Weight loss expectations and weight loss after surgery: the mediating role of body image and weight concerns

Background: Preliminary evidence suggests bariatric patients' unrealistic expectations regarding weight loss after bariatric surgery are related to worse weight outcomes. Objectives: This study aimed to examine preoperative weight loss expectations and their association with weight loss, body image, eating behavior, and depressive symptoms. Setting: Hospital Centers, Portugal. Methods: This longitudinal study assessed 64 bariatric patients. Participants were asked about their desired postoperative weight and responded to the following set of self-report measures before and 2 years after surgery: Eating Disorder Examination Questionnaire, Beck Depression Inventory, and Body Shape Questionnaire. Results: The majority of participants (81.1%) did not reach the desired weight, 10 (13.5%) lost more weight than initially expected, and only 4 (5.4%) obtained the desired weight. More discrepant expectations were associated with more dissatisfaction with the body image and higher scores concerning eating psychopathology after surgery but not presurgery. Postsurgery body dissatisfaction and weight concerns were significant mediators in the relationship between discrepant expectations and poorer weight loss. Conclusions: This study shows bariatric patients hold preoperative unrealistic expectations about their weight loss, and that they sustain those expectations in the postoperative time. Our findings bring evidence for an interplay between preoperative and postoperative factors to explain weight loss. Educating about flexible weight loss goals before surgery may be a simple strategy to optimize psychological functioning and weight loss after surgery. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.