PMID: 40786423 https://pubmed.ncbi.nlm.nih.gov/40786423/

Abstract

BACKGROUND: Bariatric surgery is the most effective treatment for severe obesity, offering durable weight loss and improvement in comorbidities. However, its psychosocial outcomes, particularly in non-Western settings, are less understood. This study assessed postoperative body image perceptions and mental health outcomes among adults in Saudi Arabia and identified factors associated with depressive symptoms and psychosocial functioning.

METHODS: We conducted a cross-sectional survey between January and May 2025 at three tertiary hospitals in Saudi Arabia. Adults (≥18 years) who had undergone bariatric surgery ≥ six months prior were recruited (N = 240). Participants completed a validated, self-administered questionnaire covering body image, mental health, social activity, and overall satisfaction. Multivariable logistic regression identified independent predictors of moderate-to-severe depressive symptoms.

RESULTS: Of the 240 participants, 148 (61.7%) were female and most (n = 144; 60.0%) were aged 26-45 years. Sleeve gastrectomy was the most common procedure (n = 178; 74.2%). A total of 150 participants (62.5%) reported satisfaction with their postoperative appearance, while 52 (21.7%) were dissatisfied or very dissatisfied. Excess skin was a concern for 88 participants (36.7%). Moderate-to-severe depressive symptoms were reported by 84 participants (35.0%), and 98 (40.8%) experienced anxiety on more than half the days in the prior two weeks. Social activity increased postoperatively in 114 participants (47.5%), while 66 (27.5%) reported reduced engagement. Interest in psychological support was expressed by 140 participants (58.4%). Body dissatisfaction was significantly associated with depressive symptoms: 46 of 88 dissatisfied participants (52.3%) met depression criteria versus 12 of 86 (14.0%) with low dissatisfaction (P < 0.001). Independent predictors of depression included body dissatisfaction (adjusted odds ratio (aOR), 3.46; 95% CI, 1.94-6.17), excess skin concerns (aOR, 2.21; 95% CI, 1.24-3.93), decreased social activity (aOR, 2.94; 95% CI, 1.61-5.35), and female gender (aOR, 1.82; 95% CI, 1.05-3.14).

CONCLUSIONS: Despite weight loss benefits, a substantial subset of bariatric patients in Saudi Arabia continue to face body dissatisfaction and psychological distress. Integrating culturally tailored mental health support into postoperative care is essential to optimize long-term psychosocial outcomes.