2 ) or those with less severe obesity accompanied by significant comorbidities. Sustained postoperative weight loss and improvements in obesity-related health problems make bariatric surgery the most effective treatment for this population. Nevertheless, most experts agree that psychosocial and behavioral factors contribute to successful postoperative outcomes. This paper reviews the literature on the preoperative psychosocial status, eating behaviors, and quality of life of patients who seek bariatric surgery. In addition, the paper examines studies that investigated changes in these factors postoperatively. The review concludes with an agenda for future research in this area.

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This study was the first empirical investigation of body image dissatisfaction and body dysmorphic disorder in cosmetic surgery patients. Of 132 women, 100 women (response rate, 76 percent) completed two body image measures prior to surgery, the Multidimensional Body-Self Relations Questionnaire and the Body Dysmorphic Disorder Examination Self-Report. Cosmetic surgery patients did not demonstrate greater dissatisfaction with their overall appearance compared with the reported normal values of the measures. However, when asked about the specific bodily feature they were considering for cosmetic surgery, they reported significantly greater dissatisfaction than a normative sample. In addition, 7 percent of the sample met diagnostic criteria for body dysmorphic disorder, a potential psychiatric contraindication to cosmetic surgery. Implications of these findings are discussed with respect to the nature of body image dissatisfaction and the prevalence of body dysmorphic disorder in cosmetic surgery populations.

SUMMARY This article provides an overview of the psychological aspects of obesity. The disease of obesity is associated with a significant psychosocial burden. Many individuals who have obesity also struggle with issues related to their mood, self-esteem, quality of life, and body image. This emotional distress likely plays a role in treatment seeking but also can impact successful treatment. For these reasons, most multidisciplinary obesity treatment teams include mental health professionals who can assess and treat these issues in patients as needed. Encouragingly, weight loss is typically associated with improvements in psychosocial status and functioning. These positive changes are often most profound among those who have lost large percentages of their weight, as is often seen with bariatric surgery. Unfortunately, some individuals who lose weight experience a return of pre-existing psychopathology or the development of new psychosocial issues. Those who experience weight regain, regardless of the approach to weight loss, also remain at risk for the return of unwanted psychological symptoms. The unfortunate, ubiquitous nature of weight regain reminds all treatment providers of the need to assess psychosocial functioning at the onset of treatment, monitor changes during weight loss, and remain alert for worsening of symptoms with weight regain.

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These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.

Because of the frequency with which persons with body dysmorphic disorder pursue cosmetic procedures, providers of cosmetic surgical and minimally invasive treatments may be able to identify and refer these patients for appropriate mental health care. Directions for future research are suggested.

Extreme obesity is associated with significant health issues as well as substantial psychosocial burden for many individuals. Numerous studies have documented the impairments in quality of life associated with extreme obesity. Sexual behavior and functioning is an important aspect of quality of life but is frequently overlooked in research studies as well as clinical care. This paper focuses on the quality of life and sexual functioning of obese individuals with specific focus on the changes in these domains following the substantial weight losses seen after bariatric surgery.