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Commentary on: Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort

Commentary on: Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results... Obesity is one of the world’s most pressing public health issues. In the United States, greater than 70% of individuals are overweight (body mass index [BMI] = 25-30 kg/m2) or obese (BMI ≥ 30 kg/m2).1 Further 9.9% of women and 5.5% of men in the United States have a BMI ≥ 40 kg/m2 and, therefore, are classified as having extreme obesity. There are a number of treatments for obesity, ranging from lifestyle modification (including caloric restriction, increased physical activity, and behavioral modification), pharmacotherapy, and bariatric surgery.2 The surgical treatment of obesity is typically reserved for persons with extreme obesity. According to the American Society for Metabolic and Bariatric Surgery, approximately 200,000 bariatric procedures are performed annually in the United States.3 Bariatric surgery typically produces a weight loss of 25% to 35% of initial body weight in the first 12 to 18 months after surgery.2,4 Patients also report significant improvements, if not resolution, of weight-related comorbidities such as type 2 diabetes, hypertension, and sleep apnea. Patients also report clinically meaningful improvements in psychosocial functioning, including quality of life, body image, and self-esteem. Many of these benefits occur within the first 3 to 6 months after surgery and before individuals reach their maximum weight loss. Unfortunately, many individuals who experience these massive weight losses develop excess skin.5,6 This appears to be most common in the abdominal region, but the breasts/chest, upper arms, thighs, and rear/buttocks also can be affected.7 The excess skin is associated with unwanted physical and psychological symptoms.7-9 The majority of patients report that excess hanging skin has resulted in itching, rashes, chafing, or ulcers. Almost all patients report some degree of functional impairment. Patients experience pain as well as interference with their ability to find appropriate clothing, maintain personal hygiene, and engage in physical activity or sexual behavior. These physical symptoms, and the psychosocial distress seen with them, lead many patients to present for body contouring surgery.6,9 The study by Suijker et al provides new information on self-reported changes in quality of life in persons who have undergone body contouring surgery.10 Using the Body-QoL developed by the authors, patients reported significant improvements in quality of life within the first year of body contouring surgery, which were well maintained into the third postoperative year. This study adds to the growing literature which suggests that patients who undergo body contouring surgery report high levels of satisfaction with the procedures, but also experience improvements in relevant psychosocial domains, including body image and quality of life.5,6,11,12 The maintenance of the longer-term improvements in quality of life is one of the more important findings from this study. As the authors note, patients may still be healing in the first 6 months after body contouring. In addition, there is growing evidence to suggest that the majority of bariatric surgery patients experience weight regain within the first two to six years.13,14 The average weight regain appears to be 5% to 10% of initial body weight for most individuals. However, a subset experience more significant weight regain. This weight regain has potential to negatively impact the physical and psychosocial benefits of bariatric surgery; it also could compromise the aesthetic results of body contouring. To that point, the present study found that patients who experienced an increase in their BMI during the study reported less improvement on the Body-QoL.10 Despite these important findings, the current study has some limitations. While the Body-QoL holds promise as an appropriate assessment tool for this patient population, a more comprehensive assessment of psychosocial functioning would have provided a greater wealth of information. Use of other cosmetic surgery patients as a comparison group added only modest value to the study. A group of individuals who underwent bariatric surgery but not body contouring, and who were similar in BMI, would have been a more compelling comparison group. Finally, the study also suffered from substantial loss to follow up. Unfortunately, this is a well-known issue for many investigators who study the psychosocial changes seen with surgical interventions. Studies with the highest possible retention rates will allow for the most convincing statements on the psychosocial benefits associated with aesthetic procedures. Disclosures The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The author received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA . 2016; 315( 21): 2284- 2291. Google Scholar CrossRef Search ADS PubMed  2. Jensen MD, Ryan DH, Apovian CMet al.  ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol . 2014; 63( 25 Pt B): 2985- 3023. Google Scholar CrossRef Search ADS PubMed  3. American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2016 . 4. De Luca M, Angrisani L, Himpens Jet al.   Indications for surgery for obesity and weight-related diseases: position statements from the international federation for the surgery of obesity and metabolic disorders (IFSO). Obes Surg . 2016; 26( 8): 1659- 1696. Google Scholar CrossRef Search ADS PubMed  5. Ellison JM, Steffen KJ, Sarwer DB. Body contouring after bariatric surgery. Eur Eat Disord Rev . 2015; 23( 6): 479- 487. Google Scholar CrossRef Search ADS PubMed  6. Sarwer DB, Polonsky HM. Body image and body contouring procedures. Aesthet Surg J . 2016; 36( 9): 1039- 1047. Google Scholar CrossRef Search ADS PubMed  7. Kitzinger HB, Abayev S, Pittermann Aet al.   The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg . 2012; 22( 1): 8- 12. Google Scholar CrossRef Search ADS PubMed  8. Steffen KJ, Sarwer DB, Thompson JK, Mueller A, Baker AW, Mitchell JE. Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery. Surg Obes Relat Dis . 2012; 8( 1): 92- 97. Google Scholar CrossRef Search ADS PubMed  9. Mitchell JE, Crosby RD, Ertelt TWet al.   The desire for body contouring surgery after bariatric surgery. Obes Surg . 2008; 18( 10): 1308- 1312. Google Scholar CrossRef Search ADS PubMed  10. Suijker J, Troncoso E, Pizarro Fet al.   Long-term quality-of-life outcomes after body contouring surgery: phase IV results for the Body-QoL® cohort. Aesthet Surg J . 2017 June 3. doi:10.1093/asj/sjx090. 11. Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring) . 2006; 14( 9): 1626- 1636. Google Scholar CrossRef Search ADS PubMed  12. Larsen M, Polat F, Stook FP, Oostenbroek RJ, Plaisier PW, Hesp WL. Satisfaction and complications in post-bariatric surgery abdominoplasty patients. Acta Chir Plast . 2007; 49( 4): 95- 98. Google Scholar PubMed  13. Adams TD, Davidson LE, Litwin SEet al.   Health benefits of gastric bypass surgery after 6 years. JAMA . 2012; 308( 11): 1122- 1131. Google Scholar CrossRef Search ADS PubMed  14. Courcoulas AP, Christian NJ, Belle SHet al.  ; Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA . 2013; 310( 22): 2416- 2425. Google Scholar PubMed  © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Aesthetic Surgery Journal Oxford University Press

