Body image: Appearance orientation and evaluation in the severely obese. Changes with weight loss

Background: The severely obese experience discrimination and embarrassment regarding their appearance, causing psychosocial distress. We assessed the importance of appearance, presentation and self-evaluation of appearance before and after weight loss, in severely obese subjects (BMI >35 kg/m(2)). Methods: Appearance orientation (AO) and appearance evaluation (AE) sections of the Multi-dimentional Body Self Relations Questionnaire were completed by preoperative patients and those attending an annual follow-up after Lap-Band(R) gastric restrictive surgery over a 2-year period. AO is a measure of the importance one places in appearance. AE is a self-evaluation of one's appearance. Results: Before surgery 322 consecutive patients (48 men and 274 women) completed the survey. AO was similar to that of community norms (mean scores 3.76 +/- SD 0.6 vs 3.84 +/- 0.6), with the exception of the super obese (BMI >50 kg/m(2)) who placed significantly less importance on their appearance (3.34 +/- 0.8, p=0.001). There was no change in AO at 1-4 years after surgery, with the exception of the super obese whose mean values rose to normal by 1 year. AE was very low before surgery compared with community normal values (1.6 +/- 0.6 vs 3.4 +/- 0.8, p<0.001). Major improvement in mean AE was seen at 1 year after surgery (n=209, 2.6 ± 0.8, p<0.001) and the improvement was maintained out to 4 years. The change in AE from pre-surgery to 1 year (n=122 paired) correlated positively with the percentage of excess weight lost (r=0.32, p<0.01) and positively with measures of quality of life and psychological disturbance. Conclusion: Major improvements in appearance evaluation occur with weight loss after surgery and this is associated with psychological benefit.