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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12 Original Research Bariatric Times • March 2018 Bariatric Surgery: Not the 'Easy' Way Out—the 'Healthy' Way Out by MARY ANN ROSE, EdD, RN; MARY LISA PORIES, PhD, LCSW; DONNA ROBERSON, PhD, RN; and JANICE A. NEIL, PhD, RN Bariatric Times. 2018;15(3):12–14. ABSTRACT Objective: Bariatric surgery is often stigmatized as the "easy way out" for patients with morbid obesity. However, research suggests that for patients with obesity, the surgery is not viewed as an easy weight loss method but rather a "last resort" toward dealing with their health problems. This qualitative study sought to identify patients' experiences with negative attitudes following their surgery. Design: A qualitative design using patient interviews and Colaizzi's Method of Analysis was used. Setting: The study took place in a large southeastern regional academic bariatric surgery clinic and Center of Excellence. Participants: The study included 14 patients who were interviewed at their six-month clinic visit following surgery. Measurements: Analysis of data was performed using Colaizzi's Method of Analysis for phenomenological studies. Results: Subjects described hearing that bariatric surgery was the "easy way out," particularly in support groups and online. Some participants limited the number of people they told about their surgery to avoid negative attitudes or remarks. Conclusions: Society still holds the attitude that surgery is the easy way out, but research suggests that patients with obesity opt for surgery most frequently as the "last resort" in the face of relentlessly deteriorating health. A recommendation is made to reframe discussion about surgery toward taking the "healthy way out" rather than the "easy" way. A recommendation is also made to support group facilitators, both face-to face and online, to stress this approach to viewing bariatric surgery in order to combat the negative societal attitude regarding bariatric surgery. KEYWORDS Bariatric, easy way out, stigma, weight loss surgery (WLS) INTRODUCTION Stigma directed against individuals with obesity is still pervasive in Western society. Numerous studies 1–8 have confirmed its existence among not only lay people but also among healthcare professionals. People with obesity are often viewed as lazy, unmotivated, lacking in self- discipline, and sloppy. 9 The existence and effects of stigma directed at a patient who is either considering bariatric surgery or who has undergone bariatric surgery has been described less fully. There is evidence that bariatric surgery is considered "low effort," unnecessary, and of less value than lifestyle changes that would result in weight loss. For example, Groven 10 conducted a qualitative study of Norwegian post-operative surgical patients in which a major theme identified was that those participants strongly rebutted the notion that weight loss surgery (WLS) was the "low effort" approach to weight loss. Vartanian and Fardouly 11 investigated whether teaching individuals about the lifestyle changes required after bariatric surgery would mitigate their negative attitudes, and found that this was to some extent successful. Negative attitudes regarding surgery were noted in a recent study 12 in which participants were asked what factors motivated them to move forward with the surgery. The major theme identified was that health concerns rather than weight loss, per se, prompted the decision to undergo surgery, and many noted that it was simply their "last resort" after repeated weight loss failures. Several participants in that study noted that others accused them of taking the "easy way out." One woman commented, "Let the ultimate be about you and not about other people and not be moved by the stigma of 'Oh, you had weight loss surgery— you took the easy way out.' Because it's not the easy way out." Prompted by these findings, the research team questioned what negative attitudes or remarks related to the surgery itself were actually experienced by patients during the post-operative period. Stigma related to bariatric surgery might be reflected in negative comments or attitudes directed toward the patient when a person became aware that the patient had undergone surgery. Using a qualitative methodology, the research team asked post-op bariatric surgery patients, "How have family, friends, and others reacted to your having weight loss surgery?" Probing questions focused on patient experiences in telling family, friends, and other individuals about their WLS. METHODS The setting for this study was a large southeastern regional academic bariatric surgery clinic that is a center of excellence as defined by the American Society for Metabolic and Bariatric Surgery (ASMBS). The clinic serves a referral center for 29 counties that are primarily rural. This purposeful sample included male and female adult WLS patients over the age of 18 who had undergone either a Roux-en-Y or sleeve gastrectomy procedure and were returning for their six-month postoperative follow- up visit. The research team consisted of four investigators, three doctoral level nursing faculty and one doctoral-level social work/family therapist, all of whom are experienced in qualitative research and bariatric care. They also maintain an established relationship with the research site surgeons and staff who support this study. Following Institutional Review Board (IRB) approval, the potential participants were approached to participate in this study at their six-month postoperative follow-up visit to the surgery clinic. Patients who agreed to be interviewed for the study signed the informed consent documents and were interviewed in the clinic room. Demographic information was gathered as well. Fourteen patients agreed to participate. Two members of the research team were present for each interview, and all interviews were digitally recorded. All recordings were transcribed verbatim, removing any participant names, and the research team met at several intervals to review the data and compare findings to identify the prevalent themes apparent in the data. Analysis of the data followed Colaizzi's 13 method of analysis for phenomenological studies, as listed below: • Investigators independently review the verbatim transcripts several times to immerse themselves in the data. • Investigators underline significant statements and formulated a meaning separately. • Investigators review and agree upon the significant statements and formulate meanings. • Investigators group the common themes into clusters. • Each cluster carefully examined

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