Bariatric Times

MAR 2018

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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14 Original Research Bariatric Times • March 2018 when someone said it to me". Another commented, "My family feels that I'm taking the easy way out." It was a pleasant surprise to this research team that the participants in this particular study, for the most part, did not experience negative attitudes or behavior related to their surgery. This contradicts the findings of other studies. 10,11,15,19 Although personal support without stigma was their experience, these participants were aware of the stigma surrounding both obesity and bariatric surgery that is prevalent in society. It is interesting to note that several participants in this study limited the number of people whom they told about their surgery. Although some were completely open, others limited this communication, it appeared, in an effort to avoid negative responses from others. Perhaps the increasing safety and effectiveness of the surgery has begun to limit some of the negativity, or perhaps it is due to the increasing number of famous people who have undergone the surgery and have been open in public about it. Al Roker, a TV personality and weatherman, noted, "I wrote this book to share my personal journey [of weight loss surgery] and what I went through, and I hope it will be helpful to whoever reads it." 17 In August 2017, People magazine named 10 celebrities who were open about their weight loss surgery. 18 While the impact of celebrities being open about the surgery and all that it entails is unclear, perhaps it is helpful. Perhaps we should refocus, viewing it not as "weight loss surgery," per se. For patients, it is the "healthy choice" rather than the "easy way out." In our previous study, 12 patients overwhelmingly felt that their decision to undergo the surgery was a "last resort". Thus, the surgery represented for them a dramatic approach to regaining their own health rather than a choice simply to help them lose weight. Trainer and colleagues 19 called for such a refocusing, suggesting emphasis on the hard work that must be done postoperatively. We suggest that the refocusing should be toward the return to good health that can occur postoperatively. Viewing these patients as individuals who are taking responsibility for their own health by undergoing surgery is a useful paradigm shift for healthcare professionals and also the general public. It is clearly realistic and much more positive in describing the decision to opt for surgery. One far-reaching approach to adopting this more positive attitude might lie in the support groups, those conducted both face-to-face and online. Perhaps this is the time and place for support group facilitators or those running Facebook sites and other online support sites to stress viewing surgery as not the "easy way out" but rather the "healthy way out." If it is indeed the last resort in a situation of deteriorating health, then undergoing surgery is a step toward regaining health and assuming a healthy lifestyle. With the improvement or amelioration of diabetes, orthopedic problems, infertility, and other complications of obesity 20,21 through surgery, the patient is indeed choosing a return to better health. While dealing with these lifestyle changes, a positive approach as described above would also provide patients with a response to negativity. When and if confronted with statements concerning the "easy way out," they could respond by saying, "No, I am taking the healthy way out." That response would be true, realistic, and represent progress in changing the stigma of bariatric surgery. All members of a healthcare team— nurses, physicians, social workers, psychologists, nutritionists, and case workers—could be delivering the same positive message: choosing bariatric surgery is making a decision to opt for the "healthy way out." REFERENCES 1. Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity. 2008;16(5):1129–1134. 2. Allison D, Basile V, Yuker H. The measurement of attitudes toward and beliefs about obese persons. Int J Eat Dis. 1991;10: 599–607. 3. Ambwani S, Thomas K, Hopwood C, et al. Obesity stigmatization as the status quo: structural considerations and prevalence among young adults in the US. Eat Behav. 2014:15(3);366–370. 4. Friedman K, Ashmore J, Applegate K. Recent experiences of weight-based stigmatization in a weight loss surgery population: psychological and behavioral correlates. Obesity. 2008;16(S2): S69–S74. 5. Hunger J, Major B, Blodorn A, Miller C. Weighed down by stigma: how weight-based social identity threat contributes to weight gain and poor health. Soc Personal Psychol Compass. 2015;9(6):255– 268. 6. Phelan SM, Burgess DJ, Yeazel MW, et al. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015;16(4): 319–326. 7. Puhl RM, Brownell KD. Bias, discrimination, and obesity. Obesity. 2009;9(12):788-805. 8. Puhl RM, Brownell KD. Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity. 2006;14(10):1802–1815. 9. Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity. 2009;17:941–964. 10. Groven KS. They think surgery is just a quick fix. Int J Qual Stud Health Well-being. 2014;9(1):24378. 11. Vartanian L, Fardouly J. Reducing stigma of bariatric surgery: Benefits of providing information about necessary lifestyle changes. Obesity. 2014;22(5):1233–1237. 12. Roberson D, Neil J, Pories ML, Rose MA. The tipping point: A qualitative study of the factors influencing a patient's decision to proceed with bariatric surgery. Surg Obes Relat Dis. 2016;12(5):1086–1090. 13. Colaizzi P. Psychological research as the phenomenologist views it. In: Vaile R, King M, (Eds). Existential phenomenological alternatives for psychology (pp. 48–71). New York: Oxford University Press; 1979. 14. Lincoln Y, Guba E. 1985. Naturalistic inquiry. New York: Sage. 15. Vartanian L, Fardouly J. The stigma of obesity surgery: negative evaluations based on weight loss. Obes Surg. 2013;23(10):1545– 1550. 16. Gastric Sleeve Support Group (VSG). (2017, Sept 21). Retrieved from groups/323569557803485/ 17. Taub-Dix B. (2013, February 3). A stormy relationship with the scale: an interview with Al Roker. Para 10. Retrieved from http://health. eat-run/2013/02/07/al-rokers- gastric-bypass-and-weight-loss. 18. Pearl, D. (2017, August 9). 10 celebrities who were honest about having weight loss surgery. Retrieved from bodies/10-celebrities-who-were- honest-about-having-weight-loss- surgery/rosie-odonnell 19. Trainer S, Brewis A, Wutich A. Not 'taking the easy way out': reframing bariatric surgery from low-effort weight loss to hard work. Anthropol Med. 2017;24(1):96–110. 20. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta- analysis. J Am Med Assoc. 2004;92(14):1724–1737. 21. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256. FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. AUTHOR AFFILIATION: Dr. Rose is a Professor of Nursing at East Carolina University. Dr. Pories is with the College of Health and Human Performance at East Carolina University. Dr. Roberson and Neil are Associate Professors of Nursing at East Carolina University. ADDRESS FOR CORRESPONDENCE: Mary Ann Rose, EdD, RN; Email: BT All members of a healthcare team—nurses, physicians, social workers, psychologists, and case workers—could be delivering the same positive message: choosing bariatric surgery is making a decision to opt for the "healthy way out." Access mobile-friendly version of the 2017 Buyers Guide issue of Bariatric Times clinical developments and metabolic insights in total bariatric patient care

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