Sex differences in psychosocial health before bariatric surgery

Sex differences in psychosocial health before bariatric surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sex differences in psychosocial health before bariatric surgery Rafaela Dutra, Victoria Sant'Anna, Alessandra Mulder This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9408119/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Purpose Severe obesity is associated with substantial psychosocial burden, including poorer body image, lower self-esteem, and impaired health-related quality of life (HRQoL). Although these outcomes may differ between men and women, sex-specific psychosocial patterns among candidates for bariatric surgery remain insufficiently explored. This study compared body image, self-esteem, and HRQoL between male and female bariatric surgery candidates. Methods In this cross-sectional study, 110 adults undergoing preoperative evaluation for bariatric surgery (93 women and 17 men) were recruited at a tertiary hospital in Rio de Janeiro, Brazil. Anthropometry and body composition were assessed using bioelectrical impedance and standard measurements. Body image perception was evaluated with the Kakeshita Silhouette Scale, body satisfaction with the Body Shape Questionnaire, self-esteem with the Rosenberg Self-Esteem Scale, and HRQoL with the SF-12. Group comparisons, correlations, and sex-stratified multiple linear regression models were performed. Results Despite similar BMI, men had higher weight, central adiposity indicators, and lean mass percentage, whereas women had higher fat mass percentage. Body image distortion was common, affecting 80.2% of participants, with women more often overestimating and men underestimating body size. Approximately 61% of the sample reported body dissatisfaction. Men showed higher self-esteem scores, whereas women had lower mental HRQoL. Among women, body satisfaction was associated with both physical and mental HRQoL, while self-esteem was associated only with mental HRQoL. Among men, body satisfaction was associated only with physical HRQoL. Conclusions These findings suggest sex-related differences in psychosocial functioning among bariatric surgery candidates. Women appeared to experience broader psychosocial burden, particularly in mental HRQoL, whereas findings in men were more closely linked to physical HRQoL and should be interpreted as exploratory. Obesity Bariatric Surgery Body Image Self-Esteem Health-Related Quality of Life Sex Differences Introduction Obesity is a multifactorial condition resulting from the interaction of genetic, metabolic, psychological, sociocultural, and economic factors [ 1 ]. It represents a major global public health concern, being associated with increased morbidity and mortality, reduced functional capacity, and impaired quality of life [ 2 ]. In Brazil, projections from the National Health Survey indicate that by 2030 approximately 2.6% of adults will present severe obesity [ 3 ]. In this context, bariatric and metabolic surgery (BMS) is considered the most effective treatment for severe obesity, being associated with sustained weight loss, reduction of comorbidities, and improvements in health-related quality of life (HRQoL) [ 4 , 5 ]. Among candidates for BMS, significant impairments in HRQoL are frequently reported, and the expectation of improvement in this outcome represents an important aspect of the treatment process [ 6 ]. Beyond clinical aspects, psychosocial factors such as self-esteem and body image play a relevant role in the experience of obesity. Excess body weight and the social stigma associated with obesity may contribute to psychological distress, social isolation, and negative perceptions of body image [ 7 – 9 ]. Evidence suggests that the impacts of obesity may differ between men and women. Men exhibit a higher prevalence of obesity-related metabolic comorbidities [ 10 ], whereas women represent the majority of patients undergoing bariatric surgery. Data from the Global Registry of the International Federation for the Surgery of Obesity and Metabolic Disorders indicate that women accounted for approximately 82.9% of patients undergoing BMS between 2016 and 2020 [ 11 ]. In the domain of body image, research indicates that women tend to exhibit greater body dissatisfaction compared to men, reflecting, in part, sociocultural pressures related to aesthetic standards [ 12 – 14 ]. However, when analyzing HRQoL, findings remain inconsistent, with some studies showing similar impacts across sexes and others indicating greater impairment among women [ 15 – 17 ]. However, despite growing evidence regarding psychosocial aspects of obesity, studies simultaneously evaluating self-esteem, body satisfaction, and health-related quality of life according to sex among candidates for bariatric surgery remain scarce. Therefore, the present study aimed to compare self-esteem, body satisfaction, and HRQoL between men and women undergoing preoperative evaluation for bariatric surgery. Materials and Methods Study Design and Participants This is a cross-sectional study approved by the Research Ethics Committee (CAAE: 70486123.8.0000.5259), which included patients who were candidates for bariatric surgery after signing the Informed Consent Form. Participants were recruited at the Multiuser Clinical Research Center (CEPEM) of the Pedro Ernesto University Hospital (Rio de Janeiro, Brazil), with no restrictions regarding ethnicity or sex, and independently of comorbidities. Of the 133 patients approached, 110 agreed to participate. Data collection was conducted by two trained interviewers, and double data entry was performed in Excel® to ensure accuracy. Anthropometric and Body Composition Assessment Body weight, height, body mass index (BMI), and body composition were measured using tetrapolar bioelectrical impedance with an integrated scale (InBody370s). Measurements were performed with participants barefoot, without accessories, and wearing light clothing, according to a standardized protocol. Waist, hip, and neck circumferences were measured in triplicate by a trained evaluator, and the arithmetic mean was used for analysis. All assessments were conducted preoperatively, before surgical clearance. The sample was stratified into two groups according to sex, consisting of 93 women and 17 men. Psychosocial Assessment Instruments Kakeshita Silhouette Scale Body image perception was assessed using the Kakeshita Silhouette Scale, composed of 15 sex-specific figures, with BMI ranging from 12.5 to 47.5 kg/m² in increments of 2.5 kg/m² [ 18 ]. Participants indicated the figure that best represented their current body. Perceptual distortion of body image was calculated by comparing the BMI range corresponding to the chosen figure with the measured BMI. If there was no difference, no distortion was considered; if the figure’s BMI range was lower than the measured BMI, underestimation was indicated; if higher, overestimation was indicated [ 19 ]. Three categories were thus created: no distortion, overestimation, and underestimation. Due to the scale’s upper limit, only participants with BMI ≤ 50 kg/m² were included in this analysis (n = 81). Body Shape Questionnaire (BSQ) Body satisfaction was assessed using the Body Shape Questionnaire (BSQ), which measures attitudinal and subjective aspects of body image. Scores range from 34 to 204 points and are classified as follows: absence of dissatisfaction (≤ 110), mild dissatisfaction (111–138), moderate (139–167), and severe (> 167) [ 20 ]. Rosenberg Self-Esteem Scale Global self-esteem was measured using the Rosenberg Self-Esteem Scale, considered the gold standard in the field. Total scores range from 10 to 40 points, with higher scores indicating higher self-esteem [ 21 ]. For interpretation, the classification proposed by Echeburúa in 1995 was used: low self-esteem (10–25), medium (26–29), and high (≥ 30) [ 22 ]. SF-12 (12-Item Short-Form Health Survey) Health-related quality of life (HRQoL) was assessed using the 12-Item Short-Form Health Survey (SF-12), a validated instrument encompassing eight HRQoL domains, including physical, emotional, and social aspects. Results are summarized in two main components: physical (PCS) and mental (MCS), with scores ranging from 0 to 100, where higher scores indicate better quality of life [ 23 ]. Statistical Analysis Normality of variables was tested using the Kolmogorov-Smirnov test. Categorical variables were presented as absolute and relative frequencies (%), and comparisons between sexes were performed using the independent samples t-test (continuous variables) and Fisher’s exact test (categorical variables). Associations between body satisfaction and self-esteem with physical and mental HRQoL, by sex, were assessed using Spearman’s correlation coefficient. To evaluate the effect of body satisfaction and self-esteem on physical and mental HRQoL, multiple linear regression models were performed separately for women and men. Initially, a model including only the main variables (body satisfaction and self-esteem) was conducted to assess their crude effect on HRQoL. A second adjusted model was then performed, including the main variables plus age and BMI as covariates due to their potential confounding effect on HRQoL. All models were checked for linear regression assumptions (linearity, independence and homoscedasticity of residuals, normality, absence of multicollinearity, and influential values). A significance level of p < 0.05 was adopted. All analyses were conducted using SPSS software, version 28. Given the small number of male participants, sex-stratified analyses in men were considered exploratory and hypothesis-generating. Results Sample Characterization A total of 110 bariatric surgery candidates participated in the study, with a mean age of 42.85 ± 10.13 years. The sample was predominantly female (84.5%; n = 93), while men represented 15.5% of participants (n = 17). Regarding self-reported race, 38% identified as White (n = 41), 29% as Black (n = 32), and 34% as Brown/mixed race (n = 37). Concerning socioeconomic status, 75.5% of the sample reported a monthly income of up to two minimum wages, and approximately half of the participants had completed or incomplete high school education (Table 1 ). Table 1 Sociodemographic characteristics of the sample Sociodemographic profile Variables n = 110 % Age a 42.85 ± 10.13 Sex Female 93 84.5 Male 17 15.5 Ethnicity White 41 37.3 Black 32 29.1 Mixed race 37 33.6 Income < 2 minimum wages 83 75.5 ≥ 2 minimum wages 23 2.9 Education level Primary education (complete or incomplete) 40 36.4 Secondary education (complete or incomplete) 52 47.3 Higher education (complete or incomplete) 18 16.4 ᵃContinuous variable expressed as mean ± standard deviation. Anthropometry and Body Composition No significant differences in BMI were observed between male and female bariatric surgery candidates. However, relevant differences were identified in other anthropometric and body composition parameters. Men presented significantly higher body weight, neck circumference, waist circumference, waist-to-hip ratio, and