Outcomes of a study assessing the experience of patients ten years after bariatric surgery from Lund University and the University of Gothenburg, Sweden, has revealed that the effect on eating and weight regulation persisted, whereas other problems, such as feelings of guilt about still not being healthy enough, remained. The findings were featured in the study, 'Patients’ views of long-term results of bariatric surgery for super-obesity: sustained effects, but continuing struggles', published in the journal Surgery for Obesity and Related Diseases.
"This is one of few follow-ups from a patient's perspective so long after surgery," said My Engström, researcher in nursing at the University of Gothenburg. "Several respondents found that one reason why they managed their lives with a gastrointestinal modification as well as they did was that they had been warned and expected more complications than they actually suffered.”
The study sought to explore and describe patients’ long-term experiences of living with a bariatric procedure and capture their overall experiences by encouraging participants to talk about the topics they found most relevant about living with bariatric surgery (Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion with duodenal switch (BPD/DS)) for more than a decade.
When asked to reflect broadly on their experiences of living with bariatric surgery for over a decade, the participants rarely mentioned procedure-specific issues and complications. Instead, their accounts revealed two broad themes: sustained effects after surgery, incorporating subthemes of better health, brighter futures, and better eating and weight regulation, and continuing struggles, including difficulties with physical activity, finding support, helping their children with overweight, and self-criticism. Many positive changes were sustained, but continuing personal struggles were similar to those pre-surgery.
In total, 18 patients were interviewed in the study. All of them said that their eating habits and appetite were still affected after the operation and that their bodies still objected, preventing them from eating as much as before surgery, and the reduction in cravings for unhealthy foods was maintained. Several participants also reported still being more easily affected by alcohol, which had consequences for their social life. However, while the operation had brought several changes, many described their existence with their surgically altered body as the new normal, or their new everyday life.
"This was interesting to hear as just over 70 percent of those we interviewed actually did experience an event that healthcare classified as a complication, such as malnutrition, abdominal pain, gall-bladder surgery or ileus," said Engström.
The participants reported still struggling to manage their lives and their weight after the surgery. This concerned aspects like how to support their children who were often also overweight. Some of the parents said that they felt resigned to their children's weight problems; they tried to provide the best possible guidance but found it difficult.
Several respondents also spoke about physical activity as a continuous cause for bad conscience. They were well aware that they should be physically active, but struggled with this. As a reason, they stated pain or their personal history of always having been bad at physical activity.
"Even if the excess weight was no longer there or did not constitute a real hindrance, the old self-image persisted as an obstacle to progress.”
One response common to most of the patients interviewed was the great gratitude they expressed for the procedure itself and towards society for bearing the cost of it. Some participants blamed themselves when something did not work optimally and thought that they were not "conscientious patients."
"Follow-up of these patients is often insufficient and must improve," says Kajsa Järvholm, researcher in psychology at Lund University. "The patients should be called back to their primary healthcare centre once a year but this is seldom the case. The patients are instead expected to remember to contact their healthcare provider themselves. When they did get in touch, they often found that knowledge about the surgery was poor."
Participants expressed overall satisfaction with their bariatric surgery and related outcomes. Most participants acknowledged a continued effect on their appetite, which could be important information for patients who worry about a diminished effect after the first year post-surgery. Participants were prone to self-blame when things did not turn out the way they wanted.
"Those who encounter bariatric surgery patients in the course of their work need both to help create realistic expectations of what the operation can change, and to take into account that many patients blame themselves and therefore hesitate to raise problems with their healthcare providers," added Järvholm. "This process is facilitated if the healthcare providers have a non-judgemental attitude and take the time to ask the patients how they are managing in their everyday lives."
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