Skip to main content

Advertisement

Log in

Body Image and Emotional Eating as Predictors of Psychological Distress Following Bariatric Surgery

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to shed light on the ambiguity concerning the variables affecting psychological distress following bariatric surgery, specifically the roles of body image dissatisfaction (BID) and emotional eating in detecting and predicting such outcomes.

Methods

Of 169 consecutive bariatric surgery candidates from a university-based bariatric center, who participated in the psychosocial pre-surgery survey from 2015 to 2017 (67% females, mean age 41.8 years (SD = 11.46), mean body mass index (BMI) 42.0 kg/m2 (SD = 11.0)), 81 patients consented to be included in the follow-up phase (56% females, mean age 44.3 years (SD = 12.3, range 21–70), and BMI 30.1 kg/m2 (SD = 6.2, range 19.7 to 56.2)). Risk of suicide (SBQ-R), depressive symptoms (PHQ-9), anxiety symptoms (PHQ-7), emotional eating behaviors (EES), and body image dissatisfaction (BID-BSQ8) measures were assessed before and after surgery.

Results

Post-surgery improvements were observed in body image and emotional eating total measures, as well as in percent total weight loss (TWL%) and percent excess weight loss (EWL%), but not in psychological distress outcomes. However, improvement in BID predicted better post-surgery in all the psychological distress outcomes whereas improvement in emotional eating predicted less post-surgery depression. Post-surgery BID positively correlated with depression and anxiety, whereas post-surgery emotional eating positively correlated with anxiety.

Conclusions

Weight loss is insufficient to determine a change in psychological distress following surgery. Physicians and other health professionals who treat bariatric surgery patients should be encouraged to asses BID pre- and post-surgery, as it is a sensitive indicator of improvement of psychological well-being after surgery.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Welbourn R, Small P, Finlay I, et al. The United Kingdom National Bariatric Surgery Registry. Second Registry Report 2014. Nbsr 2014:1–220. Available online: http://nbsr.co.uk/wp-content/uploads/2014/11/Extract_from_the_NBSR_2014_Report.pdf.

  2. Jumbe S, Bartlett C, Jumbe SL, et al. The effectiveness of bariatric surgery on long term psychosocial quality of life–a systematic review. Obes Res Clin Pract. 2016;10(3):225–42. https://doi.org/10.1016/j.orcp.2015.11.009.

    Article  PubMed  Google Scholar 

  3. Alabi F, Guilbert L, Villalobos G, et al. Depression before and after bariatric surgery in low-income patients: the utility of the Beck Depression Inventory. Obes Surg. 2018;28:3492–8.

    Article  Google Scholar 

  4. Mamplekou E, Komesidou V, Bissias CH, et al. Psychological condition and quality of life in patients with morbid obesity before and after surgical weight loss. Obes Surg. 2005;15(8):1177–84.

    Article  CAS  Google Scholar 

  5. Gordon K, King W, White G, et al. A prospective, longitudinal examination of suicidal ideation among bariatric surgery patients. Surg Obes Relat Dis. 2016;12(7):S44–5.

    Article  Google Scholar 

  6. van Hout GC, Boekestein P, Fortuin FA, et al. Psychosocial functioning following bariatric surgery. Obes Surg. 2006;16(6):787–94.

    Article  Google Scholar 

  7. de Zwaan M, Enderle J, Wagner S, et al. Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133(1–2):61–8.

    Article  Google Scholar 

  8. Castaneda D, Popov VB, Wander P, et al. Risk of suicide and self-harm is increased after bariatric surgery—a systematic review and meta-analysis. Obes Surg. 2019;29(1):322–33. https://doi.org/10.1007/s11695-018-3493-4.

    Article  PubMed  Google Scholar 

  9. Dixon JB, Dixon ME, O’Brien PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med. 2003;163(17):2058–65.

    Article  Google Scholar 

  10. Mack I, Ölschläger S, Sauer H, et al. Does laparoscopic sleeve gastrectomy improve depression, stress and eating behaviour? A 4-year follow-up study. Obes Surg. 2016;26(12):2967–73.

