Understanding the psychosocial impact of weight loss following bariatric surgery: a qualitative study

Abstract

BackgroundBariatric surgery leads to changes in mental health, quality of life and social functioning, yet these outcomes differ among individuals. In this study, we explore patients’ psychosocial experiences following bariatric surgery and elucidate the individual-level factors that may drive variation in psychosocial outcomes.MethodsEleven semi-structured focus groups with Michigan Bariatric Surgery Collaborative (MBSC) patients (n = 77). Interviews were audio recorded, transcribed verbatim, and analyzed using a grounded theory approach. Data on participant demographic characteristics were abstracted from the MBSC clinical registry.ResultsMost focus group participants were female (89%), white (64%), and married (65%). We identified three major themes: (1) change in self-perception; (2) change in perception by others; and (3) change in relationships. Each theme includes 3 sub-themes, demonstrating a range of positive and negative psychosocial experiences. For example, weight loss led to increased self-confidence among many participants while others described a loss of self-identity. Some noted improved relationships with family or friends while others experienced worsening or even loss of relationships due to perceived jealousy.ConclusionWeight loss following bariatric surgery leads to complex changes in self-perception and inter-personal relationships, which may be proximal mediators of commonly assessed mental health outcomes such as depression. Individuals considering bariatric surgery may benefit from anticipatory guidance about these diverse experiences, and post-surgical longitudinal monitoring should include evaluation for adverse psychosocial events.

Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients’ experiences during 2 years of follow-up

“…The exact working mechanism is unknown, but reduced peroral intake due to exclusion of the stomach and improved glucose handling, when nutrients are entered the gastrointestinal system below the pancreas, are of great importance. Previous quantitative research has focused on the clinical outcomes of metabolic surgery, whereas qualitative research has provided detailed accounts of the psychosocial impacts of the surgery [7,8]. A recently published meta-analysis showed mixed results of HRQoL when comparing metabolic surgery with medical treatment among obese subjects with T2DM.…”

“…Previous quantitative research has focused on the clinical outcomes of metabolic surgery, whereas qualitative research has provided detailed accounts of the psychosocial impacts of the surgery [ 7 , 8 ]. A recently published meta-analysis showed mixed results of HRQoL when comparing metabolic surgery with medical treatment among obese subjects with T2DM.…”

The patient experience of bariatric surgery: a longitudinal qualitative study

“…Normality was an overriding concept. Success means that all aspects of life are more normal; this includes activities of daily living, opportunities at work, improved appearance, blending into the crowds and being socially accepted (Coulman et al, 2017;Griauzde et al, 2018;Jensen et al, 2014). Studies with allmale or all-female participants highlighted different experiences or aspirations of normality.…”

“…A discordance exists between objective post-surgery weight and an individual's perceptions of their appearance and identity (Griauzde et al, 2018). Post-surgery individuals still self-identify as fat and these feelings are worsened without clothes and when viewing excess skin (Aramburu Alegría & Larsen, 2017).…”

“…Jealousy of weight loss is a common factor influencing the relationships, sometimes resulting in breakdown or distant relationships (Ficaro, 2018) or changes to the dynamics of a relationship. Changed appearance increased positive social attention which also reinforced feelings of jealousy from friends and family (Griauzde et al, 2018). Managing this jealousy presents a dichotomy of happiness between weight loss and upset at the loss of identity and change in relationships (Griauzde et al, 2018).…”