Bariatric Surgery Boosts Self-Esteem, But Does It Last?

Medscape

a day ago

The benefits of bariatric surgery can extend beyond physical weight loss and improved metabolic parameters, according to a new study finding that self-esteem surges in the first year following the surgery.
'We certainly know that bariatric surgery can help with diabetes, hypertension, and sleep apnea, but we don't talk as much about how obesity affects basic self-esteem — how the patient feels about themselves,' study investigator Justin Dhyani, MD, Geisinger Medical Center, Danville, Pennsylvania, told Medscape Medical News .
'It seems logical that when a patient loses weight, self-esteem will increase, but the nearly 40-point rise in self-esteem scores we saw in just 12 months was really impressive,' said Dhyani.
But how long does it last?
Leslie Heinberg, PhD, Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, told Medscape Medical News that the self-esteem boost in the first year after surgery noted in this study is 'absolutely in line' with her own clinical observations.
It's after the first year when challenges may arise, said Heinberg, who wasn't involved in the research.
Early Self-Esteem Boost
For their study, Dhyani and colleagues used the Geisinger database to identify 5056 adults (mean age, 48 years; 85% women) with obesity (BMI ≥ 35) who had bariatric surgery between 2006 and 2019. Most had Roux-en-Y gastric bypass or sleeve gastrectomy.
A total of 534 participants completed a survey on self-esteem within 12 months before and 6-24 months after weight-loss surgery.
Overall, the researchers found that self-esteem scores more than doubled just 12 months after bariatric surgery — from 33.6 at baseline to 75.5 (out of 100) at 12 months ( P < .0001).
However, patients with a higher BMI at the time of surgery (BMI ≥ 50) experienced smaller gains in self-esteem compared with peers with lower baseline BMI (< 40), which could be due to lingering effects of weight stigma.
'When you start out at a higher BMI, you have a longer way to go to reach what society might think is a normal weight, said Dhyani, adding that the externalized weight stigma certainly would affect how patients feel about themselves.
'That's what I think is going on,' he told Medscape Medical News.
Dhyani presented the study at the 2025 American Society for Metabolic and Bariatric Surgery (ASMBS) Annual Scientific Meeting in Washington, DC.
He noted that longer-term follow-up will be important to see whether these gains in self-esteem persist over time, particularly in light of known trends in weight regain after surgery.
Beyond the 'Heavenly Period'
Heinberg told Medscape Medical News the first year after bariatric surgery is colloquially called the 'heavenly period' because people are losing a lot of weight, they're finding big improvements in their health and quality of life, and they're often getting a lot of positive attention.
But 'beyond the first year, quality of life may stabilize, and people find that they have to work hard so they don't experience weight recurrence,' said Heinberg. 'They still have the same challenges as before surgery, like stressful jobs. They're just in a smaller body.'
That's why ongoing counseling is so important. 'At Cleveland Clinic, the psychology team is embedded within the bariatric program. We see patients a bit more in the first year, but then annually is recommended,' Heinberg said, adding that they are available to patients more frequently if needed.
April Williams, from Gig Harbor, Washington, who had bariatric surgery in 2019, said the 'temporary high' with surgery-induced weight loss can be followed by an 'emotional crash' as the weight loss eventually slows down and people stop commenting and offering praise.
People need to realize the 'chronic and progressive nature of obesity. Just because you've treated it with bariatric surgery, the disease is still progressing in your life,' Williams told Medscape Medical News .
Driven in part by a lack of post-surgery support, much of it due to COVID, Williams founded BariNation, a patient-led organization that supports people at all stages of their bariatric weight loss journey.
Jamie Sarver, LPN, program coordinator with Cleveland Clinic's Bariatric and Metabolic Institute, said bariatric surgery is 'an opportunity to make an investment in yourself, [but] it's not a quick fix.'
Sarver also had bariatric surgery in 2019. She shared that prior to surgery, she often felt 'uncomfortable' in her own skin, but her perception of herself has 'evolved several times' since the surgery.
'Initially I was glad for the rapid weight loss, smaller clothing sizes, and noticeable changes in my abilities to do physical activities. Over time, and as I've maintained my weight loss, my perception of myself has evolved further to feeling proud and confident of what I've achieved in these 5 years since surgery,' Sarver told Medscape Medical News .
Few Takers
Despite the physical and psychological benefits of bariatric surgery, only about 1% of Americans eligible for bariatric surgery choose to pursue it.
Dhyani said highlighting the emotional and social benefits of bariatric surgery could encourage more patients to consider the procedure. 'I think letting patients know more about the self-esteem aspect of it might open up their minds to this type of care to improve their lives,' he said.
Richard M. Peterson, MD, MPH, president-elect of the ASMBS and professor of surgery at UT Health San Antonio, San Antonio, told Medscape Medical News that one of his initiatives is to 'improve the image of bariatric surgery.'
'A lot of people still have the very old-school view that bariatric surgery is dangerous. But the truth is this surgery — that improves overall health and weight loss — is safer than having your gallbladder removed,' said Peterson.