Research has shown that some bariatric patients overestimate post-surgical exercise levels, while others struggle with negative cognitions and follow-through on intentions to exercise; however, little exists on specific barriers affecting bariatric patients' post-surgical exercise behaviors. Considering that regular exercise is a predictor of weight loss maintenance, further research is warranted. Survey methodology was utilized to assess post-operative exercise barriers as well as beneficial post-surgical exercise services among a sample of bariatric patients solicited from an online support website. Qualitative assessment of responses was completed using inductive content analysis. Higher-order themes for exercise barriers included internal, external, and no barriers; generic categories determined for internal barriers included motivational and physical barriers. Of the participants, 78% reported at least one internal motivational barrier, and the most frequently reported subcategorical barrier was time (28%); physical barriers were reported related to surgery (9%) or other chronic conditions (19%). Higher-order themes for exercise services included positive descriptions such as benefits from exercise prescription as well as the importance of facilities and individuals, while negative descriptions included no services available or services that were unhelpful. Participants cited the benefit of community-based facilities, so providers might consider partnering with local professionals to deliver exercise services. Staff should be aware of physical barriers specific to bariatric populations including issues with post-surgical stamina and chronic comorbid conditions in order to provide appropriate exercise prescription. In addition, as motivational and time barriers occur frequently, providers should be well-trained on how to help patients overcome these impediments to exercise maintenance.
The physiological nature of post-surgical changes and the mental stamina required of positive eating habits contribute to postoperative adherence difficulties. Many patients likely exhibit poor habits pre-surgery, and without added help to change these behaviors may regain weight. Participants in this study indicated that convenient access to an RDN was helpful. Bariatric facilities should include staff well-trained in the specific nutritional barriers patients face and provide availability of staff beyond the initial postoperative phase.
Most facilities implement some type of dietary counseling or consultation; however, few include services related to helping patients improve physical activity patterns. Greater incorporation of behavioral and psychological services following surgery is recommended to prevent weight regain and to help patients adopt and maintain regular physical activity.
The participants in the present sample reported completing few behavioral and psychological services after surgery. However, our findings showed that these services could promote greater weight loss and maintenance. Thus, it is recommended that bariatric facilities and insurance providers consider requiring patients to complete postoperative behavioral modification programs that target improvement in diet and physical activity behaviors.
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