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Body Shape Expectations and Self-Ideal Body Shape Discrepancy

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Body Shape Expectations and Self-Ideal Body Shape Discrepancy Price et al. BMC Obesity (2014) 1:28 DOI 10.1186/s40608-014-0028-y RESEARCH ARTICLE Open Access Body shape expectations and self-ideal body shape discrepancy in women seeking bariatric surgery: a cross-sectional study Hilary I Price1, Deborah M Gregory1,2 and Laurie K Twells1,3* Abstract Background: Postoperative body shape expectations (BSE) of bariatric surgery candidates remain relatively unexplored, and may have important implications for weight loss outcomes, treatment satisfaction, and education. Methods: The ‘Silhouette Figure Rating Scale’ was administered to 69 consecutive female candidates. Self-perceived current and goal body shape and postoperative BSE in four categories; “dream, “happy”, “acceptable”,and“disappointed” were examined. Results: The mean age and BMI of the sample was 43.4 ± 8.9 years and 48.8 ± 7.0 kg/m2. Self-ideal body shape discrepancy of 4.1 ± 1.3 silhouettes was reported, indicating body image dissatisfaction. 53% incorrectly identified the silhouette associated with their actualBMI.Goalbodyshape(4.3±0.8silhouettes) corresponded to a BMI figure 23.1 kg/ m2- 26.2 kg/m2. The postoperative “dream” (4.1 ± 1.0 silhouettes), “happy” (5.0 ± 0.8 silhouettes), “acceptable” (5.3 ± 1.0 silhouettes), and “disappointed” (6.9 ± 1.0 silhouettes) BSE corresponded to silhouettes that were thinner than the thinnest silhouette clinically expected based on a 56.1% excess weight loss 1-year after laparoscopic sleeve gastrectomy (LSG) or a 22.3% to 47.2% total body weight loss. Conclusions: Women seeking bariatric surgery experience body image dissatisfaction and misperceive their actual body size. BSE do not correspond with evidence-based LSG weight loss outcomes. Keywords: Body shape expectations, Silhouette, Bariatric surgery, Laparoscopic sleeve gastrectomy Background weight loss by reducing the stomach volume by 80%, leav- Excess weight is a risk factor for the development of many ing a small stomach ‘sleeve’ [2,4,5]. Average clinically ex- associated comorbidities including hypertension, Type 2 pected percent excess weight loss (%EWL) 1- year after diabetes, cardiovascular disease, osteoarthritis, sleep apnea, LSG is 56.1% [6]. The primary focus of bariatric surgery certain cancers, and premature mortality [1-3]. Bariatric has been weight loss associated with these procedures; (weight loss) surgery is a treatment known to promote sig- however many other psychosocial (e.g., eating disorder), nificant, sustainable weight loss in individuals with class III health (e.g., improvement/resolution in comorbid condi- obesity (BMI ≥ 40 kg/m2) and individuals with medically tions), and quality of life related benefits (e.g., mobility, self complicated class II obesity (BMI 35.0-39.9 kg/m2 with a care, usual activities, pain, anxiety, depression) are ob- major comorbidity) [4]. Laparoscopic sleeve gastrectomy served postoperatively [4,7-18]. (LSG) is a restrictive type bariatric surgery that promotes Body image disturbance describes an individual’smis- perception of body size, inaccurate assessment of body part size, concern about body attributes, and/ or inability * Correspondence: [email protected] 1Clinical Epidemiology Unit, Health Sciences Centre, Faculty of Medicine, to determine a realistic attainable size [9,19-21]. The rela- Memorial University of Newfoundland, Room 1715, 300 Prince Philip DriveNL tionship between body image and obesity in adults and A1B 3V6 St. John’s, Canada the issue of body image dissatisfaction and its clinical sig- 3School of Pharmacy, Health Sciences Centre, Memorial University of Newfoundland, Room 3445, 300 Prince Philip Drive, St. John’sNL A1B 3V6 St. nificance has been the focus of a number of researchers John’s, Canada [15,22]. Studies have demonstrated that body image Full list of author information is available at the end of the article © 2014 Price et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Price et al. BMC Obesity (2014) 1:28 Page 2 of 7 disturbance improves following bariatric surgery [7,16, 2011 and March 2012 (n = 69) were eligible for inclusion 9-14,23,24]. This has been observed despite differences in in this cross-sectional survey study. There was an insuffi- the surgical populations investigated, aspects of body cient sample size to support meaningful conclusions about image disturbance measured, survey instruments used, males in this sample population (n = 7). Individuals were and study design. invited to attend the education session if the bariatric