    Article  Google Scholar 

  11. Rutledge T, Braden AL, Woods G, et al. Five-year changes in psychiatric treatment status and weight-related comorbidities following bariatric surgery in a veteran population. Obes Surg. 2012;22(11):1734–41.

    Article  Google Scholar 

  12. Jumbe S, Hamlet C, Meyrick J. Psychological aspects of bariatric surgery as a treatment for obesity. Curr Obes Rep. 2017;1:71–8.

    Article  Google Scholar 

  13. Sarwer DB, Bishop-Gilyard CT, Carvajal R. Quality of life. In: Still CD, Sarwer DB, Blankenship J, editors. The ASMBS textbook of bariatric surgery, Vol. 2: Integrated health. New York: Springer; 2014. p. 19–24.

    Google Scholar 

  14. Peat CM, Peyerl NL, Muehlenkamp JJ. Body image and eating disorders in older adults: a review. J Gen Psychol. 2008;135:343–8.

    Article  Google Scholar 

  15. Marks DF. Homeostatic theory of obesity. Health Psychol Open. 2015;29:2. https://doi.org/10.1177/2055102915590692.

    Article  Google Scholar 

  16. Libeton M, Dixon JB, Laurie C, et al. Patient motivation for bariatric surgery: characteristicsand impact on outcomes. Obes Surg. 2004;14:392–8. https://doi.org/10.1381/096089204322917936.

    Article  PubMed  Google Scholar 

  17. Guerdjikova AI, West-Smith L, McElroy SL, et al. Emotional eating and emotional eating alternatives in subjects undergoing bariatric surgery. Obes Surg. 2007;17:1091–6.

    Article  Google Scholar 

  18. Walfish S. Self-assessed emotional factors contributing to increased weight gain in pre-surgical bariatric patients. Obes Surg. 2004;14:1402–5.

    Article  Google Scholar 

  19. Geller S, Levy S, Goldzweig G, et al. Psychological distress among bariatric surgery candidates: the roles of body image and emotional eating. Clin Obes. 2019;9(2):e12298.

    Article  Google Scholar 

  20. Sarwer DB, Wadden TA, Moore RH, et al. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis. 2010;6(6):608–14.

    Article  Google Scholar 

  21. Teufel M, Rieber N, Meile T, et al. Body image after sleeve gastrectomy: reduced dissatisfaction and increased dynamics. Obes Surg. 2012;22(8):1232–7.

    Article  Google Scholar 

  22. Hrabosky JI, Masheb RM, White MA, et al. A prospective study of body dissatisfaction and concerns in extremely obese gastric bypass patients: 6-and 12-month postoperative outcomes. Obes Surg. 2006;16(12):1615–21.

    Article  Google Scholar 

  23. Larsen JK, van Ramshorst B, Geenen R, et al. Binge eating and its relationship to outcome after laparoscopic adjustable gastric banding. Obes Surg. 2004;14(8):1111–7.

    Article  Google Scholar 

  24. Nasirzadeh Y, Kantarovich K, Wnuk S, et al. Binge eating, loss of control over eating, emotional eating, and night eating after bariatric surgery: results from the Toronto Bari-PSYCH Cohort Study. Obes Surg. 2018;28(7):2032–9. https://doi.org/10.1007/s11695-018-3137-8.

    Article  PubMed  Google Scholar 

  25. O’brien KS, Latner JD, Puhl RM, et al. The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite. 2016;102:70–6. https://doi.org/10.1016/j.appet.2016.02.032.

    Article  PubMed  Google Scholar 

  26. Evans C, Dolan B. Body shape questionnaire: derivation of shortened “alternate forms”. Int J Eat Disord. 1993;13:315–21.

    Article  CAS  Google Scholar 

  27. Arnow B, Kenardy J, Agras WS. The Emotional Eating Scale: the development of a measure to assess coping with negative affect by eating. Int J Eat Disord. 1995;18:79–90.

