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Managing expectations

Bariatric web-forum study reveals need to manage expectations

The researchers did acknowledge that posters on Internet online discussion forums could possibly be anonymous, so there is no way to ascertain their demographics and whether they are telling the truth

Patients who underwent bariatric surgery had very high, and often unrealistic, expectations on how the surgery would change their lives and healthcare professionals involved in treating this group of  patients should be aware of their need for support throughout the process, and investigate the possibility of both pre- and post-operative support groups, either online or face-to-face, according to a study by researchers from University of Gävle, Gävle, in Sweden.

The authors noted that several studies have found that the Internet has become the most frequently used source of health-related information, although there are few specific studies about Internet use specifically amongst the bariatric surgery patient population. The paper, ‘The only chance of a normal weight life’: A qualitative analysis of online forum discussions about bariatric surgery’, published in PlosOne, sought to describe shared values, feelings, and thoughts among visitors to a web-based forum for those undergoing bariatric surgery.

The researchers used Google to identify suitable forums where discussions of interest were held. The search terms used were the Swedish translations of “Gastric bypass” and “online discussion forum” (“överviktskirurgi” and “diskussionsforum”). The criteria for forum inclusion were:

  • publicly available without the need for a username and password to access the information;
  • relevant for the purpose of the study;
  • an active forum (>10 daily postings, >1.000 postings total, and >100 members); and
  • d) written in a Scandinavian language

The researchers decided to use one large discussion thread containing 498 posts (based on its title and content) and they copied and pasted the to analyse. After omitting irrelevant information, the raw data comprised of 155 pages of text.

Overall, they noted four themes during data analysis:

  • A new life—anticipating dramatic changes of body and mind;
  • Negotiating the system and playing the waiting game;
  • A means to an end—managing the pre-operative diet; and
  • d) Managing the attitudes of others

The key findings were:

  • Posters in the forum often wrote about a ‘journey’ that with their current weight and had its end goal in a ‘new life’ – in which patients described themselves as different/better people (happier, healthier and no longer doubting their ability to maintain a healthy weight)
  • Posters expected their bodies would change after surgery and relief from aches, pains and co-morbidities caused by their current weight (improved quality of life)
  • Poster believe surgery would lead to improvements of mental or emotional health problems (eg. depression and social anxiety)
  • Nearly all the posters wrote about previous failed weight loss attempts and how they had gradually come to consider bariatric surgery.
  • Fear of failure even made one poster hesitate about undergoing the procedure at all
  • Posters often supported each other, providing advice and posted encouraging comments.
  • Posters had different ways of managing the pre-operative VLCD - the main coping mechanism seemed to be to reassure themselves and each other that this would be the last time they had to starve themselves with bad-tasting products in order to lose weight.
  • Several posters had encountered, or feared encountering, negative reactions and comments from friends, colleagues and family.

The researchers did acknowledge that posters on Internet online discussion forums could possibly be anonymous, so there is no way to ascertain their demographics and whether they are telling the truth. Conversely, the fact that they could post anonymously provides them with a platform to be more candid about their thoughts and feelings.

“It is important for those who encounter this group before surgery to be aware of this tendency and to take measures to ensure that patients undergo the surgery with realistic expectations,” the authors concluded. “This might be done in several ways - through oral and written information, simple summaries of research in the area, or through putting patients in contact with others who have undergone the procedure.”

To access this paper, please click here

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