Res 46(3):275–281. https://doi.org/10.1016/S0022-3999(98)00094-4

    Article  CAS  PubMed  Google Scholar 

  31. Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH (2006) Body image and quality of life in post massive weight loss body contouring patients. Obesity 14(9):1626–1636. https://doi.org/10.1038/oby.2006.187

    Article  PubMed  Google Scholar 

  32. Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN (2010) Changes in quality of 35 life and body image after gastric bypass surgery. Surg Obes Relat Dis 6(6):608–614. https://doi.org/10.1016/j.soard.2010.07.015

    Article  PubMed  PubMed Central  Google Scholar 

  33. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric 40 surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737

    Article  CAS  Google Scholar 

  34. van Hout GC, Boekestein P, Fortuin FA, Pelle AJ, van Heck GL (2006) Psychosocial functioning following 44 bariatric surgery. Obes Surg 16(6):787–794. https://doi.org/10.1381/096089206777346808

    Article  PubMed  Google Scholar 

  35. Varns JA, Fish AF, Eagon JC (2018) Conceptualization of body image in the bariatric surgery patient. Appl Nurs Res 41:52–58. https://doi.org/10.1016/j.apnr.2018.03.008

    Article  PubMed  Google Scholar 

  36. Ristanto A, Caltabiano ML (2019) Psychological support and well-being in post-bariatric surgery patients. Obes Surg 29(2):739–743. https://doi.org/10.1007/s11695-018-3599-8

    Article  PubMed  Google Scholar 

  37. Wilfley DE, Bishop ME, Wilson GT, Agras WS (2007) Classification of eating disorders: toward DSMV. Int J Eat Disord 40(S3):S123–S129. https://doi.org/10.1002/eat.20436

    Article  PubMed  Google Scholar 

  38. Wonderlich SA, Gordon KH, Mitchell JE, Crosby RD, Engel SG (2009) The validity and clinical utility of binge eating disorder. Int J Eat Disord 42(8):687–705. https://doi.org/10.1002/eat.20719

    Article  PubMed  Google Scholar 

  39. Goldschmidt AB, Hilbert A, Manwaring JL, Wilfley DE, Pike KM, Fairburn CG, Striegel-Moore RH (2010) The significance of overvaluation of shape and weight in binge eating disorder. Behav Res Ther 48(3):187–193. https://doi.org/10.11124/JBISRIR-2016-003182

    Article  PubMed  Google Scholar 

  40. Sorbara M, Geliebter A (2002) Body image disturbance in obese outpatients before and after weight loss in relation to race, gender, binge eating, and age of onset of obesity. Int J Eat Disord 31(4):416–423. https://doi.org/10.1002/eat.10046

    Article  PubMed  Google Scholar 

  41. Hilbert A, Tuschen-Caffier B, Vögele C (2002) Effects of prolonged and repeated body image exposure in binge-eating disorder. J Psychosom Res 52(3):137–144. https://doi.org/10.1016/S0022-3999(01)00314-2

    Article  PubMed  Google Scholar 

  42. Legenbauer T, Petrak F, de Zwaan M, Herpertz S (2011) Influence of depressive and eating disorders on 15 short-and long-term course of weight after surgical and nonsurgical weight loss treatment. Compr Psychiatry 52(3):301–311. https://doi.org/10.1016/j.comppsych.2010.06.012

    Article  PubMed  Google Scholar 

  43. Mussell MP, Peterson CB, Weller CL, Crosby RD, De Zwaan M, Mitchell JE (1996) Differences in body 19 image and depression among obese women with and without binge eating disorder. Obes Res 4(5):431–439. https://doi.org/10.1002/j.1550-8528.1996.tb00251.x

    Article  CAS  PubMed  Google Scholar 

  44. Fichter MM, Quadflieg N, Brandl B (1993) Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity. Int J Eat Disord 14(1):1–16. https://doi.org/10.1002/1098-108X(199307)14:1<1::AID-EAT2260140102>3.0.CO;2-3

  45. Lewer M, Nasrawi N, Schroeder D, Vocks S (2016) Body image disturbance in binge eating disorder: a 29 comparison of obese patients with and without binge eating disorder regarding the cognitive, behavioral and 30 perceptual component of body image. Eat Weight Disord Stud Anorex Bulim Obes 21(1):115–125. https://doi.org/10.1007/s40519-015-0200-5

    Article  Google Scholar 

  46. Chao AM, Wadden TA, Faulconbridge LF, Sarwer DB, Webb VL, Shaw JA, Williams NN (2016) 36 Binge eating disorder and the outcome of bariatric surgery in a prospective, observational study: two year 37 results. Obesity 24(11):2327–2333. https://doi.org/10.1002/oby.21648

    Article  PubMed  Google Scholar 

  47. Stolberg CR, Mundbjerg LH, Funch-Jensen P et al (2018) Effects of gastric bypass surgery followed by 41 supervised physical training on inflammation and endothelial function: a randomized controlled trial. Atherosclerosis 273:37–44. https://doi.org/10.1016/j.atherosclerosis.2018.04.002

    Article  CAS  PubMed  Google Scholar 

  48. Mento C, Silvestri MC, Bruno A, Muscatello MRA, Rizzo A, Celona G, Navarra G, Zoccali RA (2021) Body image and obese identity in bariatric patients. In: Psychological factors and clinical management. Series Psychology Research Progress, Nova Publisher, BISAC: PSY036000

Download references

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Clinical Psychology, Psychiatric Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico Hospital Messina, University of Messina, Consolare Valeria str. 1, 98125, Messina, Italy

    Carmela Mento

  2. University of Messina, Messina, Italy

    Maria Catena Silvestri & Clemente Cedro

  3. Psychiatric Unit, BIOMORF Department, Policlinico Hospital in Messina, University of Messina, Messina, Italy

    Maria Rosaria Anna Muscatello, Rocco Antonio Zoccali & Antonio Bruno

  4. Psychiatric Unit, Policlinico Hospital Messina, University of Messina, Messina, Italy

    Amelia Rizzo & Laura Celebre

  5. General Surgery Unit, Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy

    Giuseppe Navarra

Authors
  1. Carmela Mento
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Catena Silvestri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Rosaria Anna Muscatello
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amelia Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Celebre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Clemente Cedro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rocco Antonio Zoccali
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giuseppe Navarra
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antonio Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors participated in the concept and writing of this manuscript. All authors approved the final version of this manuscript.

Corresponding author

Correspondence to Carmela Mento.

Ethics declarations

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Informed consent

For this study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mento, C., Silvestri, M.C., Muscatello, M.R.A. et al. The role of body image in obese identity changes post bariatric surgery. Eat Weight Disord 27, 1269–1278 (2022). https://doi.org/10.1007/s40519-021-01270-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-021-01270-w

Keywords

Search

Navigation