Penn State DrPH student examines patients’ views and quality of life before and after bariatric surgery

Bariatric surgery can help patients reach their health and weight loss goals, however, patients’ expectations don’t always align with their post-surgery reality, according to a new study by Penn State researchers.

Aiming to better understand the effects that bariatric surgery has on one’s psychopathology, researchers conducted focus groups to uncover how patients’ health, social behavior, relationships, body image and quality of life are impacted before and after surgery. The study is published in Bariatric Surgical Practice and Patient Care.

Led by Melissa Butt, a Penn State doctor of public health (DrPH) candidate, the qualitative study included adults with a preoperative body mass index of 35 or greater, and who were patients at the Penn State Health Surgical Weight Loss clinic in 2019.

Two men and 11 women made up the preoperative focus group, while the postoperative focus group consisted of two men and nine women. Researchers interviewed the patients about their surgical journeys and asked questions about body image, life experiences, physical struggles, quality of life and weight-loss expectations.

“The goal of this research is to explore the patient-centered narratives and experiences in this patient population, as well as use qualitative research methods to understand the nuances and intricacies of complex emotional and mental constructs,” said Butt.

In the preoperative group, researchers identified the following themes:

• Surgical motivations and expectations: Focus group members anticipated positive changes and improvements in regard to body image and overall health.
• Negative cognition and affect: The majority grappled with an internalized bias regarding their weight, and several expressed feelings of disbelief regarding their size. Many expressed fears and concerns over the thoughts of others, deemed “mind-reading” that often had a negative impact on self-perception.
• Physical and daily life challenges: The majority of patients said they had to take their size into consideration when traveling, dining out and socializing. Many exhibited avoidance behaviors, such as not looking at themselves in mirrors or wearing baggy clothes.
• Relationships: Participants mentioned self-acceptance and the importance of social support. They talked about social isolation and the negative impact their weight had on having intimate relationships.
• Social comparisons: Researchers uncovered that body image differed by gender. Patients identified positive and negative influences that served as motivation for surgery. Many women pursued bariatric surgery to improve their appearance, while men opted for surgery as a result of deteriorating health.

The postoperative group expressed several positive outcomes from having surgery, such as improved health, better social lives, and reduced challenges in daily activities. However, some of their early expectations fell short of their post-surgery reality. Their responses echoed the following themes:

• Social relationships: Patients expressed that surgery had both positive and negative impacts on their relationships. Some mentioned a lack of support following their procedure.
• Body image: Confidence increased, but many still struggled with accepting their new bodies despite weight- and nonweight-based markers, such as looser clothes.
• Health and physical changes: Patients noted behavioral and lifestyle changes mostly related to exercise and food. Some experienced medical setbacks as a result of surgery and preexisting health conditions. As the weight loss transformed their bodies, many patients were left with excess skin.

Overall findings show that body image and internalized weight bias impact behaviors, psychosocial health, and surgical outcomes for bariatric surgery patients. The relationships between and complex nature of these concepts revealed using qualitative research methods allude to the multidimensional realities of patients that can be difficult to ascertain and contextualize from quantitative research. Research shows that patients could benefit from nuanced conversations to help them prepare for surgery and manage expectations. In addition, health care professionals should look for ways to provide ongoing support to patients following weight loss surgery.

Joining Butt on this study were Andrea Rigby, PsyD, of Penn State Health Surgical Weight Loss, and Allison Wagner, MA, of Penn State College of Medicine.

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