lean mass percentage. Conversely, women presented higher hip circumference and body fat percentage. These results indicate that, despite similar BMI, men and women differ regarding body distribution and composition (Table 2 ). Table 2 Anthropometric and body composition variables by sex in bariatric surgery candidates Variables Total sample (n = 110) Mean ± SD Female (n = 93) Mean ± SD Male (n = 17) Mean ± SD p Weight (kg) 122.56 ± 18.52 119.73 ± 17.22 138.03 ± 18.14 0.01 BMI (kg/m2) 45.62 ± 5.85 45.56 ± 5.98 45.95 ± 5.19 0.79 Neck circumference (cm) 41.49 ± 4.27 40.46 ± 3.37 47.07 ± 4.34 0.01 Waist circumference (cm) 118.34 ± 11.58 116.61 ± 11.01 127.71 ± 10.21 0.01 Hip circumference (cm) 137.67 ± 10.61 138.87 ± 10.69 131.15 ± 7.52 0.01 Waist-to-hip ratio 0.87 ± 0.09 0.85 ± 0.08 0.97 ± 0.07 0.01 Fat mass (%) 51.92 ± 3.99 52.73 ± 3.22 47.66 ± 4.92 0.01 Lean mass (%) 27.00 ± 2.50 26.50 ± 2.10 29.58 ± 2.84 0.01 *Comparisons between sexes were performed using the Student’s t-test for independent samples; p < 0.05 considered significant. Psychosocial Parameters Among the participants assessed with the Kakeshita Silhouette Scale (n = 81; 69 women and 12 men), perceptual body image distortion was observed in 80.2% of the sample. Significant sex differences were identified using Fisher’s exact test (p = 0.04), with women showing a greater tendency to overestimate body size, whereas men tended to underestimate it. Regarding body satisfaction, assessed using the Body Shape Questionnaire (BSQ), approximately 61% of participants reported some level of body dissatisfaction. No significant sex differences were observed in the distribution of dissatisfaction levels (Table 3 ). Table 3 Distribution of self-esteem and body satisfaction categories by sex among candidates for bariatric surgery Psychosocial parameters Categories Total sample n = 110 (%) Female n = 93 (%) Male n = 17 (%) p Body satisfaction (BSQ) No dissatisfaction 43 (39.1%) 32 (34.4%) 11 (64.7%) 0.12 Mild dissatisfaction 26 (23.6%) 23 (24.7%) 3 (17.6%) Moderate dissatisfaction 27 (24.5%) 25 (26.8%) 2 (11.7%) Severe dissatisfaction 14 (12.8%) 13 (14.1%) 1 (6.0%) Self-esteem (RSES) Low 25 (22.7%) 24 (25.8%) 1 (6.0%) 0.05 Medium 36 (32.7%) 32 (34.4%) 4 (23.5%) High 49 (44.6%) 37 (39.8%) 12 (70.5%) Data are presented as absolute (n) and relative (%) frequencies. BSQ = Body Shape Questionnaire; RSES = Rosenberg Self-Esteem Scale. Comparisons between sexes were performed using Fisher’s Exact Test. p < 0.05 was considered statistically significant. Concerning self-esteem, assessed with the Rosenberg Self-Esteem Scale, about 22% of participants presented low self-esteem. Distribution of self-esteem levels differed significantly between sexes (p = 0.05), with a higher proportion of low self-esteem among women and higher frequency of elevated self-esteem among men. Analysis of mean scores indicated that both groups showed levels corresponding to mild body dissatisfaction, with no significant differences between sexes. Conversely, men presented significantly higher mean self-esteem scores compared to women (Table 4 ). Regarding health-related quality of life (HRQoL), the mean SF-12 scores were 35.88 for the physical component and 45.03 for the mental component. When analyzed by sex, no significant differences were observed in physical HRQoL. However, women showed significantly lower mental HRQoL scores (p = 0.01) (Table 4 ). Table 4 Mean scores of self-esteem, body satisfaction, and health-related quality of life (physical and mental components) by sex among candidates for bariatric surgery Psychosocial parameters Total sample (n = 110) Mean ± SD Female (n = 93) Mean ± SD Male (n = 17) Mean ± SD p-value Body satisfaction (BSQ) 125.45 ± 37.81 127.86 ± 37.83 112.29 ± 35.95 0.11 Self-esteem (RSES) 29.19 ± 5.41 28.73 ± 5.53 31.71 ± 3.98 0.03 Physical HRQoL (SF-12) 35.88 ± 10.76 36.01 ± 11.01 35.18 ± 9.47 0.77 Mental HRQoL (SF-12) 45.03 ± 12.66 43.68 ± 12.27 52.39 ± 12.54 0.01 BSQ = Body Shape Questionnaire; RSES = Rosenberg Self-Esteem Scale; HRQol = Health-related quality of life; SF-12 = 12-Item Short-Form Health Survey. Comparisons between sexes were performed using the Student’s t-test for independent samples; p < 0.05 was considered statistically significant. Correlations Between Body Dissatisfaction, Self-Esteem, and HRQoL Bivariate correlation analysis revealed distinct patterns between sexes (Table 5 ). Among women, self-esteem was significantly associated with mental HRQoL, while body satisfaction was associated with both physical and mental HRQoL. Additionally, a significant association was observed between self-esteem and body satisfaction in this group. Among men, self-esteem was not significantly associated with the evaluated parameters. Conversely, body satisfaction was associated exclusively with physical HRQoL. Table 5 Spearman correlation between self-esteem, body satisfaction, and health-related quality of life by sex among candidates for bariatric surgery BSQ = Body Shape Questionnaire; RSES = Rosenberg Self-Esteem Scale; HRQol = Health-related quality of life; SF-12 = 12-Item Short-Form Health Survey; rs = Spearman correlation coefficient; p < 0.05; p < 0.01. Female (n = 93) Variables 1 2 3 4 1. Body satisfaction (BSQ) - 2. Self-esteem (RSES) − 0.49** - 3. Physical HRQoL (SF-12) − 0.24** 0.17 - 4. Mental HRQoL (SF-12) − 0.42** 0.37** − 0.14 - Male (n = 17) Variables 1 2 3 4 1. Body satisfaction (BSQ) - 2. Self-esteem (RSES) − 0.12 - 3. Physical HRQoL (SF-12) − 0.56** 0.46 - 4. Mental HRQoL (SF-12) − 0.30 0.21 − 0.02 - Multiple Linear Regression Analysis Multiple linear regression models were conducted to evaluate whether body satisfaction and self-esteem could explain the variance in physical and mental HRQoL in men and women. Regression assumptions were verified and met, ensuring model adequacy. For women, the first regression model, including only the main variables (body satisfaction and self-esteem), was significant for both physical and mental HRQoL. For physical HRQoL, only body satisfaction was a significant predictor, while for mental HRQoL, both body satisfaction and self-esteem were individually significant predictors. After adjustment for age and BMI, the models remained significant for both HRQoL domains. For physical HRQoL, body satisfaction and age were significant predictors, whereas for mental HRQoL only body satisfaction remained significant. These findings indicate that, among women, body satisfaction has an independent effect on both physical and mental HRQoL, while the effect of self-esteem on mental HRQoL is partially influenced by age and BMI (Table 6 ). For men, in the regression analysis including only the main variables (body satisfaction and self-esteem), the model was significant for physical HRQoL, with only body satisfaction as a significant predictor. For mental HRQoL, the model was not significant, and none of the main variables had an individual effect. When adjusting the model to include age and BMI as covariates, findings remained similar: for physical HRQoL, the model remained significant with only body satisfaction as a significant predictor, whereas for mental HRQoL, the model continued to be non-significant, and neither main variables nor covariates had an individual effect. These results indicate that, in this small male sample, body satisfaction was the only variable associated with physical HRQoL, while self-esteem, age, and BMI were not significantly associated with mental HRQoL. (Table 7 ). Table 6 Multiple linear regression models (crude and adjusted) for physical and mental health-related quality of life among female bariatric surgery candidates Crude model (n = 93) Physical HRQoL Mental HRQoL Model summary B SE β P Model summary B SE β p Body satisfaction (BSQ) -0.07 0.03 -0.24 0.04 Body satisfaction (BSQ) − 0.10 0.03 − 0.31 0.01 Self-esteem (RSES) 0.12 0.23 0.06 0.59 Self-esteem (RSES) 0.55 0.23 0.25 0.02 R 2 0.07 R 2 0.24 R 2 * 0.05 R 2 * 0.22 Sig. 0.02 Sig. 0.01 Adjusted model (n = 93) Physical HRQoL Mental HRQoL Model summary B SE β p Model summary B SE β p Body satisfaction (BSQ) -0.07 0.03 -0.26 0.02 Body satisfaction (BSQ) − 0.10 0.03 − 0.31 0.01 Self-esteem (RSES) 0.19 0.23 0.09 0.41 Self-esteem (RSES) 0.46 0.25 0.20 0.06 Age -0.40 0.10 -0.36 0.01 Age 0.22 0.11 0.18 0.06 BMI -0.34 0.18 -0.18 0.06 BMI 0.02 0.19 0.01 0.90 R 2 0.21 R 2 0.27 R 2 * 0.18 R 2 * 0.23 Sig. 0.01 Sig. 0.01 BSQ = Body Shape Questionnaire; RSES = Rosenberg Self-Esteem Scale; HRQoL = Health-Related Quality of Life; B = unstandardized coefficient; SE = standard error; β = standardized coefficient; p = significance level; R² = coefficient of determination; Adjusted R² = adjusted coefficient of determination. Table 7 Multiple linear regression models (crude and adjusted) for physical and mental health-related quality of life among male bariatric surgery candidates Crude model (n = 17) Physical HRQoL Mental HRQoL Model summary B SE β p Model summary B SE β p Body satisfaction (BSQ) -0.13 0.05 -0.52 0.02 Body satisfaction (BSQ) -0.15 0.08 -0.43 0.08 Self-esteem (RSES) 0.84 0.47 0.35 0.09 Self-esteem (RSES) 0.68 0.73 0.21 0.36 R 2 0.44 R 2 0.25 R 2 * 0.36 R 2 * 0.15 Sig. 0.01 Sig. 0.12 Adjusted model (n = 17) Physical HRQoL Mental HRQoL Model summary B SE β p Model summary B SE β p Body satisfaction (BSQ) -0.15 0.05 -0.59 0.01 Body satisfaction (BSQ) -0.12 0.07 -0.35 0.13 Self-esteem (RSES) 0.94 0.46 0.39 0.06 Self-esteem (RSES) 0.37 0.68 0.11 0.59 Age -0.19 0.18 -0.21 0.30 Age 0.49 0.26 0.42 0.08 BMI 0.56 0.34 0.31 0.12 BMI 0.45 0.51 0.18 0.38 R 2 0.57 R 2 0.46 R 2 * 0.43 R 2 * 0.29 Sig. 0.02 Sig. 0.08 BSQ = Body Shape Questionnaire; RSES = Rosenberg Self-Esteem Scale; HRQoL = Health-Related Quality of Life; B = unstandardized coefficient; SE = standard error; β = standardized coefficient; p = significance level; R² = coefficient of determination; Adjusted R² = adjusted coefficient of determination. Discussion The present study investigated sex differences among candidates for bariatric and metabolic surgery, focusing on psychosocial parameters relevant to preoperative evaluation. The findings suggest distinct patterns in body image perception, self-esteem, and health-related quality of life between men and women. Men were underrepresented in the sample, which is consistent with the lower utilization of bariatric treatment by males reported in clinical practice and previous studies. However, because the number of male participants was small, male-specific findings should be interpreted as exploratory. From a psychosocial perspective, men presented higher self-esteem scores, while women showed poorer mental health-related quality of life (HRQoL). Furthermore, sex-specific patterns were also observed in the associations between psychosocial variables and HRQoL. However, given the small number of male participants, these findings should be interpreted with caution and considered exploratory, highlighting the need for further studies with more balanced samples. Consistent with previous studies, the sample was predominantly composed of women, accounting for approximately 85% of participants, which reflects the