Bariatric Times

DEC 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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8 Original Research Bariatric Times • December 2017 INTRODUCTION Obesity has become an epidemic in the United States. While traditional methods have been used to address the obesity epidemic, such as dietary advice, exercise, lifestyle changes, and medication, bariatric surgery has been viewed as the most effective treatment, specifically for morbid obesity. 1 Although there has been an increasing number of researchers that have explored bariatric surgery, it is a life-changing procedure that has strict regulations. Initially, patients must qualify for all criteria recommended by the American Society for Metabolic and Bariatric Surgery (ASMBS) to be considered for surgery. 2 After surgery, patients must adhere to lifelong commitments to maintain weight loss. Unfortunately, patients face more difficulty post-surgery, because they are required to make dramatic lifestyle changes for long- term weight loss success. 3 Fostering resiliency in post-surgery patients might be the key to the acceptance of changes in their lives. 4 As the number of bariatric surgeries continues to grow, more medical and mental health professionals are acknowledging the importance of pre- and post-surgery support for patients' optimal weight loss. However, within the literature, there has been a lack of discussion regarding how marriage and family therapists (MFTs) broach working with bariatric patients, and specifically how they are trained in this regard. The purpose of this study was to explore how MFTs broach working with bariatric patients through the weight loss surgery process based on their experiences as well as their perspectives. METHODOLOGY The research mission was to explore how MFTs envision working with bariatric patients during the weight loss surgery process and to explore their experiences while in graduate school. For this study, the weight loss surgery process was defined as perioperative clinical intervention. The overarching research question derived was, "How do MFTs conceptualize working with bariatric surgery patients?" Additional research questions included the following: "What theoretical frameworks do MFTs utilize when thinking about c linical work with bariatric patients?" and "How do MFTs view their role in clinical treatment?" The authors employed phenomenology to gain insight into how MFTs u nderstand and conceptualize working with bariatric surgery patients. Phenomenology is a qualitative research methodology that is used to explore the thick description and close analysis of lived experiences as created through meaning. 5 Likewise, in phenomenology, reality is understood through examination of lived experiences as individuals transition through space and time. 6 Research design. The researchers aimed to organize 45- to 60-minute semi-structured individual phone interviews, with the goal of obtaining depth and unique perception of each individual interviewee. Individual interviews allow for the participant to answer questions from their own perspective without possible influence of others, which might occur in focus group interviews. 7 Individual interviews allowed for a streamlined approach that is congruent with the use of phenomenology as a research method, as phenomenology studies conscious experience as perceived from the subjective or first person point of view of the patient. 8 Interviews were conducted until saturation was reached. 9 Please see Appendix A for a list of sample interview questions. Recruitment and data collection. After Institutional Review Board (IRB) approval, the authors engaged in a variety of recruitment strategies, including traditional and online recruitment. Traditional recruitment included a member of the research team sending an e-mail to program directors, identified faculty members, and/or administrative staff of an accredited master's program to inform them of the study and to ask them to forward to a ny recent graduates. The authors also reached out to their personal network of individuals that met the criteria of being recent graduates to inquire about possible participation v ia snowball sampling. 1 0 F urther, the use of an online mechanism (Facebook, a social media platform) was incorporated in an effort to secure potential candidates. 11,12 Once an individual expressed an interest in participating in the study, they were scheduled for an interview. Before starting the interview, each respondent signed the informed consent document. After collecting the informed consent, participants identified a pseudonym, which was used to protect confidentiality. Directly after, an audio device was turned on and the interview was initiated. Interviews were audio recorded for transcribing purposes. Each interview was transcribed and stored securely either on the Dr. Darren Moore's personal computer or on a device provided to an outside consultant. Analysis. After conducting the study, Dr. Moore met with the research team to identify initial impressions and key points from the interviews. Data were analyzed by Dr. Moore and members of the research team independently and then were discussed to gain consensus regarding emerging themes. Data were analyzed by utilizing the five key stages of the "frame work analytical process," which included the following: 1. Familiarization—authors became familiarized with the transcripts of data collected and gained an overview of the collected data. 2. Identifying a thematic framework—authors recognized emerging themes or issues in data set. 3. Indexing—authors identified portions or sections of data that corresponded to a particular theme. 4. Charting—authors arranged the by DARREN D. MOORE, PhD, LMFT (GEORGIA); JACOB MOK, BS; TAYLOR CHANDLER, BS; and POOJA MAMIDANA, MS Bariatric Times. 2017;14(12):8–12. The Marriage and Family Therapy Perspective of Bariatric Surgery Patients ABSTRACT The aims of this study were to 1) explore the level of training and exposure to working with bariatric patients among recent graduates of a master's program in marriage and family therapy, and 2) gain insight regarding how recent graduates conceptualize w orking with bariatric patients and providing perioperative care. The authors utilized a qualitative research methodological approach (phenomenological inquiry). The research occurred in the southern United States. Participants were recent graduates of an accredited master's programs in marriage and family therapy, specifically graduating within the last five years. The authors conducted semi-structured interviews, which were coded and analyzed by the research team. The following themes emerged in the study: 1) knowledge of bariatric surgery, 2) theoretical frameworks, and 3) perceptions of clinical treatment. The authors recommend that the topic of obesity and weight loss surgery be considered a topic of discussion within marriage and family therapy graduate and post-graduate programs. Further, marriage and family therapy students who want to specialize in bariatric counseling should gain direct exposure during graduate school by working in a collaborative healthcare setting. KEYWORDS Marriage and family therapy (MFT), obesity, bariatric surgery, perioperative care

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