What is the experience of obese people undergoing
Bariatric Surgery in the UK?
BSA Medical Sociology Group 44th Annual Conference 2012.
Homer, C, V., Tod, A, M. Centre for Health and Social Care Research, Sheffield Hallam University
This poster presents findings from a review of literature on patients’ experiences of bariatric surgery. The findings have been used to develop a
qualitative longitudinal study 'Weight Loss Surgery: Through the patients' Eyes'.
Background
Bariatric surgery is becoming an increasingly accessed treatment of obesity. Demand for NHS funded procedures is rising at alarming
rates, over 7,000 bariatric surgical procedures were carried out in 2009/10, 69% commissioned by the NHS in England and 31% were
funded independently (National Bariatric Surgery Register, 2010). The increase in procedures is coupled with a wealth of published
evidence (Colquitt et al 2009) positively evaluating the clinical effectiveness of surgery through weight loss and weight loss maintenance.
A positive post-operative impact on health status and quality of life (QOL) when measured using standardised tools is evident in much of
the research.
Methodology
• A literature search of patient experience of bariatric surgery; support needs of patients undergoing bariatric surgery; and,
improvements to the QOL in bariatric surgery patients.
• Electronic databases included: MEDLINE, EMBASE, CINAHL, PSYCINFO and BNI.
• Dates: 2000 to February 2012.
• Methodology: Qualitative research studies
• 16 abstracts were reviewed for inclusion in the literature review
Results
The literature review revealed little in the way of in-depth qualitative data relating to bariatric surgery. Existing research is extensively
non-UK based and uses reflexive methodologies to ascertain pre and post-surgery experiences. There is a limited understanding of the
patient experience, what influences their behaviour, support needs and the QOL changes following surgery. The majority of studies
focused on pre-operative issues rather than post-operative long term care and behaviours. Themes that were identified in the studies
include: 'last resort'; the reality and decision making related to the surgery (Wysoker 2005); patient motivation for surgery (Munoz et al
2007), support (Marcias et al 2004) and 'rebirth' of patients' lives.
Conclusion
The literature findings have aided the methodological design of a qualitative study. Our current study aims to generate recommendations
to clinical groups and future commissioners of bariatric surgery, regarding the delivery of services to improve the intervention outcomes,
and the quality of patient experience.
References
Colquitt, J, L., Picot, J., Loveman, E., and Clegg, J. (2009). Surgery for Obesity (Review). The Cochrane Collaboration. Publishes by John Wiley & Sons, Ltd
Welbourn, R., Fiennes, A., Kinsman, R., Walton, P. (2010) National Bariatric Surgery Registry, First Registry Report to March 2010. Henley-on-Thames, Dendrite Clinical Systems.
Marcias, J, A., Vaz Leal, F, J., Lopez-Ibor, J, J., Rubio, M, A., and Caballero, M, G. (2004). Marital status in morbidly obese patients after bariatric surgery. German Journal of
Psychiatry. 7:3: 22-27
Munoz, D, J., Lal, M., Chen, E, Y., Mansour, M., Fischer, S., Roehrig, M., Sanchez-Johnson., L., Dymek-Valentine, M., Alverdy, J., and Le-Grange,D. (2007). Why Patients Seek
Bariatric Surgery: A Qualitative and Quantitative Analysis of Patient Motivation. Obesity Surgery. 17:1487-1491
Wang, C, C., Yi, W, K., Toa, Z, W., and Carovano, K. (1998). Photovoice as a participatory health promotion strategy. Health Promotion International. 13:1:75-86.
Williams, G. (1984). The genesis of chronic illness: narrative re-construction. Sociology of Health and Illness. 6:2:175-200.
Wysoker, A. (2005). The Lived Experience of Choosing Bariatric Surgery to Lose Weight. Journal of the American Psychiatric Nurses Association. 11:26
The next steps: 'Weight Loss Surgery: Through the Patients' Eyes
The limited findings from previous studies indicates an evidence gap. We
have designed our current study to meet that gap. Three key methodological
decisions were made to ensure the required in-depth evidence is generated.
These are as follows:
1. Narrative Reconstruction theory (Williams 1984). The elective option of
undergoing bariatric surgery is often referred to as a turning point in an
obese person's life. Narrative Reconstruction theory provides a means to
understanding this turning point. Narrative Reconstruction examines ways in
which people normalise or make sense of acute or chronic illness in the
context of their life narrative (Williams 1984). Current literature offers limited
consideration of the psycho-social issues associated with obesity surgery or
how people's narrative changes as a result of the procedure. Our study with
patients electing for, and undergoing bariatric surgery uses the concept of
Narrative Reconstruction during the interview process to allow participants
to: discuss and mentally organise their thoughts and feelings regarding the
origin of their obesity and weight gain; the disruption this has had on their
lives; the role of surgery; and, the contribution of others in the development
of, and recovery from their condition.
2. Photovoice methods can be used to explore how people reconstruct
their narrative. Based on participatory action research methods, participants
create and discuss photographs as a vehicle to explore issues in the context
of their everyday lives. The method has been used in research to identify
problems with interventions and public health programs using dialogue
generated through pictures, and to inform health policy. Photovoice has
been used successfully for research with various stigmatized groups. The
technique enhances ‘people's ability to identify and define their own
community's root-cause problems and to advocate change' Wang et al
(1998). Photovoice will be used in this current study to promote participant's
thinking about the root causes of their obesity, the challenges these cause,
and their experience of life and changing behaviours following surgery.
3. Longitudinal methods. Previous methodologies have limited capacity to
capture in-depth insight in changes to QOL and the patient experience of the
complete service pathway. This study 'Weight Loss Surgery: Through the
Patients' Eyes' will use a longitudinal real time approach. Participants are
recruited and interviewed before surgery and post-surgery at three and nine
months. Using the themes identified in previous research, Narrative
Reconstruction and Photovoice methods to devise interview questions and
guide the interview, will together contribute to identifying the type and levels
of care and support required by patients at different stages of the bariatric
surgical pathway.
Contact
Catherine Homer
c.homer@shu.ac.uk