Background

Weight stigma among patients with obesity is a risk factor for psychological and physical health comorbidities. However, little is known about the effects of weight stigma in the bariatric surgery context, when significant weight loss unleashes a 'butterfly effect.' A recent meta-analysis (Bennett et al., 2022) called for longitudinalds and psychometrically validated outcomes. The current study addresses this gap by examining longitudinal effects of weight stigma on mental health, eating behaviors, and BMI before and after bariatric surgery.

Methods

148 patients completed pre-bariatric surgery psychological evaluation and follow-up assessments between 1.5-3 years post-surgery, including the Impact of Weight on Quality of Life (Public Distress subscale assessing externalized weight stigma), Patient Health Questionnaire (depression), Generalized Anxiety Questionnaire (anxiety), and Binge Eating Scale (dysregulated eating).

Results

1) Weight stigma improved, on average, pre- to post-bariatric surgery. 2) Bivariately, change in weight stigma pre- to post-surgery was positively correlated with change in depression, anxiety, dysregulated eating, and BMI. In regression models controlling for demographic covariates and each outcome at baseline, change in weight stigma predicted depression, anxiety, dysregulated eating, and BMI. 3) In parallel models, weight stigma post-surgery continued to predict depression, anxiety, dysregulated eating, and BMI.

Conclusions

Beyond BMI, demographics, and pre-surgery measurements of mental health, weight stigma continues to influence outcomes in the years following bariatric surgery. Those who experienced less improvement in weight-related distress were at greater risk for mental health challenges, dysregulated eating, and reduced weight loss approximately 2 years after surgery.