Exploring individual experiences of preparedness for bariatric surgery

Introduction:

Obesity is associated with an increase in morbidity and mortality.  Over the past 30 years the rate of obesity has been rising in almost all countries.  The number of weight loss surgery procedures has also increased in England in recent years.  Research into the psychological impact of weight loss surgery has found positive outcomes (e.g. reduced emotional distress and depression) as well as tensions (e.g. loss of identity and feeling vulnerable). Despite research into preparation for generic surgery, there is a gap in the literature on preparation for weight loss surgery patients.

Aims:

1) To examine what a UK sample of bariatric surgery patients have received in terms of preparation for surgery.

2) To explore individual patients’ personal experience of bariatric surgery, with a focus on participants’ experiences of preparation for the subsequent physical and psychological changes.

Method:

A mixed methods approach was used.  An online structured questionnaire was developed for this study and made available on the Weight Loss Surgery Information and Support (WLSinfo) and the British Obesity Surgery Patient Association (BOSPA) websites.  It was completed by 148 people who have had weight loss surgery.  A sample of seven adults were recruited from a weight loss surgery support group and participants were interviewed using a semi-structured interview schedule.  Interviews were transcribed and analysed using Interpretative Phenomenological Analysis (IPA).

Findings:

Participants reported receiving information on; the different parts of the weight loss surgery process, changes in diet, eating behaviour, and physical changes.  Participants reported that information was lacking on relationship and psychological changes.  Five master themes and 16 super-ordinate themes emerged following the group analysis of the interviews.  Participants reflected on their lead up to surgery and their experience of preparing for surgery.  Participants tried to make sense of their relationship with food and their emotional attachment to it.  They reflected on their experience of changing relationships andidentity post-surgery.  Participants highlighted the value of support groups and the internet in preparing them for surgery, particularly communicating with individuals who have had weight loss surgery.

Clinical implications:

This study highlights that preparation for weight loss surgery is an important part of the journey.  Currently, preparation regarding the mechanics of what will happen before and during surgery, and changes in diet and eating behaviour before and after surgery, is well established.  Such information is often provided during pre-surgery appointments with different professionals such as surgeons, dietitians and bariatric specialist nurses.  However, more preparation is needed for the psychological changes and adjustments experienced throughout the journey.  Despite limited research in this area, the literature acknowledges the psychological tensions that bariatric surgery patients go through.

Conclusions:

The findings of this study indicate that preparation for bariatric surgery patients should include; medical information provided by medical staff (e.g. what the surgical procedure involves, possible complications and side effects), dietary information provided by dietitians (e.g. pre and post-surgery diet, what to expect in the days, weeks and months following surgery, information on dietary supplements, managing temptation, managing social eating, weight management and diet plans), and information regarding psychological changes provided by psychologists (e.g. identifying expectations, factors contributing to obesity, changes in relationships, work life and identity, managing emotions, finding alternative coping strategies, understanding the role of food and weight, experiencing loss and disappointment).  It could be delivered in a group setting to encourage peer support throughout the journey.  Significant others could attend specific sessions on changing relationships.  Post-surgery patients could attend the group to share their personal experiences.  Written information could be provided to supplement each session and group members could be directed to other sources of information and support (e.g. WLSinfo and BOSPA).  Each group member could be assigned a ‘buddy’ who has had weight loss surgery to contact for support.  After surgery, a continuation of the group should be offered to patients as part of their post surgical support package of care. 

Rachael Noble

Clinical Psychologist

University of Leeds

e-mail:  noblerachael@hotmail.com