A Qualitative Analysis of Post-operative Nutritional Barriers and Useful Dietary Services Reported by Bariatric Surgical Patients

Peacock, Jessica C.; Schmidt, Charlene E.; Barry, Kathy

doi:10.1007/s11695-016-2096-1

Cited by 24 publications

(21 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bariatric surgery, however, also permanently alters the stomach and intestines and frequently includes long-term deficiencies and absorption issues, which contributes to the view that it is a tactic of “last resort” (Ogden et al, 2005 , 2006 ; Fardouly and Vartanian, 2012 ; Homer et al, 2016 ). Moreover, in the years following surgery, research has shown either insufficient weight loss or significant long-term weight regain to be common in some patients, with greater risk of weight regain and obesity-related comorbidities seen after 2 years post-surgery (Sjöström et al, 2004 ; Magro et al, 2008 ; da Silva et al, 2016 ; Peacock et al, 2016 ). Long-term success at maintaining weight loss after bariatric surgery is multifactorial; however, research has shown that one important contributor is the ability to adhere voluntarily to strict dietary guidelines (Elkins et al, 2005 ; Kalarchian and Marcus, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

“…Grazing, snacking, binge eating, and emotionally triggered eating are often reported (Kalarchian et al, 2002 ; Elkins et al, 2005 ; Poole et al, 2005 ; Beck et al, 2012 ; Chesler, 2012 ; Sheets et al, 2015 ; Hübner et al, 2016 ). There are numerous reasons for such behaviors—which end up being labeled “dietary non-compliance”—including psychological, physiological, social, and environmental factors found to have more of an impact with greater time since surgery (Peacock et al, 2016 ). Lack of support, both before and after surgery, is a major issue, whether that lack is familial, workplace-based, or simply the result of living in an environment in which unhealthy foods and constant social eating are the norm (Benson-Davies et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

et al. 2016

View full text Add to dashboard Cite

Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings.Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

et al. 2016

View full text Add to dashboard Cite

show abstract

“…These include patient behaviours in eating and exercise, [24] better follow-up attendance [13,24,25] as well as achieving better outcomes at specialist bariatric care centres over non-specialist care [26]. Additional interventions may also improve trajectories, such as increasing the role of dietitians [27] and psychologists for follow-up behavioural therapy, [28] or physical therapy and exercise programs may encourage more physical activity [29]. The present analysis serves as an estimate of what is at stake for providers in terms of patient outcomes and associated costs should post-bariatric surgery trajectories not be optimised.…”

Section: Discussionmentioning

confidence: 99%

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Davis

Saunders

2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories. The present analysis explores how improving a patient's post-surgical weight change could impact co-morbidity prevalence, treatment and associated costs in the Canadian setting. Methods: Published data were used to derive statistical models to predict weight loss and co-morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language. Results: Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million. Conclusions: Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

show abstract

“…These include patient behaviours in eating and exercise, [24] better follow-up attendance [13,24,25] as well as achieving better outcomes at specialist bariatric care centres over non-specialist care. [26] Additional interventions may also improve trajectories, such as increasing the role of dietitians [27] and psychologists for follow-up behavioural therapy, [28] time horizon. From the patient cohort demographics, the modelled TWL is converted to body mass index (BMI) for each post-surgical year in the two trajectories and time after surgery converted to age.…”

Section: Discussionmentioning

confidence: 99%

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Davis¹,

Saunders²

2020

Preprint

View full text Add to dashboard Cite

Background Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories . The present analysis explores how improving a patient’s post-surgical weight change could impact co‑morbidity prevalence, treatment and associated costs in the Canadian setting. Methods Published data were used to derive statistical models to predict weight loss and co‑morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language. Results Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1,710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million. Conclusions Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

show abstract

A Qualitative Analysis of Post-operative Nutritional Barriers and Useful Dietary Services Reported by Bariatric Surgical Patients

Cited by 24 publications

References 17 publications

Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Contact Info

Product

Resources

About