    Article  CAS  Google Scholar 

  28. Osman A, Bagge CL, Gutierrez PM, et al. The Suicidal Behaviors Questionnaire–Revised (SBQ–R). Validation with clinical and nonclinical samples. Assessment. 2001;4:443–54. https://doi.org/10.1177/107319110100800409.

    Article  Google Scholar 

  29. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.

    Article  CAS  Google Scholar 

  30. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.

    Article  Google Scholar 

  31. Brethauer SA, Kim J, El Chaar M, et al. ASMBS Clinical Issues Committee. Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015;25:587–606. https://doi.org/10.1016/j.soard.2015.02.003.

    Article  PubMed  Google Scholar 

  32. Micanti F, Loiarro G, Pecoraro G, et al. Preventing weight regain: what’s the importance of body image change after bariatric surgery? J Nutr Disorders Ther. 2016;6:4.

    Google Scholar 

  33. Strain GW, Kolotkin RL, Dakin GF, et al. The effects of weight loss after bariatric surgery on health-related quality of life and depression. Nutr Diabetes. 2014;4:e132.

    Article  CAS  Google Scholar 

  34. Bertoletti J, Galvis Aparicio MJ, Bordignon S, et al. Body image and bariatric surgery: a systematic review of literature. Bariatric Surg Pract Patient Care. 2019;14(2):81–92.

    Article  Google Scholar 

  35. van Strien T. Causes of emotional eating and matched treatment of obesity. Curr Diab Rep. 2018;18(6):35.

    Article  Google Scholar 

  36. Canetti L, Berry EM, Elizur Y. Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight loss program: the mediating role of emotional eating. Int J Eat Disord. 2009;42(2):109–17.

    Article  Google Scholar 

  37. Busetto L, Buongiorno F, Schiff S. Studies on body image changes after bariatric surgery in adults. In: Cuzzolaro M, Fassino S, editors. Body image, eating, and weight. Cham: Springer; 2018. p. 233–45.

    Chapter  Google Scholar 

  38. Song AY, Rubin JP, Thomas V, et al. Body image and quality of life in post massive weight loss body contouring patients. Obesity. 2006;14:1626–36.

    Article  Google Scholar 

  39. Efferdinger C, König D, Klaus A, et al. Emotion regulation and mental well-being before and six months after bariatric surgery. Eat Weight Disord. 2017;22(2):353–60.

    Article  Google Scholar 

  40. Berman MI, Morton SN, Hegel MT. Health at every size and acceptance and commitment therapy for obese, depressed women: treatment development and clinical application. Clin Soc Work J. 2016;44:265–78. https://doi.org/10.1007/s10615-015-0565-y.

    Article  Google Scholar 

  41. Braden A, Flatt SW, Boutelle KN, et al. Emotional eating is associated with weight loss success among adults enrolled in a weight loss program. J Behav Med. 2016;39(4):727–32.

    Article  Google Scholar 

  42. Thereaux J, Lesuffleur T, Païta M, et al. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg. 2017;104(10):1362–71. https://doi.org/10.1002/bjs.10557.

    Article  CAS  PubMed  Google Scholar 

  43. Sakran N, Raziel A, Goitein O, et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3003 patients: results at a high-volume bariatric center. Obes Surg. 2016;26(9):2045–50.

    Article  Google Scholar 

  44. Ivezaj V, Grilo CM. The complexity of body image following bariatric surgery: a systematic review of the literature. Obes Rev. 2018;19(8):1116–40.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

All authors declare that they have substantially contributed to the manuscript and have met the main criteria of authorship: conceptualization, methodology, data collecting and processing, writing and editing, and supervision.

Corresponding author

Correspondence to Shulamit Geller.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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

Geller, S., Dahan, S., Levy, S. et al. Body Image and Emotional Eating as Predictors of Psychological Distress Following Bariatric Surgery. OBES SURG 30, 1417–1423 (2020). https://doi.org/10.1007/s11695-019-04309-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-019-04309-1

Keywords

Navigation