title: Prospective changes in body image dissatisfaction among adolescent bariatric patients: the importance of body size estimation.
abstract: BACKGROUND
  Body image dissatisfaction (BID) is pervasive among patients presenting for bariatric surgery but improves significantly postoperatively. These findings have been determined primarily from studies of adults. The objective of the present study was to examine the changes in BID among adolescents with extreme obesity from baseline/preoperatively to 6 and 12 months after receiving bariatric surgery at a pediatric medical center using body size estimation.
  
  
  METHODS
  BID was prospectively assessed among 16 adolescent bariatric patients (mean age 16.3 ± 1.2 years, mean body mass index [BMI] 66.2 ± 12.0, 67% female) using a standard visual/perceptual measure (i.e., Stunkard Figure Rating Scale). Participants identified their current and ideal body size, with a discrepancy score (current minus ideal) indicating BID. The body size estimation ratings were compared with attitudinal (i.e., Impact of Weight on Quality Of Life-Kids: Body Esteem and Self-Perception Profile for Adolescents: Physical Appearance) body image scores, BMI, and total weight-related quality of life.
  
  
  RESULTS
  A significant reduction occurred in the current body size (from 7.9 to 6.4, P <.001) from baseline to 6 months but not from 6 to 12 months. The current body size was related to BMI and percentage of excess weight loss but not attitudinal body image at each follow-up point. A smaller discrepancy (current minus ideal) was associated with greater total weight-related quality of life (r = -.68), with a trend toward significance for body esteem (r = -.65) at 12 months.
  
  
  CONCLUSIONS
  Adolescents undergoing bariatric surgery experience a significantly decreased BID within the first 12 months after surgery, with the most substantial change occurring from baseline to 6 months. The postoperative weight-related quality of life is more closely associated with the body size discrepancy than with the current body size.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. megan.ratcliff@cchmc.org
authors.forename: Megan B
authors.initials: MB
authors.lastname: Ratcliff
authors.forename: Kate E
authors.initials: KE
authors.lastname: Eshleman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reiter-Purtill
authors.forename: Meg H
authors.initials: MH
authors.lastname: Zeller
mesh_terms: D000293:Adolescent; D001828:Body Image; D049628:Body Size; D005260:Female; D015390:Gastric Bypass / Q000523:psychology*; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012649:Self Concept