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Patients’ perceptions of living with obesity and the prospect of having bariatric surgery

Integrating mindfulness, mindful eating and self-compassion before and after bariatric surgery could be beneficial for patients to support positive adaptive coping mechanisms and to promote helpful eating behaviour to optimise response to bariatric surgery, especially for individuals who experience self-blame and self-stigmatisation, according to a study led by researchers from Birmingham City University, Birmingham, UK.

The authors stated that there is a paucity of data on how contemporary psychology could assist in the pre-operative preparation of people living with obesity who are planning to undergo bariatric surgery. Therefore, they investigated how healthcare professionals can intervene early on, and manage expectations, predominantly aiming to support physical and psychological wellbeing for individuals in both pre- and post-bariatric surgery.


The study included 22 participants were recruited, with 17 participants completing the interview (males n=4, females n=13; mean age of participants: 46 years). Twelve individuals participated before undergoing bariatric surgery (4 months—3 weeks prior to surgery) with a mean BMI of 45.9kg/m2; five of those participants were scheduled to have a sleeve gastrectomy (SG), five were scheduled to have a Roux-en-Y gastric bypass (RYGB) and two were scheduled to have an adjustable gastric band (AGB). Five individuals participated post-bariatric surgery (3 weeks - 3 months post-surgery) with a mean BMI41.5kg/m2; three of those participants had a SG, and two had an AGB.


In the semi-structured interviews they assessed participants' beliefs about their obesity and the impact obesity has had on their lives, exploring the reasons behind their lifestyle choices and health behaviours. The interview then discussed patients’ views towards, and any experiences with, weight management, including barriers to weight management participants have experienced and thoughts and feelings towards bariatric surgery.


Outcomes

All participants described a life-long ‘battle’ in attempting to control their weight, consisting of various ‘diets’ and exercise regimens, with participants expressing frustration and sadness in response to their weight and a clear desire for change. Participants highlighted that they were not aware of the biology of obesity and their weight, and instead highlighted a wealth of different motivators that they felt had influenced their eating behaviours (and therefore their weight), such as their socioeconomic status, their culture and their work.


Participants reported that food was deemed to provide more than a functional role for participants, with it being apparent from some participants' discourse that eating provides some form of comfort, with such participants giving a range of reasons for their obesity, including sexual abuse, family death, and difficulty accepting their sexuality.


In addition to the distress and trauma described by some participants in their personal life which they perceived to influence their eating behaviours, many participants discussed their attitudes and beliefs regarding themselves (particularly in response to their weight) which they explained was partly influenced by societal reactions.


The discrimination, criticism, and judgement that participants had received from others, along with their psychological distress, impacted their willingness to engage in activities pre-surgery (e.g., social events and attending a gym) and was often the initial motivation for them to consider bariatric surgery. Many participants believed that post-surgery they would be able to lead what they perceived to be a more ‘normal life’ and engage in social activities without feeling they are being judged for their weight.


Participants also discussed the beneficial impact they believed bariatric surgery would have on their physical health (e.g., improving the comorbidities associated with their obesity) and were excited and hopeful for their future post-surgery, however, they explained how it did take them a while to accept the need for surgery, being frustrated and upset that they could not lose the weight themselves, demonstrating elements of self-criticism.


All participants interviewed had perceived that they had been on a ‘long journey’ filled with what they deemed to be a personal ‘failure’ in their weight management attempts and held a strong belief that bariatric surgery would be different.


Overall, participants due to, or having recently undergone, bariatric surgery expressed that they had been given a great deal of support from dietitians to change their eating behaviours, e.g., focusing on portion size and what food to consume. However, some participants felt they lacked psychological support in response to personal suffering and trauma experienced  which they believed had influenced their eating behaviours and therefore weight. Participants perceived that psychological support during this time would assist them to ‘work with’ their bariatric surgery, with a pre- and post-surgery psycho-social-behavioural support plan having the potential to act as relapse prevention.


The authors called for further research to investigate more thoroughly the experience of having undergone bariatric surgery and recovering in the early post-operative period, as well as further research exploring how and why eating behaviours change post-surgery, and the lived experience at different time periods post-surgery.


“Pre-surgery interventions are necessary to support individuals during the post-operative period,” the authors concluded. “Integrating mindfulness and self-compassion alongside bariatric surgery care could alleviate self-blame and stigma and support the development of helpful adaptive coping mechanisms and eating behaviours; to optimise response to bariatric surgery.”


The findings were reported in the paper, ‘‘Surgery is my only hope’: A qualitative study exploring perceptions of living with obesity and the prospect of having bariatric surgery’, published in Clinical Obesity. To access this paper, please click here

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