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.