Body shape expectations and self-ideal body shape dis- nurse practitioner determined them to be eligible for bariat- crepancy are components of body image disturbance ric surgery based on screening of their physician referral that focus on specific expectations of body shape, and form and the Canadian clinical practice guidelines [4]. All the discrepancy between perceived current body shape eligible candidates agreed to complete the questionnaire be- and ideal body shape, respectively [25,26]. Self-ideal fore the start of the education session. All candidates agreed body shape discrepancy has been used as an indicator of to participate in this research study. Ethical approval body image dissatisfaction [27,28]. was obtained from the Human Research Ethics Au- A limited number of studies have used the Silhouette thority of Newfoundland and Labrador before data col- Figure Rating Scale (SFRS) to study body shape expecta- lection commenced. tions and body image disturbance in adults seeking bariat- ric surgery [27,29]. These studies observed that body image Survey instruments improves after Roux-en-Y gastric bypass (RYGB) [29] and This study evaluated different levels of body shape ex- that current body image improves after bariatric surgery al- pectation and self-ideal body shape discrepancy using a though patients may idealize thinner silhouettes than be- combination of two reliable and valid instruments as a fore surgery [27]. Rapid, surgically induced weight loss may review of the literature did not yield any existing tool be seen by patients as a mechanism to achieve their ideal- that could measure these constructs. Therefore, the ized body shape, thereby elevating their expectations of ‘Goals and Relative Weights Questionnaire’ (GRWQ) body shape change after surgery [27]. Unrealistic expecta- [34] and the validated ‘Silhouette Figure Rating Scale’ tions for postoperative weight loss have been observed in (SFRS) [51] were used to achieve this aim. populations seeking both non-surgical [30-38] and surgical The GRWQ was developed and validated [34] to further [39-43] weight loss interventions. Studies have noted that the understanding of patient’s goals, expectations, and younger, Caucasian women with higher BMIs seem to have evaluations of behavioral weight loss therapy. Part II of the the most unrealistic postoperative weight loss expectations questionnaire asks participants to numerically define their and idealize thinner body images [37,38,41,44]. postoperative weight loss expectations in the categories Evidence suggests that unmet expectations may nega- “dream”, “happy”, “acceptable”,and“disappointed” weight. tively impact postoperative outcomes such as treatment Simple alteration of the GRWQ definitions was necessary satisfaction, weight loss, mood, and behavior mainten- to put them into context for bariatric surgery candidates. ance [33,34,37,45,46], or motivate patients to pursue These modifications were made to suit the study popula- weight maintenance behaviors [30,45,47-50]. In the latter tion according to similar studies in the clinical literature case, these negative states may contribute to weight re- [42,43]. The modified weight loss expectation categories gain after bariatric surgery, which would negate the and descriptions are presented in Table 1. long-term health risk reduction used to justify the surgi- The SFRS is a series of nine gendered silhouettes of cal risk and expense associated with this procedure. An progressively larger body size used to quantitatively as- understanding of the goals and expectations of surgical sess body shape expectation and the degree and direction candidates is therefore of critical importance to patient of self-ideal body shape discrepancy [51]. It has been care and treatment outcomes, and should be included in psychometrically validated with two-week test-retest reli- the discussion of surgical risks and benefits. ability (r = 0.55-0.92, p < 0.001) and small to moderate To the best of our knowledge, no research findings correlations with other measure of body image disturb- have been published that profile the body shape expecta- ance, eating disturbance, and overall self-esteem (r = tions of bariatric surgery candidates using the SFRS. 0.16-0.60, p < 0.01) [52]. The SFRS has been used to Therefore the aim of the current study was to describe evaluate body image in populations of individuals with the body shape expectations and self-ideal body shape overweight and obesity [12,27,53,54] despite some meth- discrepancy using the SFRS in women seeking LSG sur- odological concerns relating to the use of silhouettes to gery in Newfoundland
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