greater female demand for bariatric surgery despite obesity affecting both sexes [ 24 , 11 ]. Despite their lower representation, men presented significantly higher values of body weight, neck circumference, waist circumference, waist-to-hip ratio, and lean mass percentage. Similar findings have been reported in prior studies with BMS candidates, which also observed no significant differences in BMI between sexes, although men exhibited greater central adiposity and muscle mass, while women showed higher body fat percentage [ 25 , 26 ]. These findings are clinically relevant, as indicators such as waist circumference, neck circumference, and waist-to-hip ratio are associated with increased cardiometabolic risk. They may also be consistent with previous evidence suggesting that men often present for bariatric treatment with a less favorable anthropometric profile. However, this interpretation should be made cautiously, particularly in light of the small male subsample. [ 27 , 28 ]. Regarding body image, a high prevalence of perceptual distortion was observed, with a tendency toward overestimation among women and underestimation among men. Previous studies have also described elevated levels of body image distortion in BMS candidates, although generally with lower prevalence than that observed in the present study. For instance, Da Silva et al. [ 29 ] reported a prevalence of 55.5% in this population. Moreover, evidence suggests that men are more likely to underestimate their body size, particularly among individuals with overweight and obesity [ 30 , 31 ]. A high prevalence of body dissatisfaction was also identified, with approximately 61% of participants reporting some degree of dissatisfaction. This finding is consistent with meta-analyses demonstrating that individuals with overweight or obesity tend to evaluate their body appearance more negatively compared to those with normal weight [ 32 – 34 ]. However, contrary to studies reporting higher levels of dissatisfaction among women [ 35 , 36 ], the present study found a similar distribution between sexes, a pattern also observed in some previous investigations [ 37 , 38 ]. With respect to self-esteem, most participants presented medium or high levels, consistent with prior studies involving BMS candidates [ 39 , 40 ]. Nevertheless, men exhibited significantly higher self-esteem scores compared to women. While some evidence suggests that BMI may influence self-esteem similarly across sexes [ 19 ], other studies indicate slightly higher levels among men [ 41 , 42 ]. This difference may be explained by the greater influence of sociocultural pressures related to body image on women, for whom self-esteem is often more closely linked to appearance. HRQoL findings revealed substantial impairments in both physical and mental domains compared to normative data for the Brazilian population [ 43 ]. Although these impairments were observed in both sexes, women presented significantly lower mental HRQoL scores, a finding consistently reported in the literature [ 44 , 45 , 6 ]. Potential explanations include greater internalization of weight-related stigma and higher societal pressure regarding body image among women [ 46 – 48 ]. The analysis of associations between psychosocial variables and HRQoL revealed distinct patterns between sexes. Among women, both self-esteem and body satisfaction were associated with mental HRQoL, while body satisfaction was also associated with physical HRQoL. In contrast, among men, body satisfaction was associated only with physical HRQoL, whereas no significant associations were observed for mental HRQoL. Given the small number of male participants, these findings should be interpreted as preliminary and may reflect either true sex-specific patterns or limited statistical power. Importantly, these sex-stratified patterns remained partially consistent in the regression models after adjustment for age and BMI, allowing a more cautious estimation of the independent effects of body satisfaction and self-esteem [ 49 ] These differences may also contribute to understanding distinct motivational patterns for seeking BMS, as suggested in the literature, with women more frequently motivated by psychosocial and body image-related factors, whereas men tend to seek treatment due to physical limitations and health concerns [ 50 – 51 ]. The present findings highlight the importance of incorporating psychosocial assessment into the preoperative evaluation of BMS candidates, particularly considering sex-specific differences. Such an approach may support more individualized and comprehensive patient care. However, some limitations should be acknowledged, including the cross-sectional design, which precludes causal inferences, the recruitment from a single reference center, which may limit generalizability, and the unequal sex distribution, particularly the small male subsample, which limits the robustness of sex-stratified analyses in men. Conclusion The present findings suggest possible sex-related differences in body image, self-esteem, and health-related quality of life among candidates for bariatric surgery. Women showed broader psychosocial impairment, particularly in mental HRQoL, whereas in men the observed associations were more closely related to physical HRQoL. Because the male subsample was small, these findings should be interpreted as exploratory. Preoperative assessment of psychosocial factors may help support more individualized care strategies for individuals with severe obesity. Declarations • This work was supported by by the Carlos Chagas Filho Foundation for Research Support in the State of Rio de Janeiro (FAPERJ), (Grant numbers E.26/211.974/2026). • The authors have no relevant financial or non-financial interests to disclose. Author Contribution All authors contributed to the study conception and design. Conceptualization: Rafaela Dutra and Alessandra Mulder; Methodology: Rafaela Dutra and Victoria Sant’Anna; Formal analysis and investigation: Rafaela Dutra and Victoria Sant’Anna; Writing - original draft preparation: Rafaela Dutra and Victoria Sant’Anna; Writing - review and editing: Alessandra Mulder; Funding acquisition, Resources and Supervision: Alessandra Mulder. References ​​Lobstein T, Brinsden H, Neveux M. World Obesity Atlas 2022. London: World Obesity Federation; 2022 [cited 2025 Feb 12]. Available from: http://www.worldobesity.org Brasil. Ministério da Saúde. Manual de atenção às pessoas com sobrepeso e obesidade no âmbito da atenção primária à saúde (APS) do Sistema Único de Saúde. Brasília: Ministério da Saúde; 2022 [cited 2024 Nov 10]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/manual_atencao_pessoas_sobrepeso_obesidade.pdf Brasil IBGE. 2020 [cited 2025 Feb 12]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101758.pdf Ozsoy Z, Demir E. Which bariatric procedure is the most popular in the world? A bibliometric comparison. Obes Surg. 2018;28:2339–52. Tsilingiris D, Koliaki C, Kokkinos A. Remission of type 2 diabetes mellitus after bariatric surgery: fact or fiction? Int J Environ Res Public Health. 2019;16(17):3171. Apple R, Samuels LR, Fonnesbeck C, et al. Body mass index and health-related quality of life. Obes Sci Pract. 2018;4(5):417–26. Macedo TTS, Portela PP, Palamira CS, Mussi FC. Percepção de pessoas obesas sobre seu corpo. Escola Anna Nery. 2015;19(3):505–10. Mehrdad N, Abbasi NH, Nikbakht-Nasrabadi A. The hurt of judgment in excessive weight women: a hermeneutic study. Glob J Health Sci. 2015;7:263–70. Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Dixon JB. Joint international consensus statement for ending stigma of obesity. Nature. 2020;583:785–8. Saeedi P, Petersohn I, Salpea P et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. Brown WA, Kow L, Shikora S et al. 6th IFSO Global Registry Report. Naples: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO); 2021 [cited 2023 Feb 7]. Available from: https://www.ifso.com/pdf/ifso-6th-registry-report-2021.pdf López-Guimerà G, Levine MP, Sánchez-Carracedo D, Fauquet J. Influence of mass media on body image and eating disordered attitudes and behaviors in females: a review of effects and processes. Media Psychol. 2010;13(4):387–416. Brechan I, Kvalem IL. Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression. Eat Behav. 2015;17:49–58. Franchina V, Coco GL. The influence of social media use on body image concerns. Int J Psychoanal Educ. 2018;10:5–14. Available from: http://www.psychoedu.org/index.php/IJPE/article/view/218 Fabricatore AN, Wadden TA, Sarwer DB, Faith MS. Health-related quality of life and symptoms of depression in extremely obese persons seeking bariatric surgery. Obes Surg. 2005;15:304–9. Truthmann J, Mensink G, Bosy-Westphal A, et al. Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany. Health Qual Life Outcomes. 2017;15:191. Alghamdi M. Exploring body mass index and gender-based self-esteem differences in Saudi Arabia. Front Public Health. 2025;12:1495973. Kakeshita IS. Adaptação e validação de escalas de silhuetas para crianças e adultos brasileiros [tese]. Ribeirão Preto: Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto; 2008. Coelho CG, Giatti L, Molina MD, et al. A imagem corporal e o estado nutricional estão associados à atividade física em homens e mulheres: o estudo ELSA-Brasil. Rev Int Pesqui Ambient Saúde Pública. 2015;12(6):6179–96. Di Pietro M, Silveira DXD. Validade interna, dimensionalidade e desempenho da escala Body Shape Questionnaire em uma população de estudantes universitários brasileiros. Braz J Psychiatry. 2009;31:21–4. Rosenberg M, Schooler C, Schoenbach C, Rosenberg F. Global self-esteem and specific self-esteem: different concepts, different outcomes. Am Sociol Rev. 1995;60:141–56. Echeburúa E. Evaluación y tratamiento de la fobia social. Barcelona: Martínez Roca; 1995. Ware JJ, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33. Fuchs HF, Broderick RC, Harnsberger CR, et al. Benefits of bariatric surgery do not reach obese men. J Laparoendosc Adv Surg Tech A. 2015;25(3):196–201. Alves L, Mattiello R, Todescatto A, et al. Bariatric patient's body composition: an option to BMI? Clin Nutr ESPEN. 2020;40:121–4. Sobás K, Suliga E, Bryk P, Głuszek S. Dietary patterns and nutritional status in bariatric surgery candidates: a cross-sectional study. Nutrients. 2025;17(4):716. Jayedi A, Soltani S, Zargar MS, et al. Central fatness and risk of all-cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies. BMJ. 2020;370:m3324. Van Olst N, Reiber BM, Vink MR, Gerdes VE, Galenkamp H, Van der Peet DL, et al. Are male patients undergoing bariatric surgery less healthy than female patients? Surg Obes Relat Dis. 2023;19(9):1013–22. Da Silva HBA, Rossoni CR, Oliveira TMS, et al. Percepção da imagem corporal e tolerância alimentar de pacientes submetidos à cirurgia bariátrica e metabólica em um Hospital do Sul de Minas Gerais. Semin Ciênc Biol Saúde. 2020;41:123–40. Robinson E, Hogenkamp PS. Visual perceptions of male obesity: a cross-cultural study examining male and female lay perceptions of obesity in Caucasian males. BMC Public Health. 