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Social impact from surgery

Patients - how surgery affects their lives and social interactions

Dr Yikta Graham with co-authors Professor Small and Dr Mahawar (Credit: University of Sunderland)
Most participants reported that prior to surgery, they had experienced weight-related stigma from others, this had been a source of anxiety which they felt would reduce following surgery as they lost weight
The outcomes from this study can be used by healthcare professions to help prepare patients for surgery and support them afterwards by raising awareness of issues that they may encounter in social situations

An investigation into how bariatric patients adjust to life after surgery offers new insights which can be used by healthcare professionals to support both patients pre- and post-operatively.  A study carried out by researchers from the Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK, has explored the experiences of patients who underwent bariatric surgery and how surgery affected their lives and social interactions. The researchers found that social aspects of bariatric surgery did not appear to be widely understood by those who had not undergone bariatric surgery.

The authors note, there is a paucity of research that has examined patient experiences of adjusting to life after bariatric surgery, specifically in social contexts. Therefore, the aim of their study was to explore how people adjust to the social aspects of their lives in this first two years after surgery.

Dr Yitka Graham

The paper, ‘Patient experiences of adjusting to life in the first 2 years after bariatric surgery: a qualitative study’, published in Clinical Obesity ( doi: 10.1111/cob.12205), was carried out  Senior Lecturer in Public Health, Dr Yitka Graham, who led the research for her PhD. Dr Graham also holds an embedded research post in the bariatric surgical unit, at Sunderland Royal Hospital.

After bariatric surgery, patients make significant changes to their lifestyles, including dealing with altered eating habits, a rapidly changing physical appearance, as well as experiencing a period of psychosocial adjustment.

The researchers wanted to identify the patient-reported complex social processes that occurred after bariatric surgery to establish ‘why’ and ‘how’ these occurred, what they meant to the patients, and the actions they took to adjust to adjust to a life profoundly affected by bariatric surgery.  Patients were actively involved in the research, from design to dissemination, which ensured that the patient voice was embedded throughout the study.  Participants were identified and recruited from post-surgical clinic lists; 18 (11 female, 7 male) who were between 5 – 24 months post-surgery at the time of interview took part in face to face, individual interviews conducted by Dr Graham. Patients were encouraged to speak about their experiences openly without being constrained by a prescriptive list of questions.

Overall, the investigators reported that none of the participants in any of the risk attitude profiles regretted their decision to undergo the operation.

Findings from the study

Most participants reported that prior to surgery, they had experienced weight-related stigma from others.  This had been a source of anxiety which they felt would reduce following surgery as they lost weight.

From the interviews, the researchers constructed six themes based on the participants’ attitudes towards risks they encountered in social interactions after bariatric surgery.  The concept of social risk was identified as being evident in their pre-surgical lives, but interestingly, remained and took on new meaning post-surgery. The stigma of obesity was exchanged for the judgment of bariatric surgery as the method of weight loss. Three different categories of the interpretations were constructed: Risk Accepters, Risk Challengers and Risk Contenders.

The researchers found that the Risk Accepters (n=12) generally understood that changes to their lives were needed to lose weight and that failure to make life changes would mean their individual expectations of surgery (e.g. weight loss, improved health, etc) would not be achieved. Most Risk Accepters reported feeling comfortable disclosing bariatric surgery as the reason for their changed appearance, and in most social encounters (e.g. eating with others in a restaurant) when explaining why they were eating a smaller portion of food or not finishing a meal.

Following surgery, Risk Accepters had a tendency to be disciplined and positive in their outlook and about the required changes to their lives.

Patients who were deemed Risk Contenders (n=5) reported more difficulties pre- and post-surgery. Participants who reported these difficulties fell into two categories; either within their control or not. For example, not losing weight as a result of eating too much/wrong food was a situation they could control, but issues such as a continuing need for medication, despite weight loss and/improved health status was difficult because it was not an issue that they could do anything about. Similar to Risk Accepters, Risk Contenders also expressed the positive effects of weight loss and improved health associated with bariatric surgery. However, this group expressed greater anxiety and a greater difficulty in disclosing surgery as the reason for their weight loss for fear of being judged or accused of ‘cheating’, being lazy by letting surgery do the work, or taking an easy way out.  Several Risk Contenders reported being told they were ‘wasting NHS money’ that could be spent on other health conditions deemed to be more important.   As with all risk types, this group said that it was difficult to tell others about undergoing surgery, but reported that they had people they considered ‘safe’ to tell and others who they felt were ‘not safe’ to tell. In many cases, Risk Contenders lied about the way their weight was lost.

Only one participant appeared to be different from the Risk Accepter and Risk Contender types and was conceptualised as a Risk Challenger. This participant expressed a desire for a ‘normal life’ and had an overt and openly challenging attitude towards these adjustments imposed by surgery. The Risk Challenger had an individual interpretation of post-surgical advice, tailoring these to ensure a minimal life disruption.  For example, still drinking alcohol, but swapping beer (too gassy) for spirits, or continuing to pick at unhealthy foods (as before surgery), but picking ‘sensibly’.

Overall, the investigators reported that none of the participants in any of the risk attitude profiles regretted their decision to undergo the operation.

“This study sought to explore patients’ experiences of adjustment to life after bariatric surgery. We found that many participants were reluctant to discuss their experiences of surgery in social situations, sometimes even with close relatives, with frequent partial or non-disclosure of the method of their weight loss,” the authors write. “Within social environments, discussions surrounding bariatric surgery were reported to be a source of worry with regards to the potential risks of revealing having undergone bariatric surgery due to being judged by others.”

The researchers argue that the outcomes from this study can be used by healthcare professions to help prepare patients for surgery and support them afterwards by raising awareness of issues that they may encounter in social situations, discussing how other patients have dealt with these situations and how they might deal with a similar situation.

“More research into patient experiences of bariatric surgery in social contexts would help develop the limited research in this area, which is needed given the increasing number of people with obesity and metabolic disease who seek bariatric surgery as a result of changing eligibility,” the authors conclude. “Participants reported a lack of knowledge around bariatric surgery by the public, and that the social experiences of adjusting to bariatric surgery are not widely understood. It is also important to examine the negative societal attitudes towards judgement about bariatric surgery, with a view to challenging mind-sets through the understanding of how this information is being interpreted.”

To access this paper, please click here

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