A prospective assessment of weight bias internalization in patients seeking body contouring after bariatric surgery

Surg Obes Relat Dis. 2025 Aug 22:S1550-7289(25)00859-7. doi: 10.1016/j.soard.2025.06.020. Online ahead of print.

ABSTRACT

BACKGROUND: Weight bias internalization (WBI), or the internalization of “antifat” attitudes, is associated with greater eating-disorder psychopathology, body image, and mental health concerns in patients following bariatric surgery. Yet, WBI in patients seeking body contouring surgery (BCS) after bariatric surgery remains unstudied.

OBJECTIVES: This study prospectively examined the relationship between WBI, eating-disorder psychopathology, and depressive symptoms in patients seeking BCS after bariatric surgery.

SETTING: Yale University School of Medicine, United States METHODS: Participants were 56 adults (93% female) seeking consultation for BCS after bariatric surgery; 42.9% (n = 24) went on to have BCS. Participants completed established measures assessing WBI, eating-disorder psychopathology, and depressive symptoms at baseline following the BCS consultation, then repeated at 1-month and 3-month follow-ups.

RESULTS: WBI was positively associated with eating-disorder psychopathology and depression at all assessments (all P < .01) including baseline (all r > .40), 1-month (all r > .33), and 3-month (all r > .45) follow-ups. In a prospective analysis of WBI, a significant group by time interaction was observed (P = .03) owing to lower postbaseline levels among BCS at both 1-month (P = .03) and 3-months (P = .009) assessments. Groups with and without BCS did not differ significantly on body mass index (BMI), weight loss, or eating-disorder psychopathology.

CONCLUSIONS: WBI is associated significantly with greater eating-disorder psychopathology and depressive symptoms, but not BMI or weight loss, in patients seeking BCS after bariatric surgery. Group differences in WBI at 1-month and 3-month follow-ups suggest that BCS may help reduce WBI independent of BMI. Bariatric teams should be aware that higher WBI may persist for patients unable to obtain BCS.

PMID:40940272 | DOI:10.1016/j.soard.2025.06.020