2015;15:492. Gruszka W, Owczarek AJ, Glinianowicz M, et al. Perception of body size and body dissatisfaction in adults. Sci Rep. 2022;12:1159. Papadopoulos S, Brennan L. Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obes (Silver Spring). 2015;23(9):1743–60. Weinberger NA, Kersting A, Riedel-Heller SG, Luck-Sikorski C. Body dissatisfaction in individuals with obesity compared to normal-weight individuals: a systematic review and meta-analysis. Obes Facts. 2016;9(6):424–41. Siqueira BB, Assumpção MC, Barroso SM, et al. Weight stigma and health–repercussions on the health of adolescents and adults: integrative review of the literature. J Bras Psiquiatr. 2021;70:162–78. Fallon EA, Harris BS, Johnson P. Prevalence of body dissatisfaction among a United States adult sample. Eat Behav. 2014;15:151–8. Quittkat H, Hartmann A, Düsing R, et al. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry. 2019;10:771. Lavender JM, Gratz KL, Anderson DA. Mindfulness, body image, and drive for muscularity in men. Body Image. 2012;9:289–92. Burlew LD, Shurts WM. Men and body image: current issues and counseling implications. J Counsel Dev. 2013;91:428–35. Mendes AB, Sá JDS, Souza FCD, et al. Autoestima e prevalência de depressão em pacientes com indicação de cirurgia bariátrica. Int J Dev Res. 2021;11(1):43977–80. Liu X, Zhang W, Yue W, et al. From weight bias internalization to health-related quality of life: self-esteem and psychopathology in pre-bariatric surgery patients. Obes Surg. 2022;32:3705–13. Zuckerman M, Li C, Hall JA. When men and women differ in self-esteem and when they don’t: a meta-analysis. J Res Pers. 2016;64:34–51. Magee W, Upenieks L. Gender differences in self-esteem, unvarnished self-evaluation, future orientation, self-enhancement and self-derogation in a U.S. national sample. Pers Individ Dif. 2019;149:66–77. Laguardia J, Campos MR, Travassos C, et al. Brazilian normative data for the Short Form 36 questionnaire, version 2. Rev Bras Epidemiol. 2013;16(4):889–97. Mannucci E, Petroni ML, Villanova N, et al. Clinical and psychological correlates of health-related quality of life in obese patients. Health Qual Life Outcomes. 2010;8:90. Gibson-Smith D, Bot M, Paans NP, et al. The role of obesity measures in the development and persistence of major depressive disorder. J Affect Disord. 2016;198:222–9. Maine MD. Eating disorders and body image distress in women at midlife. Medscape Today. 2005 [cited 2013 Nov 8]. Available from: http://www.medscape.org/viewarticle/508299 Himmelstein MS, Puhl RM, Quinn DM. Intersectionality: an understudied framework for addressing weight stigma. Am J Prev Med. 2017;53:421–31. Pearl RL, Puhl RM, Lessard LM, et al. Prevalence and correlates of weight bias internalization in weight management: a multinational study. SSM Popul Health. 2021;13:100755. Kolotkin RL, Crosby RD, Gress RE, et al. Health and health-related quality of life: differences between men and women who seek gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):651–9. Robertson C, Archibald D, Avenell A, Douglas F, Hoddinott P, van Teijlingen E, et al. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess. 2014;18(35):1–424. Lacerda R, Castanha C, Castanha A, et al. Perception of body image by patients undergoing bariatric surgery. Rev Col Bras Cir. 2018;45(2):e1793. Additional Declarations No competing interests reported. Supplementary Files Graphicalabstract.png Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 15 May, 2026 Reviews received at journal 08 May, 2026 Reviewers agreed at journal 23 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 15 Apr, 2026 Editor assigned by journal 14 Apr, 2026 Submission checks completed at journal 13 Apr, 2026 First submitted to journal 13 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9408119","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626591055,"identity":"224af46c-1774-45a8-b4e3-664864d5d301","order_by":0,"name":"Rafaela Dutra","email":"","orcid":"","institution":"Rio de Janeiro State University","correspondingAuthor":false,"prefix":"","firstName":"Rafaela","middleName":"","lastName":"Dutra","suffix":""},{"id":626591056,"identity":"53d7a12f-43a3-433f-9731-d643265821bc","order_by":1,"name":"Victoria Sant'Anna","email":"","orcid":"","institution":"Rio de Janeiro State University","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Sant'Anna","suffix":""},{"id":626591057,"identity":"9a6fede8-b6da-462b-8699-1f2db1b24bca","order_by":2,"name":"Alessandra Mulder","email":"data:image/png;base64,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","orcid":"","institution":"Rio de Janeiro State University","correspondingAuthor":true,"prefix":"","firstName":"Alessandra","middleName":"","lastName":"Mulder","suffix":""}],"badges":[],"createdAt":"2026-04-13 20:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9408119/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9408119/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107707385,"identity":"ca64590a-50b1-4d65-adc1-263e46b1109f","added_by":"auto","created_at":"2026-04-24 09:20:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":581389,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9408119/v1/1e3fe556-2bc4-4da0-9da1-09c17a9f3ae5.pdf"},{"id":107650363,"identity":"f69b1770-8949-412f-9a79-4a9d3ceb6e07","added_by":"auto","created_at":"2026-04-23 14:57:25","extension":"png","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":4500200,"visible":true,"origin":"","legend":"","description":"","filename":"Graphicalabstract.png","url":"https://assets-eu.researchsquare.com/files/rs-9408119/v1/105e19880ceded98a2e4a263.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sex differences in psychosocial health before bariatric surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is a multifactorial condition resulting from the interaction of genetic, metabolic, psychological, sociocultural, and economic factors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It represents a major global public health concern, being associated with increased morbidity and mortality, reduced functional capacity, and impaired quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Brazil, projections from the National Health Survey indicate that by 2030 approximately 2.6% of adults will present severe obesity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In this context, bariatric and metabolic surgery (BMS) is considered the most effective treatment for severe obesity, being associated with sustained weight loss, reduction of comorbidities, and improvements in health-related quality of life (HRQoL) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong candidates for BMS, significant impairments in HRQoL are frequently reported, and the expectation of improvement in this outcome represents an important aspect of the treatment process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Beyond clinical aspects, psychosocial factors such as self-esteem and body image play a relevant role in the experience of obesity. Excess body weight and the social stigma associated with obesity may contribute to psychological distress, social isolation, and negative perceptions of body image [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvidence suggests that the impacts of obesity may differ between men and women. Men exhibit a higher prevalence of obesity-related metabolic comorbidities [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], whereas women represent the majority of patients undergoing bariatric surgery. Data from the Global Registry of the International Federation for the Surgery of Obesity and Metabolic Disorders indicate that women accounted for approximately 82.9% of patients undergoing BMS between 2016 and 2020 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the domain of body image, research indicates that women tend to exhibit greater body dissatisfaction compared to men, reflecting, in part, sociocultural pressures related to aesthetic standards [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, when analyzing HRQoL, findings remain inconsistent, with some studies showing similar impacts across sexes and others indicating greater impairment among women [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, despite growing evidence regarding psychosocial aspects of obesity, studies simultaneously evaluating self-esteem, body satisfaction, and health-related quality of life according to sex among candidates for bariatric surgery remain scarce. Therefore, the present study aimed to compare self-esteem, body satisfaction, and HRQoL between men and women undergoing preoperative evaluation for bariatric surgery.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional study approved by the Research Ethics Committee (CAAE: 70486123.8.0000.5259), which included patients who were candidates for bariatric surgery after signing the Informed Consent Form. Participants were recruited at the Multiuser Clinical Research Center (CEPEM) of the Pedro Ernesto University Hospital (Rio de Janeiro, Brazil), with no restrictions regarding ethnicity or sex, and independently of comorbidities. Of the 133 patients approached, 110 agreed to participate. Data collection was conducted by two trained interviewers, and double data entry was performed in Excel\u0026reg; to ensure accuracy.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnthropometric and Body Composition Assessment\u003c/h3\u003e\n\u003cp\u003eBody weight, height, body mass index (BMI), and body composition were measured using tetrapolar bioelectrical impedance with an integrated scale (InBody370s). Measurements were performed with participants barefoot, without accessories, and wearing light clothing, according to a standardized protocol. Waist, hip, and neck circumferences were measured in triplicate by a trained evaluator, and the arithmetic mean was used for analysis. All assessments were conducted preoperatively, before surgical clearance. The sample was stratified into two groups according to sex, consisting of 93 women and 17 men.\u003c/p\u003e\n\u003ch3\u003ePsychosocial Assessment Instruments\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eKakeshita Silhouette Scale\u003c/h2\u003e \u003cp\u003eBody image perception was assessed using the Kakeshita Silhouette Scale, composed of 15 sex-specific figures, with BMI ranging from 12.5 to 47.5 kg/m\u0026sup2; in increments of 2.5 kg/m\u0026sup2; [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Participants indicated the figure that best represented their current body. Perceptual distortion of body image was calculated by comparing the BMI range corresponding to the chosen figure with the measured BMI. If there was no difference, no distortion was considered; if the figure\u0026rsquo;s BMI range was lower than the measured BMI, underestimation was indicated; if higher, overestimation was indicated [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Three categories were thus created: no distortion, overestimation, and underestimation. Due to the scale\u0026rsquo;s upper limit, only participants with BMI\u0026thinsp;\u0026le;\u0026thinsp;50 kg/m\u0026sup2; were included in this analysis (n\u0026thinsp;=\u0026thinsp;81).