Commentary on: Long-Term Quality-of-Life Outcomes After Body Contouring Surgery: Phase IV Results for the Body-QoL® Cohort

PhD, David B Sarwer,
Aesthetic Surgery Journal , Volume 38 (3) – Mar 1, 2018
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References (14)

Publisher
Oxford University Press
Copyright
© 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com
ISSN
1090-820X
eISSN
1527-330X
DOI
10.1093/asj/sjx118
Publisher site
See Article on Publisher Site

Abstract

Obesity is one of the world’s most pressing public health issues. In the United States, greater than 70% of individuals are overweight (body mass index [BMI] = 25-30 kg/m2) or obese (BMI ≥ 30 kg/m2).1 Further 9.9% of women and 5.5% of men in the United States have a BMI ≥ 40 kg/m2 and, therefore, are classified as having extreme obesity. There are a number of treatments for obesity, ranging from lifestyle modification (including caloric restriction, increased physical activity, and behavioral modification), pharmacotherapy, and bariatric surgery.2 The surgical treatment of obesity is typically reserved for persons with extreme obesity. According to the American Society for Metabolic and Bariatric Surgery, approximately 200,000 bariatric procedures are performed annually in the United States.3 Bariatric surgery typically produces a weight loss of 25% to 35% of initial body weight in the first 12 to 18 months after surgery.2,4 Patients also report significant improvements, if not resolution, of weight-related comorbidities such as type 2 diabetes, hypertension, and sleep apnea. Patients also report clinically meaningful improvements in psychosocial functioning, including quality of life, body image, and self-esteem. Many of these benefits occur within the first 3 to 6 months after surgery and before individuals reach their maximum weight loss. Unfortunately, many individuals who experience these massive weight losses develop excess skin.5,6 This appears to be most common in the abdominal region, but the breasts/chest, upper arms, thighs, and rear/buttocks also can be affected.7 The excess skin is associated with unwanted physical and psychological symptoms.7-9 The majority of patients report that excess hanging skin has resulted in itching, rashes, chafing, or ulcers. Almost all patients report some degree of functional impairment. Patients experience pain as well as interference with their ability to find appropriate clothing, maintain personal hygiene, and engage in physical activity or sexual behavior. These physical symptoms, and the psychosocial distress seen with them, lead many patients to present for body contouring surgery.6,9 The study by Suijker et al provides new information on self-reported changes in quality of life in persons who have undergone body contouring surgery.10 Using the Body-QoL developed by the authors, patients reported significant improvements in quality of life within the first year of body contouring surgery, which were well maintained into the third postoperative year. This study adds to the growing literature which suggests that patients who undergo body contouring surgery report high levels of satisfaction with the procedures, but also experience improvements in relevant psychosocial domains, including body image and quality of life.5,6,11,12 The maintenance of the longer-term improvements in quality of life is one of the more important findings from this study. As the authors note, patients may still be healing in the first 6 months after body contouring. In addition, there is growing evidence to suggest that the majority of bariatric surgery patients experience weight regain within the first two to six years.13,14 The average weight regain appears to be 5% to 10% of initial body weight for most individuals. However, a subset experience more significant weight regain. This weight regain has potential to negatively impact the physical and psychosocial benefits of bariatric surgery; it also could