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Racial Disparities in Body Image Satisfaction following Bariatric Surgery
*Danny Mou¹, *Claire de Vries¹, *Rene Wiezer², *Simon Nienhuijs³, *Ronald Liem⁴, *Maarten Hoogbergen³, *Dennis Makarawung⁵, *Regan Bergmark¹, *Anne Klassen⁶, Ali Tavakkoli¹, *Andrea Pusic¹, *RN van Ween^7
1Brigham and Women's Hospital, Boston, MA;²Sint Antonius Ziekenhuis, Gouda, Netherlands³Catharina Ziekenhuis, Eindhoven, Netherlands⁴Groene Hart Hospital, Gouda, Netherlands⁵Sint Antonius Ziekenhuis, Nieuwegein, Netherlands⁶McMasters University, Hamilton, ON, Canada⁷OLVG West, Amsterdam, Netherlands

Background
Bariatric surgery has the potential to improve body image and appearance as measured by patient reported outcomes (PROs). However, there may differences in body image satisfaction based on race.
Design:
PRO data was measured with the BODY-Q, a PRO instrument designed for bariatric surgery patients. Linear mixed models were used to analyze associations with race and BODY-Q outcomes from preoperative to 4 months postoperatively.
Patients:
The sample included participants from a multicenter, prospective, longitudinal cohort study collecting clinical and PRO data before and after bariatric surgery.
Intervention:
Patients completed the BODY-Q instrument before and after surgery
Main outcome Measures:
Primary endpoints included PRO scores reflecting body image, satisfaction with body, buttocks, hips/thighs, and abdomen.
Results
We analyzed 564 bariatric surgery patients. Non-Caucasians had lower age (p < 0.0001), higher rates of hypertension (p=0.009) and osteo-articular disease (p < 0.0001). There were no significant differences in BODY-Q scores before bariatric surgery. While weight loss at 4 months was similar between Caucasians and non-Caucasians, Caucasians improved significantly more on BODY-Q scales measuring body image (p = 0.014) and satisfaction with body (p < 0.001), buttocks (p = 0.001), hips and outer thighs (p = 0.011) and abdomen (p = 0.014).
Conclusions
Body image and satisfaction with appearance following bariatric surgery varied significantly by race. These data suggest the existence of different standards of preferred body types.

Patient demographics and BMI before and after bariatric surgery

		Caucasian (n=453)	Non-caucasian (n=111)	P
Preoperative
	Mean age (years)	46	37	<0.0001
	Female	374	100	0.347
	Mean BMI (kg/m2)	43	44	0.278
Bariatric surgery
	Procedure type			0.370
	Primary gastric bypass	276	63
	Primary sleeve gastrectomy	150	42
	Revisional surgery	11	2
4-months post-operative
	% TWL (4 months)	21.9	20.2	0.070
	BMI change	-9.35	-8.65	0.209

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