Negotiating control: Patients’ experiences of unsuccessful weight-loss surgery

Abstract

Interviews were carried out with 10 men and women who had undergone weight loss surgery up to 10 years ago and felt that it had failed. 7 had had a further successful procedure. Data were analysed using Interpretative Phenomenological Analysis (IPA). Weight regain following surgery was explained in terms of either the mechanics of the operation or with participants describing ways to 'cheat' as food continued to be used for emotional regulation. All also spoke of how surgery neglected their mind. Following the second successful surgery, participants described changes in both their eating behaviour and cognitions emphasising how their mind had been brought 'in gear' through the investment of two invasive procedures. Transcending all accounts was the mind / body relationship and the issue of control with attributions for both failed and successful surgery shifting from the self to the surgical mechanism as participants negotiated the pathway between self blame and responsibility and utilised conflicting frameworks in which the mind and body were either divided or united. Whereas failed surgery is characterised by a battle for control, successful surgery involves handing control over to their restricted stomachs or considering WLS as a tool to be worked with.

Contrasting Views of the Post-bariatric Surgery Experience between Patients and their Practitioners: a Qualitative Study

“…Findings indicate that the physical restriction induced by the procedure provides an external control to weight and eating that patients previously lacked [16,17], with reported new experiences of reduced hunger despite occasional negative feedback, e.g., nausea and pain [18,19]. However, it seems that this external control fades typically a year or two after surgery, and maintaining weight loss becomes a struggle, triggering lingering fears of weight regain [20].…”

A Qualitative Longitudinal Exploration of the Lived Experience of Laparoscopic Adjustable Gastric Banding Surgery

“…Interview schedules were developed based on the existing literature and conversations with the lead clinician [21]. The schedule encouraged participants to reflect on their individual experiences with LAGB [34,35,49].…”

“…Findings from qualitative studies suggest over time many individuals adjust their relationship with food so it becomes a more practical part of their life rather than a focus [22]. However, individuals who fail to lose weight find this a difficult experience, and believe that they require more support to adjust to life after bariatric surgery in order to adopt and maintain lifelong healthy eating habits [21,40,41]. In a study of individuals (n = 11) with LAGB who had unsuccessful weight loss (defined as a Body Mass Index [BMI] ≥ 40 kg/m 2 ) two years after surgery, Zijlstra, Boeije, Larsen, van Ramshorst and Geenen (2009) demonstrated that the lack of success was linked to a lack of awareness of an individual's own responsibility to change habits following LAGB, believing the LAGB itself would be the key factor in change rather than their own behaviour [42].…”

“…Of the published longitudinal studies exploring the lived experience of bariatric surgery, none have been specifically concerned with LAGB [36,37]. Qualitative studies have been conducted exploring the lived experience five years or more post-surgery for individuals having a duodenal switch [38,39], and with mixed samples that include individuals with a LAGB along with other forms of bariatric surgery (e.g., gastric bypass, sleeve gastrectomy to name but two) to explore experiences between one and 10 years postsurgery [21,22,40]. Findings from qualitative studies suggest over time many individuals adjust their relationship with food so it becomes a more practical part of their life rather than a focus [22].…”

“…Research exploring LAGB typically uses a cross-sectional approach [20], where only post-surgery experiences are explored [21][22][23]. Furthermore, the existing literature is primarily quantitative in nature, using validated measures to determine changes such as quality of life [24,25], eating behaviour [26,27], improvement in comorbidities [16,28], and long-term weight loss [10].…”