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBody Shape Questionnaire (BSQ)\u003c/h3\u003e\n\u003cp\u003eBody satisfaction was assessed using the Body Shape Questionnaire (BSQ), which measures attitudinal and subjective aspects of body image. Scores range from 34 to 204 points and are classified as follows: absence of dissatisfaction (\u0026le;\u0026thinsp;110), mild dissatisfaction (111\u0026ndash;138), moderate (139\u0026ndash;167), and severe (\u0026gt;\u0026thinsp;167) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRosenberg Self-Esteem Scale\u003c/h2\u003e \u003cp\u003eGlobal self-esteem was measured using the Rosenberg Self-Esteem Scale, considered the gold standard in the field. Total scores range from 10 to 40 points, with higher scores indicating higher self-esteem [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For interpretation, the classification proposed by Echebur\u0026uacute;a in 1995 was used: low self-esteem (10\u0026ndash;25), medium (26\u0026ndash;29), and high (\u0026ge;\u0026thinsp;30) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSF-12 (12-Item Short-Form Health Survey)\u003c/h3\u003e\n\u003cp\u003eHealth-related quality of life (HRQoL) was assessed using the 12-Item Short-Form Health Survey (SF-12), a validated instrument encompassing eight HRQoL domains, including physical, emotional, and social aspects. Results are summarized in two main components: physical (PCS) and mental (MCS), with scores ranging from 0 to 100, where higher scores indicate better quality of life [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eNormality of variables was tested using the Kolmogorov-Smirnov test. Categorical variables were presented as absolute and relative frequencies (%), and comparisons between sexes were performed using the independent samples t-test (continuous variables) and Fisher\u0026rsquo;s exact test (categorical variables). Associations between body satisfaction and self-esteem with physical and mental HRQoL, by sex, were assessed using Spearman\u0026rsquo;s correlation coefficient.\u003c/p\u003e \u003cp\u003eTo evaluate the effect of body satisfaction and self-esteem on physical and mental HRQoL, multiple linear regression models were performed separately for women and men. Initially, a model including only the main variables (body satisfaction and self-esteem) was conducted to assess their crude effect on HRQoL. A second adjusted model was then performed, including the main variables plus age and BMI as covariates due to their potential confounding effect on HRQoL. All models were checked for linear regression assumptions (linearity, independence and homoscedasticity of residuals, normality, absence of multicollinearity, and influential values). A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted. All analyses were conducted using SPSS software, version 28. Given the small number of male participants, sex-stratified analyses in men were considered exploratory and hypothesis-generating.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSample Characterization\u003c/h2\u003e \u003cp\u003eA total of 110 bariatric surgery candidates participated in the study, with a mean age of 42.85\u0026thinsp;\u0026plusmn;\u0026thinsp;10.13 years. The sample was predominantly female (84.5%; n\u0026thinsp;=\u0026thinsp;93), while men represented 15.5% of participants (n\u0026thinsp;=\u0026thinsp;17).\u003c/p\u003e \u003cp\u003eRegarding self-reported race, 38% identified as White (n\u0026thinsp;=\u0026thinsp;41), 29% as Black (n\u0026thinsp;=\u0026thinsp;32), and 34% as Brown/mixed race (n\u0026thinsp;=\u0026thinsp;37). Concerning socioeconomic status, 75.5% of the sample reported a monthly income of up to two minimum wages, and approximately half of the participants had completed or incomplete high school education (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of the sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSociodemographic profile\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;110\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.85\u0026thinsp;\u0026plusmn;\u0026thinsp;10.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMixed race\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eIncome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2 minimum wages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e75.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 minimum wages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education (complete or incomplete)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education (complete or incomplete)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher education (complete or incomplete)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eᵃContinuous variable expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometry and Body Composition\u003c/h2\u003e \u003cp\u003eNo significant differences in BMI were observed between male and female bariatric surgery candidates. However, relevant differences were identified in other anthropometric and body composition parameters. Men presented significantly higher body weight, neck circumference, waist circumference, waist-to-hip ratio, and lean mass percentage. Conversely, women presented higher hip circumference and body fat percentage. These results indicate that, despite similar BMI, men and women differ regarding body distribution and composition (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnthropometric and body composition variables by sex in bariatric surgery candidates\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariables\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal sample (n\u0026thinsp;=\u0026thinsp;110)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFemale (n\u0026thinsp;=\u0026thinsp;93)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMale (n\u0026thinsp;=\u0026thinsp;17)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight (kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e122.56\u0026thinsp;\u0026plusmn;\u0026thinsp;18.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e119.73\u0026thinsp;\u0026plusmn;\u0026thinsp;17.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e138.03\u0026thinsp;\u0026plusmn;\u0026thinsp;18.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e45.95\u0026thinsp;\u0026plusmn;\u0026thinsp;5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeck circumference (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e41.49\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e47.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWaist circumference (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e118.34\u0026thinsp;\u0026plusmn;\u0026thinsp;11.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e116.61\u0026thinsp;\u0026plusmn;\u0026thinsp;11.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e127.71\u0026thinsp;\u0026plusmn;\u0026thinsp;10.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHip circumference (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e137.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e138.87\u0026thinsp;\u0026plusmn;\u0026thinsp;10.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e131.15\u0026thinsp;\u0026plusmn;\u0026thinsp;7.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWaist-to-hip ratio\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFat mass (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e47.66\u0026thinsp;\u0026plusmn;\u0026thinsp;4.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLean mass (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e26.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e29.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Comparisons between sexes were performed using the Student\u0026rsquo;s t-test for independent samples; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePsychosocial Parameters\u003c/h2\u003e \u003cp\u003eAmong the participants assessed with the Kakeshita Silhouette Scale (n\u0026thinsp;=\u0026thinsp;81; 69 women and 12 men), perceptual body image distortion was observed in 80.2% of the sample. Significant sex differences were identified using Fisher\u0026rsquo;s exact test (p\u0026thinsp;=\u0026thinsp;0.04), with women showing a greater tendency to overestimate body size, whereas men tended to underestimate it.\u003c/p\u003e \u003cp\u003eRegarding body satisfaction, assessed using the Body Shape Questionnaire (BSQ), approximately 61% of participants reported some level of body dissatisfaction. No significant sex differences were observed in the distribution of dissatisfaction levels (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of self-esteem and body satisfaction categories by sex among candidates for bariatric surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePsychosocial parameters\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCategories\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eTotal sample\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;110 (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;93 (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u0026thinsp;=\u0026thinsp;17 (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (64.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (11.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere dissatisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (12.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (25.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (39.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (70.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are presented as absolute (n) and relative (%) frequencies.\u003c/p\u003e \u003cp\u003eBSQ\u0026thinsp;=\u0026thinsp;Body Shape Questionnaire; RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale.\u003c/p\u003e \u003cp\u003eComparisons between sexes were performed using Fisher\u0026rsquo;s Exact Test. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eConcerning self-esteem, assessed with the Rosenberg Self-Esteem Scale, about 22% of participants presented low self-esteem. Distribution of self-esteem levels differed significantly between sexes (p\u0026thinsp;=\u0026thinsp;0.05), with a higher proportion of low self-esteem among women and higher frequency of elevated self-esteem among men. Analysis of mean scores indicated that both groups showed levels corresponding to mild body dissatisfaction, with no significant differences between sexes. Conversely, men presented significantly higher mean self-esteem scores compared to women (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding health-related quality of life (HRQoL), the mean SF-12 scores were 35.88 for the physical component and 45.03 for the mental component. When analyzed by sex, no significant differences were observed in physical HRQoL. However, women showed significantly lower mental HRQoL scores (p\u0026thinsp;=\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean scores of self-esteem, body satisfaction, and health-related quality of life (physical and mental components) by sex among candidates for bariatric surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePsychosocial parameters\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTotal sample (n\u0026thinsp;=\u0026thinsp;110)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFemale (n\u0026thinsp;=\u0026thinsp;93)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMale (n\u0026thinsp;=\u0026thinsp;17)\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125.45\u0026thinsp;\u0026plusmn;\u0026thinsp;37.