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    Body image boost

    Study confirms psychological benefits post-MWL body contouring

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    46-year-old female, s/p 210-lb weight loss from gastric bypass. Patient is shown pre-op and 10 months after completing a staged total-body contouring that included both upper and lower body lifts. Note the new tattoo and tan lines in the post-operative photo, suggesting that the patient is much more comfortable with her new body. (Photo credit: J. Peter Rubin, M.D.)
    A new study, using assessment tools especially designed for massive weight loss (MWL) patients, shows quality of life and positive body image, which improve after bariatric surgery, receive an added boost with body contouring. Study author and plastic surgeon J. Peter Rubin, M.D., assistant professor of surgery at University of Pittsburgh Medical Center (UPMC), says that plastic surgeons have known, anecdotally, that body contouring procedures have a positive impact on the lives of MWL patients.

    "We wanted to apply scientific methods to generate some data to confirm this," Dr. Rubin tells Cosmetic Surgery Times . Dr. Rubin, director of UPMC's Life after Weight Loss clinical program, and his colleagues studied 18 patients (mean age 46) who underwent bariatric surgery and body contouring. Patients were surveyed pre-body contouring and at three and six months post-body contouring.

    CUSTOMIZED TOOLS The UPMC researchers used established quality-of-life (QOL) surveys as well as surveys designed specifically for the study to assess body perception and ideals, QOL and mood. Existing QOL and body image instruments are not adapted for the MWL patient, according to Dr. Rubin. The team modified Stunkard's silhouettes to include larger body shapes, ranging from underweight to severely obese silhouettes from which patients chose the images representing their pre-weight loss, current and ideal body appearances. They also developed the Body Image and Satisfaction Assessment (BISA) by adding questions to the commonly used Multidimensional Body-Self Relations Questionnaire.

    "For example, this is a survey that refers specifically to symptoms of rash and skin irritation related to excess skin and how those change with body contouring surgery," explains Dr. Rubin. "We also ask specific questions relating to difficulty shopping for and fitting into new clothing related to excess skin. The survey assesses for feelings of embarrassment and self esteem related to excess skin."

    In addition, the researchers modified an existing QOL assessment tool, creating the Post-Bariatric Surgery Quality of Life (PBSQOL) to address such criteria as feelings of attractiveness, skin rash and infection, ease of exercise, public embarrassment of loose skin and more.

    Finally, they developed the Current Body Image Assessment (CBIA) tool. CBIA allows patients to diagram those areas of their body with which they are most uncomfortable on a simple anatomic model which resembles a gingerbread man.

    "With the gingerbread men, patients indicated what bothered them most," relates senior author Madelyn H. Fernstrom, Ph.D., C.N.S., associate professor in psychiatry, surgery and epidemiology, and director of the Weight Management Center at UPMC. "Typically, you think with body contouring surgery, everybody would point to the stomach, but there are so many variations on this theme."

    SHIFTING PRIORITIES At three months, average BISA scores increased from 49 (before weight loss) to 64. At six months, the improvement remained stable at 65. An interesting study finding, according to Dr. Rubin, was that when patients had improvement in certain areas of their body from body contouring surgery, it would sometimes draw their attention to other parts of their body that had not been surgically treated. "For example, patients who came in with the primary complaint of dissatisfaction with the contour of their abdomen and breasts, who then had those areas treated with body contouring surgery and had good results, would then focus on other areas of their body that they have become dissatisfied with that hadn't been a priority for them in the past," Dr. Rubin says.

    Data from the CBIA indicate that the three most frequent areas of distress at the initial body contouring consultation were abdomen (69 percent), flanks (56 percent) and hips/outer thighs (44 percent). At the three-month assessment, only one of the 18 patients said the abdomen was a top area of distress; rather, subjects began focusing more on the arms, back and buttocks, with the top three areas of distress being hips/outer thighs (45 percent), medial thighs (38 percent) and flanks (31 percent). At six months, their top complaints remained medial thighs (54 percent), flanks (36 percent) and hips/outer thighs (27 percent).

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    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.

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