compromise the aesthetic results of body contouring. To that point, the present study found that patients who experienced an increase in their BMI during the study reported less improvement on the Body-QoL.10 Despite these important findings, the current study has some limitations. While the Body-QoL holds promise as an appropriate assessment tool for this patient population, a more comprehensive assessment of psychosocial functioning would have provided a greater wealth of information. Use of other cosmetic surgery patients as a comparison group added only modest value to the study. A group of individuals who underwent bariatric surgery but not body contouring, and who were similar in BMI, would have been a more compelling comparison group. Finally, the study also suffered from substantial loss to follow up. Unfortunately, this is a well-known issue for many investigators who study the psychosocial changes seen with surgical interventions. Studies with the highest possible retention rates will allow for the most convincing statements on the psychosocial benefits associated with aesthetic procedures. Disclosures The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article. Funding The author received no financial support for the research, authorship, and publication of this article. REFERENCES 1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA . 2016; 315( 21): 2284- 2291. Google Scholar CrossRef Search ADS PubMed  2. Jensen MD, Ryan DH, Apovian CMet al.  ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol . 2014; 63( 25 Pt B): 2985- 3023. Google Scholar CrossRef Search ADS PubMed  3. American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2016 . 4. De Luca M, Angrisani L, Himpens Jet al.   Indications for surgery for obesity and weight-related diseases: position statements from the international federation for the surgery of obesity and metabolic disorders (IFSO). Obes Surg . 2016; 26( 8): 1659- 1696. Google Scholar CrossRef Search ADS PubMed  5. Ellison JM, Steffen KJ, Sarwer DB. Body contouring after bariatric surgery. Eur Eat Disord Rev . 2015; 23( 6): 479- 487. Google Scholar CrossRef Search ADS PubMed  6. Sarwer DB, Polonsky HM. Body image and body contouring procedures. Aesthet Surg J . 2016; 36( 9): 1039- 1047. Google Scholar CrossRef Search ADS PubMed  7. Kitzinger HB, Abayev S, Pittermann Aet al.   The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg . 2012; 22( 1): 8- 12. Google Scholar CrossRef Search ADS PubMed  8. Steffen KJ, Sarwer DB, Thompson JK, Mueller A, Baker AW, Mitchell JE. Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery. Surg Obes Relat Dis . 2012; 8( 1): 92- 97. Google Scholar CrossRef Search ADS PubMed  9. Mitchell JE, Crosby RD, Ertelt TWet al.   The desire for body contouring surgery after bariatric surgery. Obes Surg . 2008; 18( 10): 1308- 1312. Google Scholar CrossRef Search ADS PubMed  10. Suijker J, Troncoso E, Pizarro Fet al.   Long-term quality-of-life outcomes after body contouring surgery: phase IV results for the Body-QoL® cohort. Aesthet Surg J . 2017 June 3. doi:10.1093/asj/sjx090. 11. Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring) . 2006; 14( 9): 1626- 1636. Google Scholar CrossRef Search ADS PubMed  12. Larsen M, Polat F, Stook FP, Oostenbroek RJ, Plaisier PW, Hesp WL. Satisfaction and complications in post-bariatric surgery abdominoplasty patients. Acta Chir Plast . 2007; 49( 4): 95- 98. Google Scholar PubMed  13. Adams TD, Davidson LE, Litwin SEet al.   Health benefits of gastric bypass surgery after 6 years. JAMA . 2012; 308( 11): 1122- 1131. Google Scholar CrossRef Search ADS PubMed  14. Courcoulas AP, Christian NJ, Belle SHet al.  ; Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA . 2013; 310( 22): 2416- 2425. Google Scholar PubMed  © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Journal

Aesthetic Surgery Journal – Oxford University Press

Published: Mar 1, 2018

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