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127.86\u0026thinsp;\u0026plusmn;\u0026thinsp;37.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112.29\u0026thinsp;\u0026plusmn;\u0026thinsp;35.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysical HRQoL (SF-12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.01\u0026thinsp;\u0026plusmn;\u0026thinsp;11.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.18\u0026thinsp;\u0026plusmn;\u0026thinsp;9.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental HRQoL (SF-12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.03\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.68\u0026thinsp;\u0026plusmn;\u0026thinsp;12.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.39\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBSQ\u0026thinsp;=\u0026thinsp;Body Shape Questionnaire; RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale; HRQol\u0026thinsp;=\u0026thinsp;Health-related quality of life; SF-12\u0026thinsp;=\u0026thinsp;12-Item Short-Form Health Survey.\u003c/p\u003e \u003cp\u003eComparisons between sexes were performed using the Student\u0026rsquo;s t-test for independent samples; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations Between Body Dissatisfaction, Self-Esteem, and HRQoL\u003c/h2\u003e \u003cp\u003eBivariate correlation analysis revealed distinct patterns between sexes (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Among women, self-esteem was significantly associated with mental HRQoL, while body satisfaction was associated with both physical and mental HRQoL. Additionally, a significant association was observed between self-esteem and body satisfaction in this group. Among men, self-esteem was not significantly associated with the evaluated parameters. Conversely, body satisfaction was associated exclusively with physical HRQoL.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman correlation between self-esteem, body satisfaction, and health-related quality of life by sex among candidates for bariatric surgery BSQ\u0026thinsp;=\u0026thinsp;Body Shape Questionnaire; RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale; HRQol\u0026thinsp;=\u0026thinsp;Health-related quality of life; SF-12\u0026thinsp;=\u0026thinsp;12-Item Short-Form Health Survey; rs\u0026thinsp;=\u0026thinsp;Spearman correlation coefficient; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale (n\u0026thinsp;=\u0026thinsp;93)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Body satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Self-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;0.49**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Physical HRQoL (SF-12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;0.24**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Mental HRQoL (SF-12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;0.42**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.37**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale (n\u0026thinsp;=\u0026thinsp;17)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. Body satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2. Self-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3. Physical HRQoL (SF-12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026minus;\u0026thinsp;0.56**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4. Mental HRQoL (SF-12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eMultiple Linear Regression Analysis\u003c/h2\u003e \u003cp\u003eMultiple linear regression models were conducted to evaluate whether body satisfaction and self-esteem could explain the variance in physical and mental HRQoL in men and women. Regression assumptions were verified and met, ensuring model adequacy.\u003c/p\u003e \u003cp\u003eFor women, the first regression model, including only the main variables (body satisfaction and self-esteem), was significant for both physical and mental HRQoL. For physical HRQoL, only body satisfaction was a significant predictor, while for mental HRQoL, both body satisfaction and self-esteem were individually significant predictors.\u003c/p\u003e \u003cp\u003eAfter adjustment for age and BMI, the models remained significant for both HRQoL domains. For physical HRQoL, body satisfaction and age were significant predictors, whereas for mental HRQoL only body satisfaction remained significant. These findings indicate that, among women, body satisfaction has an independent effect on both physical and mental HRQoL, while the effect of self-esteem on mental HRQoL is partially influenced by age and BMI (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor men, in the regression analysis including only the main variables (body satisfaction and self-esteem), the model was significant for physical HRQoL, with only body satisfaction as a significant predictor. For mental HRQoL, the model was not significant, and none of the main variables had an individual effect.\u003c/p\u003e \u003cp\u003eWhen adjusting the model to include age and BMI as covariates, findings remained similar: for physical HRQoL, the model remained significant with only body satisfaction as a significant predictor, whereas for mental HRQoL, the model continued to be non-significant, and neither main variables nor covariates had an individual effect. These results indicate that, in this small male sample, body satisfaction was the only variable associated with physical HRQoL, while self-esteem, age, and BMI were not significantly associated with mental HRQoL. (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression models (crude and adjusted) for physical and mental health-related quality of life among female bariatric surgery candidates\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"17\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"14\" nameend=\"c17\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eCrude model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;93)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePhysical HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c17\" namest=\"c12\"\u003e \u003cp\u003e\u003cem\u003eMental HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c17\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eAdjusted model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;93)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePhysical HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c17\" namest=\"c12\"\u003e \u003cp\u003e\u003cem\u003eMental HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBSQ\u0026thinsp;=\u0026thinsp;Body Shape Questionnaire; RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale; HRQoL\u0026thinsp;=\u0026thinsp;Health-Related Quality of Life; B\u0026thinsp;=\u0026thinsp;unstandardized coefficient; SE\u0026thinsp;=\u0026thinsp;standard error; β\u0026thinsp;=\u0026thinsp;standardized coefficient; p\u0026thinsp;=\u0026thinsp;significance level; R\u0026sup2; = coefficient of determination; Adjusted R\u0026sup2; = adjusted coefficient of determination.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression models (crude and adjusted) for physical and mental health-related quality of life among male bariatric surgery candidates\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"17\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"14\" nameend=\"c17\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eCrude model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePhysical HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c17\" namest=\"c12\"\u003e \u003cp\u003e\u003cem\u003eMental HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c17\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eAdjusted model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;17)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePhysical HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c17\" namest=\"c12\"\u003e \u003cp\u003e\u003cem\u003eMental HRQoL\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003eModel summary\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eBody satisfaction (BSQ)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e-0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSelf-esteem (RSES)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eR\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e\u003cb\u003eSig.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBSQ\u0026thinsp;=\u0026thinsp;Body Shape Questionnaire; RSES\u0026thinsp;=\u0026thinsp;Rosenberg Self-Esteem Scale; HRQoL\u0026thinsp;=\u0026thinsp;Health-Related Quality of Life; B\u0026thinsp;=\u0026thinsp;unstandardized coefficient; SE\u0026thinsp;=\u0026thinsp;standard error; β\u0026thinsp;=\u0026thinsp;standardized coefficient; p\u0026thinsp;=\u0026thinsp;significance level; R\u0026sup2; = coefficient of determination; Adjusted R\u0026sup2; = adjusted coefficient of determination.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated sex differences among candidates for bariatric and metabolic surgery, focusing on psychosocial parameters relevant to preoperative evaluation. The findings suggest distinct patterns in body image perception, self-esteem, and health-related quality of life between men and women. Men were underrepresented in the sample, which is consistent with the lower utilization of bariatric treatment by males reported in clinical practice and previous studies. However, because the number of male participants was small, male-specific findings should be interpreted as exploratory.\u003c/p\u003e \u003cp\u003eFrom a psychosocial perspective, men presented higher self-esteem scores, while women showed poorer mental health-related quality of life (HRQoL). Furthermore, sex-specific patterns were also observed in the associations between psychosocial variables and HRQoL. However, given the small number of male participants, these findings should be interpreted with caution and considered exploratory, highlighting the need for further studies with more balanced samples.\u003c/p\u003e \u003cp\u003eConsistent with previous studies, the sample was predominantly composed of women, accounting for approximately 85% of participants, which reflects the greater female demand for bariatric surgery despite obesity affecting both sexes [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Despite their lower representation, men presented significantly higher values of body weight, neck circumference, waist circumference, waist-to-hip ratio, and lean mass percentage. Similar findings have been reported in prior studies with BMS candidates, which also observed no significant differences in BMI between sexes, although men exhibited greater central adiposity and muscle mass, while women showed higher body fat percentage [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These findings are clinically relevant, as indicators such as waist circumference, neck circumference, and waist-to-hip ratio are associated with increased cardiometabolic risk. They may also be consistent with previous evidence suggesting that men often present for bariatric treatment with a less favorable anthropometric profile. However, this interpretation should be made cautiously, particularly in light of the small male subsample. