Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis

Karen D Coulman, Fiona MacKichan, Jane M Blazeby, Amanda Owen-Smith, Karen D Coulman, Fiona MacKichan, Jane M Blazeby, Amanda Owen-Smith

Abstract

Although bariatric surgery is the most effective treatment for severe and complex obesity, less is known about its psychosocial impact. This systematic review synthesizes qualitative studies investigating the patient perspective of living with the outcomes of surgery. A total of 2,604 records were screened, and 33 studies were included. Data extraction and thematic synthesis yielded three overarching themes: control, normality and ambivalence. These were evident across eight organizing sub-themes describing areas of life impacted by surgery: weight, activities of daily living, physical health, psychological health, social relations, sexual life, body image and eating behaviour and relationship with food. Throughout all these areas, patients were striving for control and normality. Many of the changes experienced were positive and led to feeling more in control and 'normal'. Negative changes were also experienced, as well as changes that were neither positive nor negative but were nonetheless challenging and required adaptation. Thus, participants continued to strive for control and normality in some aspects of their lives for a considerable time, contributing to a sense of ambivalence in accounts of life after surgery. These findings demonstrate the importance of long-term support, particularly psychological and dietary, to help people negotiate these challenges and maintain positive changes achieved after bariatric surgery.

Keywords: bariatric surgery; patient experience; qualitative; synthesis.

© 2017 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

Figures

Figure 1
Figure 1
Example of a thematic network.
Figure 2
Figure 2
PRISMA systematic review diagram for qualitative synthesis. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.
Figure 3
Figure 3
Thematic network describing the lived experience of obesity surgery.

