Introduction 1 2 3 6 5 10 11 3 6 12 4 5 13 14 15 Materials and Methods The present study was designed to increase our understanding of patients’ changes in psychosocial functioning, personality, and body image during the first 2 years after vertical banded gastroplasty (VBG). The main research questions were: what specific improvements can be achieved, is postoperative functioning noticeable different from functioning in relevant normative groups, and do all patients profit? These questions were examined based on data collection preoperatively and 6, 12, and 24 months after VBG. Procedures 16 17 Materials 11 18 19 20 21 22 20 Patients 23 Statistical Analyses t 24 Results Weight Loss P η 2 25 26 Psychosocial Functioning 11 18 19 P P P 25 1 Table 1 Postoperative changes in psychosocial functioning (mean ± SD) SCL-90 Preoperative 6 months 1 year 2 years η 2 Anxiety 14.3 ± 5.0 11.7 ± 2.4*** 12.1 ± 3.9 12.6 ± 5.6 .23 Phobic complaints 9.3 ± 3.6 7.4 ± 1.1*** 7.5 ± 1.6 7.9 ± 3.1 .20 Depression 24.8 ± 8.6 20.8 ± 6.3*** 20.9 ± 7.1 23.1 ± 11.3 .18 Somatic complaints 21.2 ± 7.9 16.2 ± 3.5*** 17.0 ± 5.2 17.9 ± 6.7 .29 Obsessive 15.0 ± 5.0 11.6 ± 2.7*** 12.0 ± 3.1 12.7 ± 5.1 .28 Sensitivity 28.7 ± 10.4 23.0 ± 6.4*** 22.8 ± 6.1 24.2 ± 10.8 .25 Hostility 7.3 ± 1.7 7.2 ± 2.0 7.1 ± 1.5 7.3 ± 2.4 .06 Sleeping problems 5.7 ± 2.9 4.6 ± 2.3* 4.9 ± 2.5 5.5 ± 3.1 .09 Psychoneuroticism 139.5 ± 41.0 113.0 ± 22.7*** 114.8 ± 26.4 122.8 ± 45.2 .30 N 93 93 93 93  Neuroticism (NPV) 11.98 ± 8.9 8.5 ± 7.4** 8.0 ± 6.6 9.3 ± 8.8 .15 N 94 94 94 94  n P P P 18 19 Personality 27 28 13 3 19 25 P P 2 Table 2 Postoperative changes in personality characteristics (mean ± SD) NPV subscales Preoperative 6 months 1 year 2 years η 2 Social anxiety 8.9 ± 7.9 6.8 ± 6.5 7.0 ± 6.5 7.5 ± 7.1. 0.07 Rigidity 24.4 ± 7.3 24.0 ± 7.9 24.2 ± 7.4 23.7 ± 7.8 0.03 Hostility 14.0 ± 8.5 14.1 ± 8.6 14.0 ± 8.9 15.3 ± 9.3 0.05. Egoism 9.7 ± 4.7 10.6 ± 5.1 9.9 ± 4.8 10.4 ± 5.0 0.04 Dominance 13.9 ± 6.4 15.3 ± 7.5 15.3 ± 7.2 15.0 ± 7.3 0.06 Self-esteem 27.9 ± 6.0 29.7 ± 5.3 29.9 ± 5.5* 28.6 ± 6.7 0.14 N 94 94 94 94  n P 19 Body Image 29 30 13 31 28 20 P 25 P 3 r Table 3 Postoperative changes in body image (mean ± SD)   Preoperative 6 months 1 year 2 years η 2 Negative appreciation of body size 26.2 ± 5.8 14.9 ± 7.1* 14.4 ± 8.2 14.2 ± 8.2 0.59 Lack of familiarity with one’s own body 16.5 ± 7.2 7.5 ± 4.7* 7.1 ± 4.8 7.5 ± 6.1 0.52 General body dissatisfaction 15.2 ± 3.6 8.1 ± 4.6* 8.0 ± 4.6 8.3 ± 5.0 0.61 Total BAT score 64.0 ± 15.4 36.9 ± 15.6* 35.8 ± 16.2 35.9 ± 17.4 0.63 N 97 97 97 97  n P P P 20 32 Heterogeneity in Postoperative Psychosocial Functioning 4 13 In the present study, in addition to a large variation in EWL, we found substantial variance with respect to changes in psychosocial functioning. Especially with respect to psychoneuroticism and neuroticism, most patients reported postoperative improvements; however, this was not the case for all patients. For instance, in the case of psychoneuroticism, 77 out of 99 patients (77.8%) reported improvement after 6 months; in contrast, 21 patients (21.2%) had higher scores, and one patient did not change. After 24 months, approximately two thirds of the patient group (64.7%) still had better scores on psychoneuroticism, whereas one third (31.4%) showed signs of an increase in psychoneuroticism. In the case of personality characteristics, a mixed picture was found; however, in general, there were only small differences between patients reporting positive or negative changes. Regarding body image, almost all patients reported improvements, and these were quite stable over time. Discussion After vertical banded gastroplasty, in addition to substantial and significant weight loss, patients also changed for the better in body image and most domains of psychosocial functioning. With respect to personality, only a significant improvement in self-esteem was found. Unfortunately, there was substantial variance in improvements, and some improvements waned over time. 33 7 8 34 35 13 13 36 37 Although we found mixed results, the overall psychosocial improvements provide additional justification for vertical banded gastroplasty as a surgical treatment option for extreme obesity. However, as some improvements wane over time and not all patients profit in the same way, surgery alone may not be sufficient to sustain success. Consequently, additional behavioral treatment may be necessary.