Body contouring surgery - the neglected sibling of bariatric surgery!
Anthony Barabas, Plastic Surgery SpR
Jonathan Leckenby and Mark Soldin
St Georges Hospital, London
19 November 2010
Your article describes the reluctance of PCTs to fund bariatric surgery, but does not discuss subsequent body contouring surgery. 25-33% of patients who successfully lose weight after bariatric surgery go on to seek body contouring surgery (1). There is no NICE guidance on body contouring after massive weight loss; however the NICE bariatric guidance states that units performing bariatric operations should have access to plastic surgery facilities for their patients once they have lost weight (2)
Morbid obesity is associated with high rates of psychopathology, including depression, anxiety, eating disorders, abnormal personality traits and personality disorders (3). Studies have shown that there is not only an improved quality of life after bariatric surgery (4), but there is also a significant improvement in patients' quality of life after subsequent body contouring procedures (5-6).
Improvement or even resolution of obesity related diseases is seen following massive weight loss. However the change in a patient's body shape can have a functional impact on their lives. Hanging folds of skin makes exercising difficult as they impede limb movement through mechanical traction of one skin surface on another, ultimately resulting in soreness and possible ulceration. Skin folds become macerated and are prone to infection. Patients are frequently so embarrassed of their new body shape that they never undress in front of other people, resulting in sexual relationship avoidance or even breakdown. In our experience they all avoid public swimming pools, as they will not contemplate being seen in swimwear. Some patients report a worsening in self-esteem and confidence with their body image after massive weight loss, exacerbating pre-existing psychiatric problems. Body contouring frequently sees the resolution of such conditions through an improvement in patients' body image and self- esteem (4-5).
There are recent verbal reports that a number of PCTs will not fund bariatric surgery unless the patient agrees to sign a waiver stating that they will not subsequently pursue body contouring surgery on the NHS. The aim of addressing obesity should not simply be to reduce the financial burden on the state through the resolution of obesity related diseases. The goal should be for the patient to return as a happy and productive member of society. Body contouring plays an important role in achieving this objective, and should always be considered part of the patient pathway when PCTs agree to fund weight loss surgery.
(1) Abela C, Stevens T, Reddy M, Soldin M. A multidisciplinary approach to post bariatric plastic surgery, International Journal of Surgery 2010; doi: 10.1016/j.ijsu. 2010.10.002
(2)http://www.nice.org.uk/usingguidance/commissioningguides/bariatric/SpecifyingABariatricSurgicalService.jsp
(3) Pecori L, Giacomo G, Cervetti S, Marinari G, Miglori F, Adami G. Attitudes of morbidly obese patients to weight loss and body image following bariatric surgery and body contouring. Obesity Surgery; 17: 68- 73
(4) Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis. 2010; 13
(5) Song A, Rubin J, Thomas V, Dudas J, Marra K, Fernstrom M. Body image and quality of life in post massive weight loss body contouring patients. Obesity 2006; 14: 1626-1636
(6) Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry. 2010; 23(1):30-6.
St Georges Hospital, London
19 November 2010
Your article describes the reluctance of PCTs to fund bariatric surgery, but does not discuss subsequent body contouring surgery. 25-33% of patients who successfully lose weight after bariatric surgery go on to seek body contouring surgery (1). There is no NICE guidance on body contouring after massive weight loss; however the NICE bariatric guidance states that units performing bariatric operations should have access to plastic surgery facilities for their patients once they have lost weight (2)
Morbid obesity is associated with high rates of psychopathology, including depression, anxiety, eating disorders, abnormal personality traits and personality disorders (3). Studies have shown that there is not only an improved quality of life after bariatric surgery (4), but there is also a significant improvement in patients' quality of life after subsequent body contouring procedures (5-6).
Improvement or even resolution of obesity related diseases is seen following massive weight loss. However the change in a patient's body shape can have a functional impact on their lives. Hanging folds of skin makes exercising difficult as they impede limb movement through mechanical traction of one skin surface on another, ultimately resulting in soreness and possible ulceration. Skin folds become macerated and are prone to infection. Patients are frequently so embarrassed of their new body shape that they never undress in front of other people, resulting in sexual relationship avoidance or even breakdown. In our experience they all avoid public swimming pools, as they will not contemplate being seen in swimwear. Some patients report a worsening in self-esteem and confidence with their body image after massive weight loss, exacerbating pre-existing psychiatric problems. Body contouring frequently sees the resolution of such conditions through an improvement in patients' body image and self- esteem (4-5).
There are recent verbal reports that a number of PCTs will not fund bariatric surgery unless the patient agrees to sign a waiver stating that they will not subsequently pursue body contouring surgery on the NHS. The aim of addressing obesity should not simply be to reduce the financial burden on the state through the resolution of obesity related diseases. The goal should be for the patient to return as a happy and productive member of society. Body contouring plays an important role in achieving this objective, and should always be considered part of the patient pathway when PCTs agree to fund weight loss surgery.
(1) Abela C, Stevens T, Reddy M, Soldin M. A multidisciplinary approach to post bariatric plastic surgery, International Journal of Surgery 2010; doi: 10.1016/j.ijsu. 2010.10.002
(2)http://www.nice.org.uk/usingguidance/commissioningguides/bariatric/SpecifyingABariatricSurgicalService.jsp
(3) Pecori L, Giacomo G, Cervetti S, Marinari G, Miglori F, Adami G. Attitudes of morbidly obese patients to weight loss and body image following bariatric surgery and body contouring. Obesity Surgery; 17: 68- 73
(4) Sarwer DB, Wadden TA, Moore RH, Eisenberg MH, Raper SE, Williams NN. Changes in quality of life and body image after gastric bypass surgery. Surg Obes Relat Dis. 2010; 13
(5) Song A, Rubin J, Thomas V, Dudas J, Marra K, Fernstrom M. Body image and quality of life in post massive weight loss body contouring patients. Obesity 2006; 14: 1626-1636
(6) Pull CB. Current psychological assessment practices in obesity surgery programs: what to assess and why. Curr Opin Psychiatry. 2010; 23(1):30-6.
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