Quality of life among adults following bariatric and body contouring surgery: a systematic review
Authors: Gilmartin Jo , Bath-Hextall Fiona , Maclean Joan , Stanton Wendy , Soldin Mark 
Published: December 2016

EXECUTIVE SUMMARY

Background
Weight loss following bariatric surgery is associated with significant improvements in obesity-related comorbidities, body satisfaction and psychosocial outcomes, at least in the short term. However, in the context of extreme weight loss, body image and appearance may worsen again because the “excess” or “loose” skin can lead to both functional and profound dissatisfaction with appearance. These concerns have led to an increasing uptake of post-bariatric surgery, “body-contouring” procedures but the implications for quality of life (QoL) have not been thoroughly considered.

Objective/purpose
The objective was to identify the best available evidence regarding the QoL outcomes for adults following bariatric and body contouring surgery.

Inclusion criteria Types of participants
The review considered studies involving people aged 18 years and beyond who underwent bariatric surgery and body contouring surgery.

Types of interventions
The review considered studies that evaluated bariatric surgery as well as body contouring surgery.

Types of studies
The review considered both experimental and epidemiological study designs.

Outcomes
The primary outcomes were QoL as measured by validated tools at less than two years, two to five years and more than five years following body contouring surgery. The secondary outcomes were adverse events, unsatisfactory aesthetic appearance and weight gain.

Search strategy
Six databases were searched, including Cochrane Central, MEDLINE, Embase, Web of Science, PsycINFO and CINAHL. Studies published from 1954 to 2014 were considered. Additional searches for unpublished studies were undertaken in BIOSIS citation index, Register of Current Controlled Trials and Global Health Observatory.

Methodological quality
The methodological quality of eligible studies was assessed independently by two reviewers using the Joanna Briggs Institute quality assessment tool.

Data extraction
Data extraction from the included studies was undertaken and summarized independently by two reviewers using the standardized Joanna Briggs Institute data extraction tool.

Data synthesis
Studies were too heterogeneous and could not be pooled in statistical meta-analysis. Therefore, the data results are presented as a narrative summary in relation to the outcomes of interest.

Results
Nine quantitative studies (four comparable cohort studies, including two group design and two four-group designs and five descriptive or case-series studies) were included in the review. The included studies reported significant clinical improvements in appearance, wellbeing and QoL. These included primary outcomes pointing to body image satisfaction, improved self-esteem and confidence, improved physical function/pain and improved social function. The secondary outcomes were related to adverse events in the early postoperative period and reported wound healing problems, including seromas, partial necrosis, dehiscence, hematoma and anemia because of blood loss. Also, some data sets shed light on appearance-related distress and body dysphoria post surgery associated with visible scars and contour deformities.

Conclusion
Body contouring surgery has been shown to have positive benefits, especially in relation to improved wellbeing, function and QoL. However, adjustment to changing body image following body contouring is both challenging and empowering and seems to be a transitional process.