Factors associated with excess skin after bariatric surgery: A mixed method study

Abstract

Introduction. After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences. Methods. A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage 46.5+-9.9 years, Mtime post-MBS 34.2+-27.6 months). During Phase I, ES quantity (arms, abdomen, thighs) and inconveniences, sociodemographic, anthropometric, clinical and behavioral outcomes were assessed. In Phase II, 7 focus groups were performed with 37 participants from Phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data. Results. Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r=.36, p<.01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r=.48, p<.05) and current BMI (r=.35, p<.05). Greater ES inconveniences was associated with higher social physique anxiety and age (R2=.50, p<.01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes. Conclusions. Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.

Competing Interest Statement

AT received funding from Johnson & Johnson, Medtronic and GI Windows for studies on bariatric surgery; AT has been consultant for Biotwin, Bausch Health, Novo Nordisk and Eli Lilly; MFL has been consultant for Eli Lilly, Novo Nordisk and Takeda and received research funding from Merck Canada and Novo Nordisk. AT and LB are codirectors of the Research Chair in Bariatric and Metabolic Surgery at Laval University. SB is the president of and own equity in Cliniques et Developpement In Virtuo, a university spin-off that uses virtual reality as part of its clinical services and distributes. RRL has received research grants from Astra-Zeneca, Eli Lilly, Merck, Novo-Nordisk, and Sanofi-Aventis. He has been a consultant or member of advisory panels of Abbott, Amgen, Astra-Zeneca, Boehringer, Carlina Technology, Eli Lilly, Janssen, Medtronic, Merck, Neomed, Novo-Nordisk, Roche, Sanofi-Aventis, and Takeda. He has received honoraria for conferences by Abbott, Astra-Zeneca, Eli Lilly, Janssen, Medtronic, Merck, Novo-Nordisk, and Sanofi-Aventis. He has received in kind contributions related to closed-loop technology from Animas, Medtronic, and Roche. He also benefits from unrestricted grants for clinical and educational activities from Eli Lilly, Lifescan, Medtronic, Merck, Novo Nordisk, and Sanofi. He holds intellectual property in the field of type 2 diabetes risk biomarkers, catheter life and the closed-loop system.

Funding Statement

Insight Development Grant from the Social Sciences and Humanities Research Council of Canada (Grant number 430-2018-00653)

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Centre Integre Universitaire de Soins et de Services de Sante de l Outaouais (2018-240_125-MP), the Institut Universitaire de Cardiologie et de Pneumologie de Quebec Universite Laval (2018-240_125_MP), the Centre Integre Universitaire de Soins et de Services de Sante (CIUSSS) du Nord de l Ile de Montreal (MEO-17-2019-1682), the CIUSSS de l Estrie (MEO-17-2019-3013), the Universite du Quebec en Outaouais (3011), and the Institut de Recherches Cliniques de Montreal (2019-963) Human Research Ethics Committees approved the study protocol.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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