Effects of Bariatric Surgery on Depression: Role of Body Image
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Effects of Bariatric Surgery on Depression: Role of Body Image Simone C. Behrens 1 & Konrad Lenhard 1 & Florian Junne 1 & Katrin Ziser 1 & Jessica Lange 2 & Stephan Zipfel 1 & Katrin E. Giel 1 & Martin Teufel 3 & Isabelle Mack 1 Received: 2 June 2020 / Revised: 8 October 2020 / Accepted: 13 October 2020 # The Author(s) 2020
Abstract Background It has been suggested that psychosocial functioning improves after bariatric surgery, but the mechanism of this effect remains unclear. We propose that body image mediates the association between %EWL and improvement in depressive symptoms. Materials and Methods To investigate this hypothesis, we conducted a mediation analysis in longitudinal data from 52 patients after LSG. Results %EWL had no direct effect on depressive symptoms as assessed through the patient health questionnaire (PHQ-9), but a small indirect effect that was mediated through negative evaluation of the body (BIQ-20). Conclusions We interpret this observation in the context of complex individual etiologies of obesity and argue for a stronger focus on psychological interventions in aftercare regimes. This may be specifically relevant for patients with eating disorders or a desire for body contouring surgery. Keywords Body image . Depression . Obesity . Bariatric surgery
Introduction Obesity is associated with significant psychosocial impairments: Compared with the normal weight population, patients have a higher rate of suffering from a psychological disorder such as depression, anxiety disorders, or eating disorders [1] and shared genetic loci for increased BMI and major psychiatric disorders are suggested [2]. Additionally, people with obesity report poor quality of life, high body image concerns, and frequent stigmatization [3–5]. While physicians typically focus on the physical and medical consequences of obesity, treatment seeking patients are often motivated by putative positive impacts on their psychosocial life [6].
* Simone C. Behrens [email protected] 1
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Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany Department of General-, Visceral- and Transplantation Surgery, Medical University Hospital Tübingen, Tübingen, Germany Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospita, University of Duisburg-Essen, Essen, Germany
It has been suggested that overall psychosocial functioning improves after bariatric surgery [4, 7], yet the likelihood of improvement and its mechanism remain unclear. A relevant mechanism of psychosocial functioning in obesity might be the interactions between disordered eating, depression and body image [4, 8, 9]. The latter is a fundamental aspect of the self-concept, because it is a constant characteristic and includes meaning of the body for self-esteem. Changing body weight does not necessarily result in a change in one’s self-concept. Therefore, body image could be relevant in obesity treatment beyond its role as an indicator of weight status r
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