Introduction
According to the World Health Organization (WHO) [1], obesity is one of the 10 most common health problems in the world. There is a higher level of body image concern [1, 23, 24] and a lower level of self-compassion [25-27] in people with obesity, compared to people with normal weight. Also, emotional regulation methods are different in people with and without obesity [1, 23]. Nowadays, cosmetic surgery has become one of the most common surgeries in the world including Iran [1]. 
Considering the surgery costs, physical problems after surgery, the prevalence of cosmetic surgery among the young people, and the possibility of weight regain after surgery, paying attention to the psychological factors influencing the best way to achieve weight loss can have a significant impact on guiding obese people to choose the right method. In case of the identification of these psychological factors, it can be hoped that, through appropriate psychological treatments, unnecessary weight loss surgeries will be prevented. Therefore, the present study aims to answer the question whether there is a difference in body image concern, self-compassion, and emotion regulation between obese women with and without metabolic weight loss surgery? It is hypothesized that women with metabolic weight loss surgery have more body image concern and are less likely to use positive methods of self-compassion and emotion regulation.

Methods
This is a causal-comparative study. Participants were two groups of obese women applying for metabolic surgery (n=80) and without applying for metabolic surgery (n=80) The inclusion criteria were: BMI >30 kg/m2, age 25-40 years, living in Tehran, and not applying for metabolic weight loss surgery (for controls). The participants gave informed consent to participate in the study. To collect data, in addition to a demographic form, the Body Image Concern Inventory, Neff’s Self-Compassion Scale, and Gross’s Emotion Regulation Questionnaire (ERQ) were used. Data analysis was done in SPSS software version 26 using multivariate analysis of variance (MANOVA) to examine the difference in the variables between the two groups.

Results
The MANOVA results (Table 1) showed a significant difference between the two groups in all study variables, except for the cognitive reappraisal subscale of ERQ.



Conclusion
It can be said that the high body image concern in obese women applying for metabolic weight loss surgery is related to low self-compassion and high use of expressive suppression for regulating emotions, which can explain their more tendency for having metabolic weight loss surgery, compared to non-applying obese woman.

Ethical Considerations

Compliance with ethical guidelines
This study has ethical approval from Islamic Azad University, Tehran Branch (Code: IR.IAU.CTB.REC.1401.140).

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization: Ashraf Sadat Mousavi & Sudabeh Dadaei; investigation: Sudabeh Dadaei; Supervision, preparing the initial draft, editing & review: Ashraf Sadat Mousavi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation, as well as the doctors from Milad Hospital for their assistance in sampling.


 

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