References

    1. World Health Organisation . Obesity and overweight. 2015. Available from: .
    1. Health and Social Care Information Centre . Health Survey for England – 2014, chapter 9: Adult obesity and overweight; 2015.
    1. Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–2260.
    1. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523–1529.
    1. Kopelman P. Health risks associated with overweight and obesity. Obes Rev 2007; 8: 13–17.
    1. Sarwer DB, Steffen KJ. Quality of life, body image and sexual functioning in bariatric surgery patients. Eur Eat Disord Rev 2015; 23: 504–508.
    1. Warkentin LM, Majumdar SR, Johnson JA et al. Predictors of health‐related quality of life in 500 severely obese patients. Obesity 2014; 22: 1367–1372.
    1. Fontaine KR, Barofsky I. Obesity and health‐related quality of life. Obes Rev 2001; 2: 173–182.
    1. Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev 2001; 2: 219–229.
    1. Luppino FS, de Wit LM, Bouvy PF et al. Overweight, obesity, and depression: a systematic review and meta‐analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220–229.
    1. Dietz WH, Baur LA, Hall K et al. Management of obesity: improvement of health‐care training and systems for prevention and care. Lancet 2015; 385: 2521–2533.
    1. Colquitt JL, Pickett K, Loveman E, Frampton Geoff K. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014; CD003641.
    1. National Institute for Health and Care Excellence . Obesity: identification, assessment and management of overweight and obesity in children, young people and adults. London, 2014.
    1. O'Brien PE, MacDonald L, Anderson M, Brennan L, Brown WA. Long‐term outcomes after bariatric surgery: fifteen‐year follow‐up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 2013; 257: 87–94.
    1. Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219–234.
    1. Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta‐analysis, 2003–2012. JAMA Surg 2014; 149: 275–287.
    1. Gloy VL, Briel M, Bhatt DL et al. Bariatric surgery versus non‐surgical treatment for obesity: a systematic review and meta‐analysis of randomised controlled trials. BMJ 2013; 347: f5934.
    1. Mann J, Jakes A, Hayden J, Barth J. Systematic review of qualitative and quantitative definitions of failure in revisional bariatric surgery. British Obesity and Metabolic Surgery Society 6th Annual Scientific Meeting. Newcastle‐upon‐Tyne, UK; 2015.
    1. Zijlstra H, Boeije HR, Larsen JK, van Ramshorst B, Geenen R. Patients' explanations for unsuccessful weight loss after laparoscopic adjustable gastric banding (LAGB). Patient Educ Couns 2009; 75: 108–113.
    1. Ogden J, Avenell S, Ellis G. Negotiating control: patients' experiences of unsuccessful weight‐loss surgery. Psychol Health 2011; 26: 949–964.
    1. Bocchieri LE, Meana M, Fisher BL. Perceived psychosocial outcomes of gastric bypass surgery: a qualitative study. Obes Surg 2002; 12: 781–788.
    1. Meana M, Ricciardi L. Obesity Surgery: Stories of Altered Lives. University of Nevada Press: Reno, Nevada, 2008.
    1. Ogden J, Clementi C, Aylwin S. The impact of obesity surgery and the paradox of control: a qualitative study. Psychol Health 2006; 21: 273–293.
    1. Stolzenberger KM, Meaney CA, Marteka P, Korpak S, Morello K. Long‐term quality of life following bariatric surgery: a descriptive study. Bariatr Surg Pract Patient Care 2013; 8: 29–38.
    1. Pope C, Mays N. Chapter 1 ‐ Qualitative methods in health research In: Pope C, Mays N. (eds). Qualitative Research in Health Care, 3rd edn. Blackwell Publishing Ltd: Malden, Massachusetts, 2006, pp. 1–11.
    1. Groven KS, Raheim M, Engelsrud G. “My quality of life is worse compared to my earlier life”: living with chronic problems after weight loss surgery. Int J Qual Stud Health Well‐being 2010; 5.
    1. Gilmartin J. Body image concerns amongst massive weight loss patients. J Clin Nurs 2013; 22: 1299–1309.
    1. Benson‐Davies S, Davies ML, Kattelmann K. Understanding eating and exercise behaviors in post Roux‐en‐Y gastric bypass patients: a quantitative and qualitative study. Bariatr Surg Pract Patient Care 2013; 8: 61–68.
    1. Campbell R, Pound P, Morgan M et al. Health Technol Assess 2011; 15.
    1. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 2008; 8: 45.
    1. Sandelowski M, Docherty S, Emden C. Qualitative metasynthesis: issues and techniques. Res Nurs Health 1997; 20: 365–371.
    1. Lachal J, Orri M, Speranza M et al. Qualitative studies among obese children and adolescents: a systematic review of the literature. Obes Rev 2013; 14: 351–368.
