Dramatic Weight Loss from Bariatric Surgery Can Alter Identity

Surgical Rounds®, January 2014,

While numerous patients require psychiatric interventions before and immediately after surgery, a new report addresses a different psychological process that can occur months or even years later: major quality-of-life (QOL) perception changes related to dramatic weight loss.

Many researchers report comorbidity between bariatric surgery candidates and psychiatric conditions like depression, anxiety, emotional dysfunction, and maladaptive behaviors. While numerous patients require psychiatric interventions before and immediately after surgery, a new report addresses a different psychological process that can occur months or even years later: major quality-of-life (QOL) perception changes related to dramatic weight loss.

Patients who undergo bariatric surgery anticipate improved physical health, but they also expect an enhanced appearance. Sometimes, they report discontent related to excess skin or dissatisfaction with their perceptions of their bodies. In fact, 16 of the 20 patients recorded in the report underwent body-contouring procedures to improve their appearance after their initial bariatric surgeries.

The researchers identified 2 core themes related to the participants’ perceptions of their post-surgical bodies: identity transformation and radical shifts in lifestyle. Though the patients became more social and outgoing as their self-esteem, self-confidence, and wellbeing improved, some of them experienced “identity lag,” which is best described as a period of confusion when a patient’s physical body changes faster than his or her long-established social perceptions of appearance. Internally, the patient is still a “large person,” but externally, the body is shrinking — though it may not be in a way he or she expects.

Some patients also had trouble dealing with comments or attention from others, which caused them emotional distress, mood disorders, and poor QOL. The researchers said those conditions deserve the same psychiatric support as pre-surgery issues receive.

Although surgeons cannot draw wide inferences from this exploratory study, it suggests that patients who undergo bariatric surgery require periodic assessment to ensure they are psychologically healthy.