Understanding bariatric patients' experiences of self‐management post‐surgery: A qualitative study

Abstract

Summary Although most bariatric patients achieve significant weight loss and improvements in both physical and mental health‐related quality of life (HRQoL) in the short‐term, there is wide variability in weight and long‐term HRQoL outcomes. The role of bariatric patients' self‐management style in explaining variability in long‐term outcomes is unclear. This qualitative study examined bariatric patients' self‐management experiences after bariatric surgery in relation to long‐term outcomes. A qualitative study was conducted using semi‐structured individual interviews with post‐surgery patients (n = 23) at a Canadian bariatric surgery program. A constant comparative approach was used to systematically analyse the data and identify overarching themes. Variation in patients' experiences and follow‐up time were the two primary units of analysis. Patients were predominantly female (n = 19; 82.6%) and had a mean age of 50 ± 8.49 years. The median time post‐surgery was 2 years (range: 6 months–7 years). Three distinct phases described the process of self‐management post‐bariatric surgery: (1) rediscovering self‐esteem and confidence in one's ability to self‐manage (1‐month to 1.5‐years post‐surgery), (2) achieving weight maintenance and addressing emotion dysregulation (1.5–3‐years post‐surgery) and (3) embracing a flexible balanced lifestyle (beyond 3‐years). Bariatric surgery patients experience distinct challenges relative to their post‐surgery time course. Facilitating access to interprofessional bariatric care after surgery allowed patients to acquire the self‐management knowledge and skills necessary to address challenges to following the bariatric guidelines in the long‐term.

Finding what works—Patients' long‐term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies

“…As patients approach weight nadir, and rapid weight loss curtails, they enter the "the work begins" phase where their newly formed good habits must be maintained to avoid or minimize weight regain. 29,30,36 Specific habits facilitating weight loss maintenance include patients' actively interrogating the role of food in their life, identifying triggers for consumption, and establishing new relationships with food. 26,29,30,34 Conversely, patients blinded by "easy" weight loss failed to modify their food relationships 24,35 ; whereas, others learnt to actively subvert the limits of their bariatric surgery: "I found that if I chewed the food tremendously to a pulp I could actually get more of it quite frequently …."…”

“…34 This may be a contributing factor to patients who reported that challenging eating behaviors re-emerged as physical limitations on eating waned, resulting in difficulty maintaining weight loss. 28,30,33,35,36…”

“…New healthy habits developed by post bariatric surgery patients during honeymoon and stabilization periods acted as facilitators of weight loss maintenance. Healthy habits included viewing planning to eat as a crucial aspect of life 30,36 and recognizing that eating habits facilitate weight loss maintenance. 27,34 Other healthy habits included placing importance on regular meal planning and portion sizes, 29,30 meal times, 36 eating frequency and duration, 22,28,30 healthy replacements for food addictions, 26,28 and the nutritional content of food.…”

“…Healthy habits included viewing planning to eat as a crucial aspect of life 30,36 and recognizing that eating habits facilitate weight loss maintenance. 27,34 Other healthy habits included placing importance on regular meal planning and portion sizes, 29,30 meal times, 36 eating frequency and duration, 22,28,30 healthy replacements for food addictions, 26,28 and the nutritional content of food. 22,29,30 3.4 | Navigating inter-and intrapersonal influences…”

Covariates of healthy diet and physical activity self-management one year after Bariatric surgery: A cross sectional study

“…Several studies have assessed the lifelong adherence to healthy lifestyle after the surgery; and found that non-adherence with dietary recommendations/loss of dietary control and exercise recommendations were important causes for weight regain post-surgery [14,15] [16-18] [19]. Several studies have shown that self-management is the best approach to maintaining weight loss (WL) and preventing weight gain after bariatric surgery [20][21][22]. The critical components of self-management after bariatric surgery to maintain WL are healthy eating behaviors and regular physical activity [23,24].…”