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding body image, a high prevalence of perceptual distortion was observed, with a tendency toward overestimation among women and underestimation among men. Previous studies have also described elevated levels of body image distortion in BMS candidates, although generally with lower prevalence than that observed in the present study. For instance, Da Silva et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] reported a prevalence of 55.5% in this population. Moreover, evidence suggests that men are more likely to underestimate their body size, particularly among individuals with overweight and obesity [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA high prevalence of body dissatisfaction was also identified, with approximately 61% of participants reporting some degree of dissatisfaction. This finding is consistent with meta-analyses demonstrating that individuals with overweight or obesity tend to evaluate their body appearance more negatively compared to those with normal weight [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, contrary to studies reporting higher levels of dissatisfaction among women [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], the present study found a similar distribution between sexes, a pattern also observed in some previous investigations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith respect to self-esteem, most participants presented medium or high levels, consistent with prior studies involving BMS candidates [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Nevertheless, men exhibited significantly higher self-esteem scores compared to women. While some evidence suggests that BMI may influence self-esteem similarly across sexes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], other studies indicate slightly higher levels among men [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This difference may be explained by the greater influence of sociocultural pressures related to body image on women, for whom self-esteem is often more closely linked to appearance.\u003c/p\u003e \u003cp\u003eHRQoL findings revealed substantial impairments in both physical and mental domains compared to normative data for the Brazilian population [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Although these impairments were observed in both sexes, women presented significantly lower mental HRQoL scores, a finding consistently reported in the literature [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Potential explanations include greater internalization of weight-related stigma and higher societal pressure regarding body image among women [\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe analysis of associations between psychosocial variables and HRQoL revealed distinct patterns between sexes. Among women, both self-esteem and body satisfaction were associated with mental HRQoL, while body satisfaction was also associated with physical HRQoL. In contrast, among men, body satisfaction was associated only with physical HRQoL, whereas no significant associations were observed for mental HRQoL. Given the small number of male participants, these findings should be interpreted as preliminary and may reflect either true sex-specific patterns or limited statistical power. Importantly, these sex-stratified patterns remained partially consistent in the regression models after adjustment for age and BMI, allowing a more cautious estimation of the independent effects of body satisfaction and self-esteem [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThese differences may also contribute to understanding distinct motivational patterns for seeking BMS, as suggested in the literature, with women more frequently motivated by psychosocial and body image-related factors, whereas men tend to seek treatment due to physical limitations and health concerns [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present findings highlight the importance of incorporating psychosocial assessment into the preoperative evaluation of BMS candidates, particularly considering sex-specific differences. Such an approach may support more individualized and comprehensive patient care. However, some limitations should be acknowledged, including the cross-sectional design, which precludes causal inferences, the recruitment from a single reference center, which may limit generalizability, and the unequal sex distribution, particularly the small male subsample, which limits the robustness of sex-stratified analyses in men.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present findings suggest possible sex-related differences in body image, self-esteem, and health-related quality of life among candidates for bariatric surgery. Women showed broader psychosocial impairment, particularly in mental HRQoL, whereas in men the observed associations were more closely related to physical HRQoL. Because the male subsample was small, these findings should be interpreted as exploratory. Preoperative assessment of psychosocial factors may help support more individualized care strategies for individuals with severe obesity.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e\u0026bull; This work was supported by by the Carlos Chagas Filho Foundation for Research Support in the State of Rio de Janeiro (FAPERJ), (Grant numbers E.26/211.974/2026).\u003c/p\u003e \u003cp\u003e\u0026bull; The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Conceptualization: Rafaela Dutra and Alessandra Mulder; Methodology: Rafaela Dutra and Victoria Sant\u0026rsquo;Anna; Formal analysis and investigation: Rafaela Dutra and Victoria Sant\u0026rsquo;Anna; Writing - original draft preparation: Rafaela Dutra and Victoria Sant\u0026rsquo;Anna; Writing - review and editing: Alessandra Mulder; Funding acquisition, Resources and Supervision: Alessandra Mulder.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e​​Lobstein T, Brinsden H, Neveux M. World Obesity Atlas 2022. London: World Obesity Federation; 2022 [cited 2025 Feb 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.worldobesity.org\u003c/span\u003e\u003cspan address=\"http://www.worldobesity.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de. Manual de aten\u0026ccedil;\u0026atilde;o \u0026agrave;s pessoas com sobrepeso e obesidade no \u0026acirc;mbito da aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria \u0026agrave; sa\u0026uacute;de (APS) do Sistema \u0026Uacute;nico de Sa\u0026uacute;de. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2022 [cited 2024 Nov 10]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://bvsms.saude.gov.br/bvs/publicacoes/manual_atencao_pessoas_sobrepeso_obesidade.pdf\u003c/span\u003e\u003cspan address=\"http://bvsms.saude.gov.br/bvs/publicacoes/manual_atencao_pessoas_sobrepeso_obesidade.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrasil IBGE. 2020 [cited 2025 Feb 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://biblioteca.ibge.gov.br/visualizacao/livros/liv101758.pdf\u003c/span\u003e\u003cspan address=\"https://biblioteca.ibge.gov.br/visualizacao/livros/liv101758.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOzsoy Z, Demir E. Which bariatric procedure is the most popular in the world? A bibliometric comparison. Obes Surg. 2018;28:2339\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsilingiris D, Koliaki C, Kokkinos A. Remission of type 2 diabetes mellitus after bariatric surgery: fact or fiction? Int J Environ Res Public Health. 2019;16(17):3171.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApple R, Samuels LR, Fonnesbeck C, et al. Body mass index and health-related quality of life. Obes Sci Pract. 2018;4(5):417\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacedo TTS, Portela PP, Palamira CS, Mussi FC. Percep\u0026ccedil;\u0026atilde;o de pessoas obesas sobre seu corpo. Escola Anna Nery. 2015;19(3):505\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehrdad N, Abbasi NH, Nikbakht-Nasrabadi A. The hurt of judgment in excessive weight women: a hermeneutic study. Glob J Health Sci. 2015;7:263\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, Dixon JB. Joint international consensus statement for ending stigma of obesity. Nature. 2020;583:785\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaeedi P, Petersohn I, Salpea P et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown WA, Kow L, Shikora S et al. 6th IFSO Global Registry Report. Naples: International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO); 2021 [cited 2023 Feb 7]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ifso.com/pdf/ifso-6th-registry-report-2021.pdf\u003c/span\u003e\u003cspan address=\"https://www.ifso.com/pdf/ifso-6th-registry-report-2021.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026oacute;pez-Guimer\u0026agrave; G, Levine MP, S\u0026aacute;nchez-Carracedo D, Fauquet J. Influence of mass media on body image and eating disordered attitudes and behaviors in females: a review of effects and processes. Media Psychol. 2010;13(4):387\u0026ndash;416.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrechan I, Kvalem IL. Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression. Eat Behav. 2015;17:49\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranchina V, Coco GL. The influence of social media use on body image concerns. Int J Psychoanal Educ. 2018;10:5\u0026ndash;14. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.psychoedu.org/index.php/IJPE/article/view/218\u003c/span\u003e\u003cspan address=\"http://www.psychoedu.org/index.php/IJPE/article/view/218\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFabricatore AN, Wadden TA, Sarwer DB, Faith MS. Health-related quality of life and symptoms of depression in extremely obese persons seeking bariatric surgery. Obes Surg. 2005;15:304\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTruthmann J, Mensink G, Bosy-Westphal A, et al. Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany. Health Qual Life Outcomes. 2017;15:191.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlghamdi M. Exploring body mass index and gender-based self-esteem differences in Saudi Arabia. Front Public Health. 2025;12:1495973.