    1. Clarke J, Fletcher B, Lancashire E, Pallan M, Adab P. The views of stakeholders on the role of the primary school in preventing childhood obesity: a qualitative systematic review. Obes Rev 2013; 14: 975–988.
    1. Pocock M, Trivedi D, Wills W, Bunn F, Magnusson J. Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies. Obes Rev 2010; 11: 338–353.
    1. Noyes J, Popay J, Pearson A, Hannes K, Booth A. Chapter 20: Qualitative research and cochrane reviews In: Higgins J, Green S. (eds). Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from
    1. Coulman KD, Howes N, Hopkins J et al. A comparison of health professionals' and patients' views of the importance of outcomes of bariatric surgery. Obes Surg 2016; 26: 2738–2746.
    1. Endnote X7. New York, NY: Thomson Reuters; 2015.
    1. Carroll C, Booth A, Lloyd‐Jones M. Should we exclude inadequately reported studies from qualitative systematic reviews? An evaluation of sensitivity analyses in two case study reviews. Qual Health Res 2012; 22: 1425–1434.
    1. Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 2001; 322: 1115–1117.
    1. Noblit GW, Hare RD. Meta‐Ethnography: Synthesizing Qualitative Studies. Sage Publications, Inc.: Newbury Park, 1988.
    1. Malpass A, Shaw A, Sharp D et al. "Medication career" or "moral career"? The two sides of managing antidepressants: a meta‐ethnography of patients' experience of antidepressants. Soc Sci Med 2009; 68: 154–168.
    1. Attride‐Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res 2001; 1: 385–405.
    1. Ogden J, Clementi C, Aylwin S, Patel A. Exploring the impact of obesity surgery on patients' health status: a quantitative and qualitative study. Obes Surg 2005; 15: 266–272.
    1. Wysoker A. The lived experience of choosing bariatric surgery to lose weight. J Am Psychiatr Nurses Assoc 2005; 11: 26–34.
    1. Earvolino‐Ramirez M. Living with bariatric surgery: totally different but still evolving. Bariatr Surg Pract Patient Care 2008; 3: 17–24.
    1. Pastoriza CA, Guimarães SM. Positives changes in the quotidian of patients submitted to the stomach reduction surgery (bariatric) [Portuguese]. Enfermagem Atual 2008; 8: 18–24.
    1. Throsby K. ‘There's something in my brain that doesn't work properly’: weight loss surgery and the medicalisation of obesity In: Malson H, Burns M. (eds). Critical Feminist Approaches to Eating Dis/orders. Routledge: London; New York, 2009, pp. 185–195.
    1. Throsby K. The war on obesity as a moral project: weight loss drugs, obesity surgery and negotiating failure. Sci Cult 2009; 18: 201–216.
    1. Throsby K. ‘That's a bit drastic’: risk and blame in accounts of obesity surgery In: Alexander F, Throsby K. (eds). Gender and Interpersonal Violence. Palgrave Macmillan: Basingstoke; New York, 2008, pp. 83–99.
    1. Throsby K. Happy re‐birthday: weight loss surgery and the 'new me'. Body Soc 2008; 14: 117‐+.
    1. Agra G, Henriques MER. The women's existence that they underwent the gastroplasty [Portuguese]. Rev Eletr Enf 2009; 11: 982–992.
    1. Norris J. Case study. Struggling for normalcy. Bariatr Surg Pract Patient Care 2009; 4: 95–101.
    1. Sutton DH, Murphy N, Raines DA. Transformation: the "life‐changing" experience of women who undergo a surgical weight loss intervention. Bariatr Surg Pract Patient Care 2009; 4: 299–306.
    1. Groven KS, Raheim M, Engelsrud G. Dis‐appearance and dys‐appearance anew: living with excess skin and intestinal changes following weight loss surgery. Med Health Care Philos 2012.
    1. LePage CT. The lived experience of individuals following Roux‐en‐Y gastric bypass surgery: a phenomenological study. Bariatr Surg Pract Patient Care 2010; 5: 57–64.
    1. Magdaleno R, Chaim EA, Pareja JC, Turato ER. The psychology of bariatric patient: what replaces obesity? A qualitative research with Brazilian women. Obes Surg 2011; 21: 336–339.
    1. Magdaleno R, Chaim EA, Turato ER. Surgical treatment of obesity: some considerations on the transformations of the eating impulse. Rev Latinoam Psicopat Fund, São Paulo 2010; 13: 425–440.
    1. Magdaleno R, Chaim EA, Turato ER. Understanding the life experiences of Brazilian women after bariatric surgery: a qualitative study. Obes Surg 2010; 20: 1086–1089.
    1. Wilson LH. Occupational consequences of weight loss surgery: a personal reflection. J Occup Sci 2010; 17: 47–54.
    1. Engstrom M, Forsberg A. Wishing for deburdening through a sustainable control after bariatric surgery. Int J Qual Stud Health Well‐being 2011; 6.
    1. Marcelino LF, Patricio ZM. The complexity of obesity and life after bariatric surgery: a public health issue. [Portuguese]. Cien Saude Colet 2011; 16: 4767–4776.
