Psychological distress among bariatric surgery candidates: The roles of body image and emotional eating

Abstract

The increased risk of psychological distress among bariatric surgery candidates may be attributed, at least in part, to body image dissatisfaction (BID). The aim of the present study was to test the hypotheses that body image could be correlated with the psychological distress variables, and that emotional eating behaviours could mediate the relationship between body image and psychological distress. A sample of consecutive participants seeking bariatric surgery (N = 169, 67% females, mean age, 41.8 years [SD = 11.46], mean body mass index 42.0 kg/m 2 [SD = 11.0]) was recruited from a university-based bariatric centre, a week prior to scheduled surgery. Results showed that BID was positively correlated with suicidality (r = 0.18, P < 0.05), depression (r = 0.39, P < 0.01) and anxiety (r = 0.20, P < 0.05). The relation between BID and depression was partially mediated by emotional eating, whereas the relation between BID and suicidality was fully mediated by emotional eating. Physicians and other health professionals who treat bariatric surgery patients should be encouraged to detect behaviours indicating emotional eating, as these could be an indicator of psychological distress resulting from poor body image. K E Y W O R D S bariatric surgery, body image dissatisfaction, emotional eating, psychological distress 1 | INTRODUCTION The epidemic of overweight and obesity presents a global major challenge to chronic disease prevention and health across the life course. 1,2 Bariatric surgery is the most effective treatment for promoting weight loss and improving obesity-related physical comorbidity. 3Patients seeking bariatric surgery cope with diverse challenges that are associated with psychological distress, such as past-year (suicide attempts) (9%), and suicidal ideation (thoughts of harming, or killing oneself), compared to family, community members 4 and other (non-bariatric) surgery candidates. 5The increased risk of depression, anxiety and suicidality (suicidality will be used hereinafter to refer to suicidal behaviours ideation and attempts) 6 among bariatric surgery candidates, may be attributed in part to a severe decrease in their quality of life. 7 Body image dissatisfaction (BID) may substantially impair the psychological quality of life of these candidates.BID is defined as the negative perceptions and feelings one has about the body. 8 Evidence indicates that individuals with extreme obesity, especially females, tend to be more dissatisfied with their bodies than their normal weight counterparts. 3 Moreover, among bariatric surgery patients BID was found to be associated with lower self-esteem, weight-related stigma or overt discrimination, increased symptoms of depression, 9,10 anxiety 11,12 and psychiatric problems. 13,14 However, there is a paucity of data concerning the association of BID with suicidality in bariatric surgery patients, and results are varied.While there is some evidence that such an association does exist, at least among adolescents with disordered eating behaviours, 15,16 other stud...

Body Image, Emotional Eating and Psychological Distress among Bariatric Surgery Candidates in Israel and the United States

“…The original English version of these three questionnaires were translated to Hebrew in previous studies (for details see [15]).…”

“…Evidence has shown that extremely obese individuals, especially females, are generally less satisfied with their bodies than the normal-weight population [3]. Furthermore, BID was found related to weight-related stigma, lower self-esteem, overt discrimination, increased symptoms of depression [9,10], anxiety [11,12], psychiatric problems, [13,14], and suicidality [15] among bariatric surgery patients. Monitoring and identifying the underlying mechanisms involved in the psychological well-being of bariatric surgery candidates is, therefore, vital, as it may improve surgery preparation and thereby promote greater satisfaction with the process.…”

“…A step toward incorporating psychological well-being in the process of preparing for bariatric surgery was made in a recent Israeli study [15] that identified a positive correlation between preoperative BID and psychological distress, specifically, depressive, and anxiety symptoms and suicidality. Their findings suggested that emotional eating should be integrated in the model in order to capture the externalized and internalized weight bias stigma that affects depression and suicidality in bariatric surgery candidates.…”

“…As emotional eating patterns are culture dependent [24], there is a need to test this model [15] across different cultures. Understanding the similarities and discrepancies between cultures in terms of their impact on bariatric surgery candidates is critical for adapting effective psychological interventions from one culture to another and developing personalized medicine for patients prior to surgery.…”

“…The present study aimed to broaden the examination of the associations between BID and psychological distress variables that were found among bariatric surgery candidates in Israel [15] and to compare the results with a different culture, namely, upstate New York. Specifically, we sought to examine whether cultural differences have an impact on Geller et al's [15] mediation model, according to which the relationship between body image and psychological distress is mediated through emotional eating.…”