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Females post-surgery

New issues for a new life after surgery

Study examined quality of life issues

In a thought provoking doctoral thesis, Karen Synne Groven from the University of Oslo, Norway, examined some of the issues women experience after gastric bypass surgery.

Previous studies on the subject have concluded bariatric surgery has led to an increase in quality of life for the majority of the patients, and have had a tendency to group these operations as either successful or unsuccessful, Groven has concluded somewhere in between.

“Surgery can be both a success and a failure, it is not either/or,” said Groven. “Some things get better, but new problems arise. And how women experience these problems vary significantly.”

For her research, she interviewed 22 women who a gastric bypass.  The interviewees are between the age of 24 and 54, most of them were interviewed twice, first about a year after the operation and then about 2.5-4 years after surgery.

Obesity

Her study claims that global figures show that approximately 70% of those who are characterised as morbidly obese are women, and women make up 70-80% of bariatric surgery patients. To a large extent, these figure corresponded with the figures in Norway.

Although one of the surgeons she spoke with characterised morbid obesity as a women’s problem, Groven stressed that there was a lot more behind the figures.

“More and more men have weight loss surgery,” she said. “We must be careful not to label women as this and men as that. Perhaps more women go through surgery because we think of it as more problematic with obese women than men?”

Karen Synne Groven (Photo: University of Oslo)

The target group for the commercial campaigns promoting bariatric surgery is women, and the dieting culture which exploded in the 1960s was also directed at women. The size of men’s bodies has not been an issue in the same way.

“Although men are under pressure to be fit, people talk about women in a different way when they are fat,” she adds.

After surgery

Going through gastric bypass surgery is like going through a radical change of both the internal and external body. All of a sudden the once obese women are treated with ‘respect’ in society, nevertheless, underneath the clothes the skin is saggy and it takes a long time to become familiar with the “new” stomach. Food which was easily digested one day makes them sick the next.

“Becoming slimmer and lighter is mostly perceived of as positive. At the same time it is ambivalent, since people start to behave differently towards the women after they’ve had surgery,” she said. “People are friendlier than before, and this may feel extremely provoking. And people often ask very invasive questions concerning the woman’s radical weight loss.”

Some of the women experienced increased self-esteem. They dared to rise to speak in a different manner than before, and people listened to what they had to say at work.

“Being heard is a good thing. But it was nevertheless also a grief, as they realised that they needed surgery in order for it to happen.”

The women also felt some ambivalence towards their “new” naked body. And not least: when do you tell others about the bariatric surgery?

Many kept telling white lies and just told people that they had been on a diet, as they were ashamed to have gone through an operation of this kind.

Loose skin

“It is given little focus before the operation; patients are often told that this is something that can be fixed afterwards. But it is not so easily fixed, and the women are not prepared for the challenge of having to live with the loose skin,” said Groven. “They think of the saggy skin as unattractive, uncomfortable and unfeminine.”

In Norway, in order to get the expenses covered for skin surgery, the women must reach a certain level of weight reduction, and then keep a stable weight. Moreover, skin removal may also involve risk, and not everything can be removed. Some were reluctant to have surgery which could involve risk in connection to future pregnancies.

Five of the 22 interviewees described their quality of life as worse after the operation. For them, life became worse due to stomach and intestine problems which became chronic after surgery.

Whereas the other 17 women talked about surgery as a watershed in terms of becoming more physically active, these five felt that they had no energy at all.

Food

Even those who were eager to change their habits in terms of food and working out experienced challenges concerning food and eating.

Eating too much, too little, the wrong food or at the wrong time of the day could all result in sudden episodes dumping. Some of the women experienced passing episodes of nausea, tiredness and dizziness, whereas others experienced intense quivering.

“I am a physiotherapist myself and wanted to study the women’s experiences with physical activity before and after the operation,” said Groven. “When I asked them about physical activity the women spoke a little about that before returning to talking about food. This is not something that I have measured scientifically, but it is my impression that the focus on food becomes even bigger after surgery. Everything revolved around food.”

Some of the women who had struggled with over-eating before the operation relapsed and started to over-eat after surgery as well, even though they became sick with dumping. Some developed grazing.

The eating disorder is not gone, one of the women explained. Others commented that their heads had after all not been in surgery.

Research claims that patients may avoid dumping as long as they follow the dietary advices. But according to Groven things are much more complex and unpredictable in reality.

“It is reasonable to ask, I think, whether the eating disorders that some of the women develop after surgery are diseases, or if they may be understood as normal changes as a result of the operation,” said Groven.

None of the 22 women regret having the operation.

“They say they would have done the same today and that they had no choice considering their life before surgery. Some said that the pains were a small price to pay.”

Groven’s analyses emphasise that the way in which women experience their own body is closely connected to society’s perception of the ideal female body. The way society regard obese women limit the women’s scope of action.

The interviewees felt stigmatised before the operation, and were very preoccupied with the way in which media and science represented weight loss surgery and its effectiveness.

“They are living with a body which is not accepted by society, and they are constantly judged from their size. The message from the media and medical science is that they are likely to get cancer or diabetes unless they lose weight and the surrounding world regards their obesity as self-inflicted. Some have children and are afraid to die and leave them alone,” said Groven. “It is well documented that morbid obesity may cause serious diseases. But on the other hand we know very little about the long-term effects of bariatric surgery and what diseases one may develop after such surgery.”

She plans to conduct further research that will look at the effects of bariatric surgery three-ten years after patients have undergone the procedure.

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