An exploratory qualitative study with post-operative bariatric patients around the psychosocial support required for sustaining long-term weight loss and psychological well-being

Van Zyl, Natascha

Abstract

Background: Bariatric surgery is considered an effective obesity management intervention for people with a BMI greater than 40 or 35 with comorbidities. However, studies show that weight regain is observed from 18-months post-operative, and pre-existing psychological problems persist post-operatively. There is a paucity of studies exploring post-operative psychosocial interventions for bariatric surgery patients exceeding 2-years. A recent systematic review suggests that an interdisciplinary post-operative approach is warranted. This exploratory qualitative study aimed to explore what psychosocial support bariatric surgery patients felt they needed from 18-months post-operative for sustaining long-term weight loss and psychological well-being.

Methods: Fifteen bariatric surgery patients from 18-months to 12-years post-operative participated in recorded semi-structured interviews lasting 60-90 minutes, conducted online using ZoomTM, then transcribed verbatim and analysed using reflexive thematic analysis.

Findings: Three themes and six sub-themes were generated. Theme 1, Journey to surgery, has two sub-themes, Deep roots and Breaking point. Theme 2, The precipice of change, has two sub-themes, Continuity of care and Can’t cut the problem out. Theme 3, Bridging the gap, has two sub-themes, Doing it together and Taking back the reigns. Findings suggest that participants had not considered psychological support for weight loss to address earlier trauma or eating behaviour before undergoing bariatric surgery. The inconsistencies they experienced in their pre-operative-and-post-operative care led to dissonance, and they felt unprepared for the demands of life post-operatively. However, over time, participants understood surgery was not a ‘quick-fix’ and change was a long-term process that required their commitment. Participants also shared their insights and preferences regarding what they envisioned as the ideal support package for bariatric surgery patients to facilitate long-term weight loss and psychological well-being.

Conclusion: Bariatric surgery is a catalyst for physical change; however, surgery alone was insufficient to ensure sustained change for participants. This study suggests that surgical and psychosocial interventions are interdependent rather than mutually exclusive. Participants favoured an integrative, personalised, stepped-care approach pre-and-post-operatively, with active patient participation fostering autonomy, including online and social support, and access to ongoing support extending beyond 2-years, including payable services. In this context, psychosocial support involves collaborative partnerships between patients, their families, communities and healthcare providers. Overall, participants aspired for independence and readiness for life beyond services. Future studies are needed to systematically explore participants’ preferences for support while revisiting the potential of pre-operative interventions and investigating the gaps identified in this study.

Citation

Van Zyl, N. An exploratory qualitative study with post-operative bariatric patients around the psychosocial support required for sustaining long-term weight loss and psychological well-being. (Thesis). University of the West of England. Retrieved from https://uwe-repository.worktribe.com/output/7864613

• Thesis Type: Thesis
• Deposit Date: Oct 8, 2021
• Publicly Available Date: Nov 7, 2022
• Keywords: bariatric surgery; psychosocial interventions; psychological support; ACT, CBT; MI; Mindfulness; integrative; multidisciplinary; stepped care; food policy; social prescribing; personalised approach
• Public URL: https://uwe-repository.worktribe.com/output/7864613
• Award Date: Nov 7, 2022