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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12 Original Research Bariatric Times • December 2017 them at a high risk for repeating the patterns as they get older. So with regard to f amilies, that's a dynamic that needs to be addressed." -Leila The overall obstacle participants of the study feel their clients might f ace post-surgery sometimes is the "miracle syndrome," where they expect that change will happen overnight or rapidly. They can be really upset when it is not the p hysical change or psychical weight loss that they expected. Other times, participants have seen clients shocked after being left with excess hanging skin after surgery, which m ight impact self-confidence and one's desire for intimacy with their partner. Participants have also mentioned that some clients might not be prepared for the amount of food restriction required after surgery, which might contribute to physical complications and mental health problems associated with the adjustment process. DISCUSSION The findings are consistent with previous work that has been conducted, which has suggested a need for training of MFTs regarding obesity and weight-related behaviors. 17 The authors' findings underscore the need to consider ways that MFTs are trained, specifically regarding working with a select group of individuals with obesity (e.g., bariatric surgery patients). Our findings suggest that while MFTs might have some ideas about the types of issues they might face when working with bariatric surgery patients, they admit that, for the most part, they have not been formally trained. While it is important that MFTs have some ideas about intervention and theoretical frameworks, some of which is conveyed in scholarly literature, 17 MFTs reported that there was not a discussion about obesity in general and bariatric surgery specifically, within their graduate education. Similar to findings among medical and nursing trainees, 18 MFTs reported feeling ill prepared to work with patients with obesity and those who have undergone bariatric surgery. MFTs were not familiar with various bariatric surgery procedures and were not familiar with such nuances regarding procedures that focus on malabsorption when compared to procedures that focus on restriction o r combine both malabsorption and restriction. Likewise, MFTs were not aware of some of the postoperative complications that might impact client's experience and mental h ealth, such as the dumping syndrome and band slippage, among others issues that might be related to the specific type of weight loss surgical intervention utilized. Given t he rise of obesity and the increasing popularity of bariatric surgery among adults and some teens, it might be important that more MFTs are trained in working w ith patients with obesity who seek surgical intervention for weight loss. Likewise, it might be worthwhile to consider how the weight loss process impacts couple and family relationships over time as suggested by other researchers. 19 One recommendation is that the topic of obesity (including weight loss surgery) is introduced within the core curriculum of MFT training. Additionally, the authors would recommend the development of formal and informal post-graduate training opportunities for MFTs to gain knowledge and experience in working with populations with obesity to include surgical and nonsurgical intervention. LIMITATIONS AND FUTURE RESEARCH One limitation of the study was that it was a small qualitative study and therefore cannot be generalized to a larger population. However, the authors do believe the sample yielded data that can be used to inform MFT education and can be used as a foundation for future research. In the study, there was a lack of variation in terms of geographical location of participants, with the majority of the participants having obtained their graduate degree in the southern part of the United States. Potentially, including graduates from training programs located in other parts of the United States, might have altered the results of the study. However, all the limitations support the need for future research regarding obesity and bariatric surgery training among MFTs. Given that research at the intersection of psychosocial factors, bariatrics, and MFT is novel, there is a need for additional research to explore MFT training in graduate programs. In particular, the r esearchers suggest a larger quantitative study that assesses obesity and bariatric surgery knowledge among MFTs. Likewise, researchers believe it is important t o consider the development of a training intervention that can be used to improve obesity and bariatric surgery knowledge of MFTs. REFERENCES 1. Schernthaner G, Morton JM. Bariatric surgery in patients with morbid obesity and type 2 diabetes. Diabetes Care. 2008;31 Suppl 2:S297–302. 2. Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obesity. 2005;13(4):639–648. 3. Richardson WS, Plaisance AM, Periou L, et al. Long-term management of patients after weight loss surgery. Ochsner J. 2009;9(3):154–159. 4. Sarvey SI. Psychosocial support after bariatric surgery: fostering resilience. Bariatric Nursing and Surgical Patient Care. 2009;4(4):323–324. 5. Starks H, Brown Trinidad S. Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qual Health Res. 2007;17(10):1372–1380. 6. Sokolowski R. Introduction to Phenomenology. Cambridge University Press; 2000. 7. Mansell I, Bennett G, Northway R, et al. The learning curve: the advantages and disadvantages in the use of focus groups as a method of data collection. Nurse Researcher. 2004;11(4):79–88. 8. Dahl CM, Boss P. The use of phenomenology for family therapy research. Research Methods in Family Therapy. 2005;2:63–84. 9. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82. 10. Sadler GR, Lee HC, Lim RS, Fullerton J. Recruitment of hard- to-reach population subgroups via adaptations of the snowball sampling strategy. Nurs Health Sci. 2010;12(3):369–374. 11. Ellison NB, Steinfield C, Lampe C. The benefits of Facebook "friends:" Social capital and college students' use of online social network sites. J Comput Mediat Commun. 2007;12(4):1143–1168. 12. Lohse B, Wamboldt P. Purposive Facebook recruitment endows cost-effective nutrition education program evaluation. JMIR Res Protoc. 2013;2(2):e27. 13. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. The Qualitative Researcher's Companion. 2002;573:305–329. 14. Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory into Practice. 2000;39(3):124–130. 15. Mays N, Pope C. Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000;320(7226):50–52. 16. Jasper MA. Issues in phenomenology for researchers of nursing. J Adv Nurs. 1994;19(2):309–4. 17. Pratt KJ, Holowacz E, Walton NL. Marriage and family therapists' perspectives on treating overweight clients and their weight-related behaviors. Am J Fam Ther. 2014;42(5):364–385. 18. Swift JA, Sheard C, Rutherford M. Trainee health care professionals' knowledge of the health risks associated with obesity. J Hum Nutr Diet. 2007;20(6):599–604. 19. Moore DD, Cooper CE. Life after bariatric surgery: Perceptions of male patients and their intimate relationships. J Marital Fam Ther. 2016;42(3):495–508. FUNDING: No funding was provided. DISCLOSURES: The authors declare that they have no conflict of interest. AUTHOR AFFILIATION: Darren D. Moore, PhD, LMFT (Georgia) is an Associate Professor & Site Director for the Couple and Family Therapy Program in San Francisco, California, at the California School of Professional Psychology at Alliant International University. Jacob Mok, BS, is a medical degree candidate at the Mercer University School of Medicine. Taylor Chandler, BS, is a marriage and family therapy master's candidates at Mercer University. Pooja Mamidana, MS, is a recent marriage and family therapy masters graduate from Alliant International University. ADDRESS FOR CORRESPONDENCE: Darren D. Moore, California School of Professional Psychology, Alliant International University, One Beach Street, Suite 100, San Francisco, CA 94133; Phone: 612-296-3758; E-mail:, "Our findings suggest that while MFTs might have some ideas about the types of issues they might face when working with bariatric surgery patients, they admit that, for the most part, they have not been formally trained."

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