Objective To investigate the influencing factors for early postoperative body image among adolescents undergoing bariatric and metabolic surgery.

Methods The cross-sectional study was conducted with retrospective data of analysis. The clinical data of 177 adolescent patients who underwent bariatric and metabolic surgery at The First Affiliated Hospital of Nanjing Medical University from June 2023 to June 2024 were collected. There were 101 males and 76 females, aged (15.8±1.8) years, with preoperative body mass index (BMI) as (42±7) kg/m² and postoperative 3 month BMI as (31±6) kg/m². Observation indicators: (1) total evaluation of the patient 3 months after surgery; (2) analysis of the relationship between body image and clinical characteristics of patients; (3) analysis of the correlation between body image and social functional characteristics of patients; (4) analysis of influencing factors for postoperative body image of patients. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test or one-way ANOVA, and LSD test was used for pairwise comparison. Pearson correlation analysis was used for correlation analysis. Univariate analysis was performed using statistical methods appropriate to the data type. Variables with P<0.05 in univariate analysis or correlation analysis were selected for multivariate analysis. Multivariate analysis was performed using the multiple linear regression analysis with stepwise method.

Results (1) Total evaluation of the patient 3 months after surgery: the body image score of 177 patients 3 months after surgery was 61.7±20.4. (2) Analysis of the relationship between body image and clinical characteristics of patients: of the 177 patients, there was a significant difference in the body image score between male and female patients, and between patients aged ≤15 years and >15 years, respectively (P<0.05). There were significant differences in the body image score among patients with preoperative BMI as >37.5 kg/m², 32.5-37.5 kg/m² and <32.5 kg/m², among patients with postoperative 3 month BMI as >32.5 kg/m², 27.5-32.5 kg/m² and <27.5 kg/m², and among patients with postoperative 3 month percentage of excessive weight loss (%EWL) as <50%, 50%-75% and >75%, respectively (P<0.05). (3) Analysis of the correlation between body image and social functional characteristics of patients: results of correlation analysis showed that the patient's body image score was positively correlated with self-esteem level, social support-objective support, quality of life-social function, and quality of life-school function (r=0.48, 0.26, 0.31, 0.18, P<0.05), and was negatively correlated with depression level and anxiety level (r=-0.62, -0.55, P<0.05). (4) Analysis of influencing factors for postoperative body image of patients: results of multivariate analysis showed that gender, age, postoperative 3 month %EWL, self-esteem, depression and anxiety were independent factors influencing postoperative body image of patients (t=-3.74, -3.07, 3.96, 3.33, -3.14, -2.71, P<0.05). The model exhibited high explanatory power (adjusted r²=0.56). Results of further analysis showed that among male patients, the higher levels of anxiety was associated with the lower levels of postoperative body image (t=-2.96, P<0.05) and the higher levels of postoperative 3 month %EWL, self-esteem and quality of life-school function were associated with the higher levels of postoperative body image (t=2.71, 3.89, 4.33, P<0.05). Among female patients, the higher levels of preoperative BMI, depression and anxiety were associated with the lower levels of postoperative body image (t=-2.37, -3.44, -3.59, P<0.05) and the higher levels of postoperative 3 month %EWL, self-esteem and quality of life-social function were associated with the higher levels of postoperative body image (t=3.16, 3.99, 2.59, P<0.05). Among patients aged ≤15 years, the higher levels of anxiety was associated with the lower levels of postoperative body image (t=-4.61, P<0.05) and the higher levels of postoperative 3 month %EWL and quality of life-social function were associated with the higher levels of postoperative body image (t=3.01, 2.60, P<0.05). Among patients aged >15 years, female and the higher levels of depression were associated with the lower levels of postoperative body image (t=-3.52, -5.42, P<0.05) and the higher levels of postoperative 3 month %EWL and self-esteem were associated with the higher levels of postoperative body image (t=3.36, 2.67, P<0.05).

Conclusions Gender, age, postoperative 3 month %EWL, self-esteem, depression and anxiety are independent factors influencing postoperative body image of patients. Specifically, anxiety has a more significant impact on patient of male and patient aged ≤15 years, while depression and female have a more significant impact on patient aged>15 years. The postopera-tive weight loss effect and improvement of psychosocial function can help improve the patient's postoperative body image level.