Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study

Abstract

ObjectivesThis study aimed to understand the experiences and expectations of people seeking bariatric surgery in England and identify implications for behavioural and self-management interventions.DesignA qualitative study using modified photovoice methods, triangulating photography with semistructured indepth interviews analysed using framework techniques.SettingAreas served by two bariatric surgery multidisciplinary teams in the north of England.Participants18 adults (14 women and 4 men) who accepted for bariatric surgery, and were aged between 30 and 61 years. Participants were recruited through hospital-based tier 4 bariatric surgery multidisciplinary teams.ResultsThe experiences of participants indicates the nature and extent of the burden of obesity. Problems included stigmatisation, shame, poor health, physical function and reliance on medications. Participants expected surgery to result in major physical and psychological improvement. They described how this expectation was rooted in their experiences of stigma and shame. These feelings were reinforced by previous unsuccessful weight loss attempts. Participants expected extreme and sometimes unrealistic levels of sustained weight loss, as well as improvements to physical and mental health. The overall desire and expectation of bariatric surgery was of ‘normality’. Participants had received previous support from clinicians and in weight management services. However, they reported that their expectations of surgery had not been reviewed by services, and expectations appeared to be unrealistic. Likewise, their experience of stigmatisation had not been addressed.ConclusionsThe unrealistic expectations identified here may negatively affect postoperative outcomes. The findings indicate the importance of services addressing feelings of shame and stigmatisation, and modifying patient's expectations and goals for the postoperative period.

(Preprint)

“…These very high, and in most cases unrealistic, expectations have also been found in previous studies, such as the doctoral thesis by Shearer already mentioned [17]. The findings of a study by Homer et al also found that bariatric surgery candidates had extreme and often unrealistic expectations on the results of their surgery, and that these were rooted in the stigma and discrimination that they experienced in their everyday lives [27]. Interestingly, the forum posters in our study wrote relatively little about perceived stigmatisation, although it is inherent in statements such as "wanting life as a fatty to end".…”

Take your pick - weight loss or clothes size goal: A longitudinal exploration of outcomes in individuals following laparoscopic adjustable gastric banding

“…Individual's whose goal is a clothes size may be able to evaluate and manage their weight changes through fit of clothing and being able to purchase these clothes in high street outlets rather than specialist stores [38], rather than a reliance on using weight alone as a measure of success. This is important, as it has been recognised that weight and BMI measures may not be good indicators of obesity as they do not account for body composition [52], therefore individuals who focus on weight alone as their personal measure of success may struggle more to achieve and subsequently sustain their (possibly) unrealistic goal [10,11].…”

“…It could be argued that one would assume that as weight, and therefore an individual's physical size reduces, self-perceptions of appearance would become more positive as an individual is seemingly becoming 'normal' [10]. Scores from the DAS- 24 scale decreased over the five-year period, which indicates that as time since LAGB surgery increases individuals do face less problems with appearance in relation to social anxiety and avoidance.…”

“…Unrealistic expectations of weight loss following surgery, and setting unachievable goals, are common [8][9][10][11][12][13]. Typically, the focus for the clinical team and individuals undergoing surgery is a weight loss goal following LAGB [14], as a reduction in 5-10% of excess body weight can lead to significant health improvements [15].…”

Impact of self‐efficacy on risk aversion in the context of surgical weight loss decision scenarios

“…Although surgical options for obesity are associated with risks, there are risks simply in having obesity. When presented with treatment options, outcomes including modest weight loss reductions may not provide enough incentive to proceed …”