There is no doubt that bariatric surgery is a hot topic of research these days. Most of this research focuses on the medical benefits that can be enjoyed after bariatric surgery, such as improvements in diabetes control, high blood pressure, sleep apnea, and so forth. Much less qualitative research has been done – the kind of research that looks at things that are hard to measure with numbers, such as psychological effects and changes in quality of life. Most of the qualitative information that has been published is on small groups of individuals, and it is challenging for patients or clinicians to synthesize this smattering of data as a whole.
Coulman and colleagues recently collected information on this topic in the first systematic review of qualitative research in the bariatric surgery field. Published in Obesity Reviews (and free to download!), they included 33 studies reporting on the patient perspective on living with the outcomes of bariatric surgery.
Three themes were identified:
1. Control. Patients reported making the decision to undergo bariatric surgery to gain control over eating, weight, and health. In general, a feeling of improved control was experienced in the first year after surgery, but after a year, there was less of a sense of physical control (described as ‘stomach control’), and it became more about relying on their own ‘head control’ to manage food intake.
2. Normality. A sense of ‘normality’ was something that many patients were striving for after bariatric surgery – lives less burdened by physical and psychological ill health, ability to participate in normal everyday activities, and what patients described as a more ‘socially acceptable’ appearance. While many people felt more ‘normal’ after surgery, there were also several issues identified that challenged patients’ desire to feel ‘normal’. This included a change in their own or others’ perceptions of their bodies, unpleasant gastrointestinal side effects (eg vomiting or diarrhoea), not being able to eat like others, and loose hanging skin.
3. Ambivalence. Patients reported that while some things changed for the better, other changes were difficult to cope with or adapt to. This included physical pros (improvement in metabolic health) and cons (gastrointestinal and nutritional side effects of surgery). This also included psychological pros (improvement in depression, self esteem, control) and cons (eg continued depression and self esteem issues with a realization by some that bariatric surgery was not going to fix these issues; challenges of finding ways other than food to cope with emotions; feeling a loss of protection from the outside world and a feeling of vulnerability with weight loss).
This review is a treasure trove of information, including quotes from patients, and is a great read in its entirety. These findings highlight that while bariatric surgery is an excellent treatment strategy for some people, for others it may not be the best choice. These findings certainly speak to the need for long term follow up for patients who have had bariatric surgery, including long term psychological and nutritional support.
As the authors write: Surgery was not the end of their journey with obesity, but rather the beginning of a new and sometimes challenging path.