Abstract
BACKGROUND: It has been suggested that psychosocial functioning improves after bariatric surgery, but the mechanism of this effect remains unclear. We propose that body image mediates the association between %EWL and improvement in depressive symptoms. MATERIALS AND METHODS: To investigate this hypothesis, we conducted a mediation analysis in longitudinal data from 52 patients after LSG. RESULTS: %EWL had no direct effect on depressive symptoms as assessed through the patient health questionnaire (PHQ-9), but a small indirect effect that was mediated through negative evaluation of the body (BIQ-20). CONCLUSIONS: We interpret this observation in the context of complex individual etiologies of obesity and argue for a stronger focus on psychological interventions in aftercare regimes. This may be specifically relevant for patients with eating disorders or a desire for body contouring surgery.