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Body image expectations

Study exposes surgical body image expectations

Self-ideal body shape discrepancy was calculated as the difference between participants’ mean current body shape and mean goal/ideal body shape using the equation (self-ideal body shape discrepancy = current shape-ideal shape
The majority (53%) of candidates incorrectly identified the silhouette associated with their actual BMI by under-estimating actual true size.

Female bariatric patients experience body image dissatisfaction in their postoperative body shape following laparoscopic sleeve gastrectomy (LSG), according to a study 'Body shape expectations and self-ideal body shape discrepancy in women seeking bariatric surgery: a cross-sectional study', published in BMC Obesity. In addition, the authors report that many patients actually underestimate their actual body size.

The authors note that body image disturbance is individual’s misperception of body size, inaccurate assessment of body part size, concern about body attributes, and/ or inability to determine a realistic attainable size. They also state that “the evidence suggests that unmet expectations may negatively impact postoperative outcomes such as treatment satisfaction, weight loss, mood, and behaviour maintenance, or motivate patients to pursue weight maintenance behaviours.” Indeed, these unmet expectations can lead to weight regain.

Therefore, the researchers from Memorial University of Newfoundland, St John's, Canada designed a study to describe the body shape expectations and self-ideal body shape discrepancy in women seeking LSG surgery in Newfoundland and Labrador (NL), Canada.

Study

Sixty nine female candidates for bariatric surgery were eligible for inclusion in the cross-sectional survey study, although there was an insufficient sample size to support meaningful conclusions about males in this sample population (n=7).

All patients were invited to attend an education session and agreed to complete a questionnaire before the start of the session. The study used the Goals and Relative Weights Questionnaire (GRWQ) and the validated Silhouette Figure Rating Scale (SFRS) to evaluate different levels of body shape expectation and self-ideal body shape. All data were self-reported.

Self-ideal body shape discrepancy was calculated as the difference between participants’ mean current body shape and mean goal/ideal body shape using the equation (self-ideal body shape discrepancy = current shape-ideal shape. The researchers also used the terminology goal body shape interchangeably with ideal body shape to allow integration between the two (SFRS and the GRWQ) scales.

Figure 1A shows the evaluated different levels of body shape expectation and self-ideal body shape discrepancy, the patients’ ‘dream’, ‘happy’, ‘acceptable’ and ‘disappointed’ body shape expectations on the modified scale to allow for visual estimation of the BMI and obesity class associated with each of these expectation categories.

Figure 1B shows the women’s mean actual BMI, calculated based on self-reported height and weight data, with the mean current perceived and goal body shapes to provide a visual reference to candidates’ current weight status compared to their body perceptions.

Figure 1 Body shape expectations of women seeking laparoscopic sleeve gastrectomy compared to average clinically expected %EWL 1-year post surgery. A depicts the silhouettes associated with women’s ‘dream’,’happy’, ‘acceptable’ and ‘disappointed’ postoperative body shape expectations. B depicts the goal, current perceived, and actual self-reported silhouettes of women seeking LSG compared to the range of clinically expected body shapes 1-year post bariatric surgery. Dotted area indicates the range of silhouettes clinically expected one-year after LSG based on a 56.1%EWL in this sample of women. BMI values assigned according to population normative data [57]. Obesity classes arranged according to Canadian Clinical Practice Guidelines. n = 69, less than 10% missing data. Reprinted with permission from Stunkard AJ, Sorenson T, Schulsinger F: Use of the Danish Adoption Register for the study of obesity and thinness. In The Genetics of Neurological and Psychiatric Disorders. Edited by Kety SS, Rowland LP, Sidman RL, Matthysse SW. New York: Raven Press; 1983: 115-120.

“Study participants had a self-ideal body shape discrepancy of 4.1+1.3 silhouettes, indicating considerable discrepancy between their self-perceived current body image and the image of their ideal body,” the authors write. “The positive nature of this value indicates that women idealised a thinner silhouette along the figure rating scale.”

The majority (53%) of candidates incorrectly identified the silhouette associated with their actual BMI (self-perceived current body shape = 8.2+0.8 silhouettes) by under-estimating actual true size.

The patients’ desired weight loss was 30.0+17.2kg for a ‘disappointed’ weight and 62.7+18 .0kg for a ‘dream’ weight or a 22.3+11.9% to 47.2+8.5% loss of total body weight from bariatric surgery.

“Participants’ postoperative body shape expectations did not correspond with evidence-based one-year weight loss outcomes from LSG surgery. Participants in the current study could at best ‘accept’ or be ‘disappointed’ with their clinically expected postoperative body shape…If surgery is perceived to be unsuccessful from the patient’s perspective, this may have potential psychological and emotional clinical implications that could possibly be addressed with further education and counselling,” the authors note. 

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