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKakeshita IS. Adapta\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o de escalas de silhuetas para crian\u0026ccedil;as e adultos brasileiros [tese]. Ribeir\u0026atilde;o Preto: Universidade de S\u0026atilde;o Paulo, Faculdade de Medicina de Ribeir\u0026atilde;o Preto; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoelho CG, Giatti L, Molina MD, et al. A imagem corporal e o estado nutricional est\u0026atilde;o associados \u0026agrave; atividade f\u0026iacute;sica em homens e mulheres: o estudo ELSA-Brasil. Rev Int Pesqui Ambient Sa\u0026uacute;de P\u0026uacute;blica. 2015;12(6):6179\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Pietro M, Silveira DXD. Validade interna, dimensionalidade e desempenho da escala Body Shape Questionnaire em uma popula\u0026ccedil;\u0026atilde;o de estudantes universit\u0026aacute;rios brasileiros. Braz J Psychiatry. 2009;31:21\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenberg M, Schooler C, Schoenbach C, Rosenberg F. Global self-esteem and specific self-esteem: different concepts, different outcomes. Am Sociol Rev. 1995;60:141\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEchebur\u0026uacute;a E. Evaluaci\u0026oacute;n y tratamiento de la fobia social. Barcelona: Mart\u0026iacute;nez Roca; 1995.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWare JJ, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFuchs HF, Broderick RC, Harnsberger CR, et al. Benefits of bariatric surgery do not reach obese men. J Laparoendosc Adv Surg Tech A. 2015;25(3):196\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlves L, Mattiello R, Todescatto A, et al. Bariatric patient's body composition: an option to BMI? Clin Nutr ESPEN. 2020;40:121\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSob\u0026aacute;s K, Suliga E, Bryk P, Głuszek S. Dietary patterns and nutritional status in bariatric surgery candidates: a cross-sectional study. Nutrients. 2025;17(4):716.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayedi A, Soltani S, Zargar MS, et al. Central fatness and risk of all-cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies. BMJ. 2020;370:m3324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Olst N, Reiber BM, Vink MR, Gerdes VE, Galenkamp H, Van der Peet DL, et al. Are male patients undergoing bariatric surgery less healthy than female patients? Surg Obes Relat Dis. 2023;19(9):1013\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDa Silva HBA, Rossoni CR, Oliveira TMS, et al. Percep\u0026ccedil;\u0026atilde;o da imagem corporal e toler\u0026acirc;ncia alimentar de pacientes submetidos \u0026agrave; cirurgia bari\u0026aacute;trica e metab\u0026oacute;lica em um Hospital do Sul de Minas Gerais. Semin Ci\u0026ecirc;nc Biol Sa\u0026uacute;de. 2020;41:123\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobinson E, Hogenkamp PS. Visual perceptions of male obesity: a cross-cultural study examining male and female lay perceptions of obesity in Caucasian males. BMC Public Health. 2015;15:492.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGruszka W, Owczarek AJ, Glinianowicz M, et al. Perception of body size and body dissatisfaction in adults. Sci Rep. 2022;12:1159.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadopoulos S, Brennan L. Correlates of weight stigma in adults with overweight and obesity: a systematic literature review. Obes (Silver Spring). 2015;23(9):1743\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeinberger NA, Kersting A, Riedel-Heller SG, Luck-Sikorski C. Body dissatisfaction in individuals with obesity compared to normal-weight individuals: a systematic review and meta-analysis. Obes Facts. 2016;9(6):424\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiqueira BB, Assump\u0026ccedil;\u0026atilde;o MC, Barroso SM, et al. Weight stigma and health\u0026ndash;repercussions on the health of adolescents and adults: integrative review of the literature. J Bras Psiquiatr. 2021;70:162\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFallon EA, Harris BS, Johnson P. Prevalence of body dissatisfaction among a United States adult sample. Eat Behav. 2014;15:151\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuittkat H, Hartmann A, D\u0026uuml;sing R, et al. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry. 2019;10:771.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLavender JM, Gratz KL, Anderson DA. Mindfulness, body image, and drive for muscularity in men. Body Image. 2012;9:289\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurlew LD, Shurts WM. Men and body image: current issues and counseling implications. J Counsel Dev. 2013;91:428\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendes AB, S\u0026aacute; JDS, Souza FCD, et al. Autoestima e preval\u0026ecirc;ncia de depress\u0026atilde;o em pacientes com indica\u0026ccedil;\u0026atilde;o de cirurgia bari\u0026aacute;trica. Int J Dev Res. 2021;11(1):43977\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, Zhang W, Yue W, et al. From weight bias internalization to health-related quality of life: self-esteem and psychopathology in pre-bariatric surgery patients. Obes Surg. 2022;32:3705\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZuckerman M, Li C, Hall JA. When men and women differ in self-esteem and when they don\u0026rsquo;t: a meta-analysis. J Res Pers. 2016;64:34\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagee W, Upenieks L. Gender differences in self-esteem, unvarnished self-evaluation, future orientation, self-enhancement and self-derogation in a U.S. national sample. Pers Individ Dif. 2019;149:66\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaguardia J, Campos MR, Travassos C, et al. Brazilian normative data for the Short Form 36 questionnaire, version 2. Rev Bras Epidemiol. 2013;16(4):889\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMannucci E, Petroni ML, Villanova N, et al. Clinical and psychological correlates of health-related quality of life in obese patients. Health Qual Life Outcomes. 2010;8:90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibson-Smith D, Bot M, Paans NP, et al. The role of obesity measures in the development and persistence of major depressive disorder. J Affect Disord. 2016;198:222\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaine MD. Eating disorders and body image distress in women at midlife. Medscape Today. 2005 [cited 2013 Nov 8]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.medscape.org/viewarticle/508299\u003c/span\u003e\u003cspan address=\"http://www.medscape.org/viewarticle/508299\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHimmelstein MS, Puhl RM, Quinn DM. Intersectionality: an understudied framework for addressing weight stigma. Am J Prev Med. 2017;53:421\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePearl RL, Puhl RM, Lessard LM, et al. Prevalence and correlates of weight bias internalization in weight management: a multinational study. SSM Popul Health. 2021;13:100755.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKolotkin RL, Crosby RD, Gress RE, et al. Health and health-related quality of life: differences between men and women who seek gastric bypass surgery. Surg Obes Relat Dis. 2008;4(5):651\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobertson C, Archibald D, Avenell A, Douglas F, Hoddinott P, van Teijlingen E, et al. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess. 2014;18(35):1\u0026ndash;424.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacerda R, Castanha C, Castanha A, et al. Perception of body image by patients undergoing bariatric surgery. Rev Col Bras Cir. 2018;45(2):e1793.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Obesity, Bariatric Surgery, Body Image, Self-Esteem, Health-Related Quality of Life, Sex Differences","lastPublishedDoi":"10.21203/rs.3.rs-9408119/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9408119/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eSevere obesity is associated with substantial psychosocial burden, including poorer body image, lower self-esteem, and impaired health-related quality of life (HRQoL). Although these outcomes may differ between men and women, sex-specific psychosocial patterns among candidates for bariatric surgery remain insufficiently explored. This study compared body image, self-esteem, and HRQoL between male and female bariatric surgery candidates.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, 110 adults undergoing preoperative evaluation for bariatric surgery (93 women and 17 men) were recruited at a tertiary hospital in Rio de Janeiro, Brazil. Anthropometry and body composition were assessed using bioelectrical impedance and standard measurements. Body image perception was evaluated with the Kakeshita Silhouette Scale, body satisfaction with the Body Shape Questionnaire, self-esteem with the Rosenberg Self-Esteem Scale, and HRQoL with the SF-12. Group comparisons, correlations, and sex-stratified multiple linear regression models were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDespite similar BMI, men had higher weight, central adiposity indicators, and lean mass percentage, whereas women had higher fat mass percentage. Body image distortion was common, affecting 80.2% of participants, with women more often overestimating and men underestimating body size. Approximately 61% of the sample reported body dissatisfaction. Men showed higher self-esteem scores, whereas women had lower mental HRQoL. Among women, body satisfaction was associated with both physical and mental HRQoL, while self-esteem was associated only with mental HRQoL. Among men, body satisfaction was associated only with physical HRQoL.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings suggest sex-related differences in psychosocial functioning among bariatric surgery candidates. Women appeared to experience broader psychosocial burden, particularly in mental HRQoL, whereas findings in men were more closely linked to physical HRQoL and should be interpreted as exploratory.\u003c/p\u003e","manuscriptTitle":"Sex differences in psychosocial health before bariatric surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 14:57:22","doi":"10.21203/rs.3.rs-9408119/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-15T13:58:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T18:27:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"165973142695081704698542240855440292806","date":"2026-04-23T14:28:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201392475655157747244908740440374675773","date":"2026-04-16T00:34:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-15T17:37:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T23:24:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T03:38:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2026-04-13T20:19:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"42b795a2-bad7-430a-a1fd-3a2008ccaf79","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T13:58:15+00:00","index":17,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T18:27:05+00:00","index":16,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T14:57:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 14:57:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9408119","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9408119","identity":"rs-9408119","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}