    1. Throsby K. Obesity surgery and the management of excess: exploring the body multiple. Sociol Health Illn 2012; 34: 1–15.
    1. Ivezaj V, Saules KK, Wiedemann AA. "I didn't see this coming.": why are postbariatric patients in substance abuse treatment? Patients' perceptions of etiology and future recommendations. Obes Surg 2012; 22: 1308–1314.
    1. Zunker C, Karr T, Saunders R, Mitchell JE. Eating behaviors post‐bariatric surgery: a qualitative study of grazing. Obes Surg 2012; 22: 1225–1231.
    1. Castro M, Ferreira V, Chinelato R, Ferreira M. Body image in women undergone bariatric surgery: sociocultural interactions. [Portuguese]. Motricidade 2013; 9: 82–95.
    1. Gronning I, Scambler G, Tjora A. From fatness to badness: the modern morality of obesity. Health (London) 2013; 17: 266–283.
    1. Knutsen IR, Terragni L, Foss C. Empowerment and bariatric surgery: negotiations of credibility and control. Qual Health Res 2013; 23: 66–77.
    1. Mariano ML, Monteiro CS, de Paula MA. Bariatric surgery: its effects for obese in the workplace. [Portuguese]. Rev Gaucha Enferm 2013; 34: 38–45.
    1. Natvik E, Gjengedal E, Raheim M. Totally changed, yet still the same: patients' lived experiences 5 years beyond bariatric surgery. Qual Health Res 2013; 23: 1202–1214.
    1. Forsberg A, Engström Å, Söderberg S. From reaching the end of the road to a new lighter life – people's experiences of undergoing gastric bypass surgery. Intensive Crit Care Nurs 2014; 30: 93–100.
    1. Geraci AA, Brunt A, Marihart C. The work behind weight‐loss surgery: a qualitative analysis of food intake after the first two years post‐op. ISRN Obes 2014; 2014: 427062.
    1. Jensen JF, Petersen MH, Larsen TB, Jorgensen DG, Gronbaek HN, Midtgaard J. Young adult women's experiences of body image after bariatric surgery: a descriptive phenomenological study. J Adv Nurs 2014; 70: 1138–1149.
    1. Lyons K, Meisner BA, Sockalingam S, Cassin SE. Body image after bariatric surgery: a qualitative study. Bariatr Surg Pract Patient Care 2014; 9: 41–49.
    1. Warholm C, Øien AM, Raheim M. The ambivalence of losing weight after bariatric surgery. Int J Qual Stud Health Well‐being 2014; 9: 22876.
    1. Coulman KD, Abdelrahman T, Owen‐Smith A, Andrews RC, Welbourn R, Blazeby JM. Patient‐reported outcomes in bariatric surgery: a systematic review of standards of reporting. Obes Rev 2013; 14: 707–720.
    1. Dixon JB, Schachter LM, O'Brien PE et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA 2012; 308: 1142–1149.
    1. O'Brien PE, Dixon JB, Laurie C et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 2006; 144: 625–633.
    1. Lindekilde N, Gladstone BP, Lubeck M et al. The impact of bariatric surgery on quality of life: a systematic review and meta‐analysis. Obes Rev 2015.
    1. Wood KV, Ogden J. Patients' long‐term experiences following obesity surgery with a focus on eating behaviour: a qualitative study. J Health Psychol 2016; 21: 2447–2456.
    1. Ogden J, Birch A, Wood K. ‘The wrong journey’: patients' experience of plastic surgery post weight loss surgery. Qual Res Sport, Exerc Health 2015; 7: 294–308.
    1. Rippe JM, Crossley S, Ringer R. Obesity as a chronic disease: modern medical and lifestyle management. J Am Diet Assoc 1998; 98: S9–15.
    1. Myers VH, Adams CE, Barbera BL, Brantley PJ. Medical and psychosocial outcomes of laparoscopic Roux‐en‐Y gastric bypass: cross‐sectional findings at 4‐year follow‐up. Obes Surg 2012; 22: 230–239.
    1. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and nutritional management of the post‐bariatric surgery patient: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2010; 95: 4823–4843.
    1. Mechanick JI, Youdim A, Jones DB et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9: 159–191.
    1. National Confidential Enquiry into Patient Outcome and Death . Too lean a service? A review of the care of patients who underwent bariatric surgery. 2012.
    1. Gesquiere I, Augustijns P, Lannoo M, Matthys C, Van der Schueren B, Foulon V. Barriers in the approach of obese patients undergoing bariatric surgery in Flemish hospitals. Obes Surg 2015; 25: 2153–2158.
    1. Reames BN, Birkmeyer NJ, Dimick JB et al. Variation in the Care of Surgical Conditions: Obesity, A Dartmouth Atlas of Health Care Series Lebanon, NH: The Dartmouth Institute for Health Policy & Clinical Practice, 2014.
    1. Parretti HM, Hughes CA, O'Kane M, Woodcock S, Pryke RG. Ten Top Tips for the management of patients post‐bariatric surgery in primary care. Br J Obes 2015; 1: 68–73.

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