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RESEARCH ARTICLE
Perioperative Antidepressant Use Improves Body Image

to a Greater Extent Compared to Those Not Taking

Antidepressants in Patients Who Undergo Bariatric Surgery

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David Fipps 1 , Sharon Holder , Dorothy Schmalz , John Scott 4
AbstrAct
Introduction: Body image often improves after bariatric surgery; however, those who are depressed are more vulnerable to continuing to have
body image concerns. Body image dissatisfaction and depression are associated with poorer quality of life, less weight loss after surgery, and
poorer overall physical/mental functioning. Our study aims to determine whether antidepressants influence the improvement seen in body
image after bariatric surgery.
Materials and methods: Body-Esteem Scale for Adolescents and Adults (BESAA), a validated tool for trending body image, was administered
preoperatively and at 3, 6, and 12 months postoperative follow-ups. Scores were compared for improvement, and linear regression models
were used to determine the influence of medications and demographic factors on score improvement.
Results: The study sample was consisted of 47 men and 57 women (22–72 years of age). Preoperative BMI was in the range of 35.87–75.66
(mean: 49.26). Sixty-nine percent (69%) were taking psychiatric medications and 57% of those medications were antidepressants (12 different
antidepressants represented). Improvement in BMI was in the range of 1.44–30.77 points (mean: 15.08). The majority (98.07%) showed improved
BESAA scores; two factors revealed statistical significance for influence on score magnitude. For every 1 point of BMI improvement, our sample
increased BESAA scores by 0.68 points (p = 0.021). Those taking antidepressants scored an average of 8.55 points higher than those not taking
antidepressants (p = 0.032). There were no significant differences found for age, gender, race, type of surgery, use of anxiolytics/hypnotics, or
stimulants.
Conclusion: Perioperative antidepressant usage is associated with a greater improvement in body image after bariatric surgery compared to
those who are not taking antidepressants. Given the high comorbidity of depression in bariatric surgery patients, this highlights potential for
improved outcomes with treatment of psychiatric comorbidities in this population.
Keywords: Antidepressant, Bariatric surgery, Body image.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1452

IntroductIon 1 Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Body image is defined as an individual’s beliefs, emotions, behaviors, Minnesota, United States
cognitions, and perceptions pertaining to his or her physical 2 Department of Psychiatry, Executive Director of the Comprehensive
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appearance. Body image is a multifaceted psychosocial construct that Outreach Research and Education (CORE) Institute, Charleston, South
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forms how we picture our own body in our minds. There are many Carolina, United States
factors that contribute to one’s perception of body image, including 3 Department of Parks, Recreation, and Tourism, University of Utah, Salt
societal norms, self-esteem, perfectionism, physical characteristics, Lake City, Utah, United States
interpersonal experiences, and history of depression. 1,3,4 The desire 4 Department of Surgery, Division of Minimal Access and Bariatric
to improve appearance and body image is often reported as being Surgery, University of South Carolina, Greenville, South Carolina,
among the most important motives for pursuing bariatric surgery. 2,5,6 United States
Overall, findings from both cross-sectional and longitudinal studies Corresponding Author: David Fipps, Department of Psychiatry
suggest that, in general, body image will improve after bariatric and Psychology, Mayo Clinic, Rochester, Minnesota, United States,
surgery, and this will often correlate to the improvement seen in the e-mail: dfipps123@gmail.com
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body mass index (BMI). However, there are still some individuals who How to cite this article: Fipps D, Holder S, Schmalz D, et al.
continue to feel dissatisfied with their body image despite appropriate Perioperative Antidepressant Use Improves Body Image to a Greater
weight loss after bariatric surgery. 7–9 A study by Pona et al. found that Extent Compared to Those Not Taking Antidepressants in Patients Who
bariatric surgery candidates who have a history of psychopathology Undergo Bariatric Surgery. World J Lap Surg 2021;14(2):126–130.
and other psychological risk factors may be more vulnerable to body Source of support: Nil

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image concerns after surgery. Specifically, individuals with poorer Conflict of interest: None
body image have been found to have a higher likelihood of depression
and depressive symptoms. 11,12
It has been estimated that 25–30% of bariatric surgery patients
report clinically significant depression that has been found to be general population. 8,13–17 Nearly 40% of bariatric surgery candidates
higher than nonsurgery-seeking adults with morbid obesity in the are taking psychotropic medications, and antidepressants are the

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