Factors associated with excess skin after bariatric surgery: A mixed method study

Abstract

IntroductionAfter metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences.MethodsA mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage46.5±9.9 years, Mtimepost-MBS34.2±27.6 months). During Phase I, ES quantity (arms, abdomen, thighs) and inconveniences, sociodemographic, anthropometric, clinical and behavioral outcomes were assessed. In Phase II, 7 focus groups were performed with 37 participants from Phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data.ResultsQuantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r=.36, p<.01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r=.48, p<.05) and current BMI (r=.35, p<.05). Greater ES inconveniences was associated with higher social physique anxiety and age (R2=.50, p<.01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes.ConclusionsMeasured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.