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      Patients’ experiences of life after bariatric surgery and follow-up care: a qualitative study

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          Abstract

          Objectives

          Bariatric surgery is the most clinically effective treatment for people with severe and complex obesity, however, the psychosocial outcomes are less clear. Follow-up care after bariatric surgery is known to be important, but limited guidance exists on what this should entail, particularly related to psychological and social well-being. Patients’ perspectives are valuable to inform the design of follow-up care. This study investigated patients’ experiences of life after bariatric surgery including important aspects of follow-up care, in the long term.

          Design

          A qualitative study using semistructured individual interviews. A constant comparative approach was used to code data and identify themes and overarching concepts.

          Setting

          Bariatric surgery units of two publicly funded hospitals in the South of England.

          Participants

          Seventeen adults (10 women) who underwent a primary operation for obesity (mean time since surgery 3.11 years, range 4 months to 9 years), including Roux-en-Y gastric bypass, adjustable gastric band and sleeve gastrectomy, agreed to participate in the interviews.

          Results

          Experiences of adapting to life following surgery were characterised by the concepts of ‘normality’ and ‘ambivalence’, while experiences of ‘abandonment’ and ‘isolation’ dominated participants’ experiences of follow-up care. Patients highlighted the need for more flexible, longer-term follow-up care that addresses social and psychological difficulties postsurgery and integrates peer support.

          Conclusions

          This research highlights unmet patient need for more accessible and holistic follow-up care that addresses the long-term multidimensional impact of bariatric surgery. Future research should investigate effective and acceptable follow-up care packages for patients undergoing bariatric surgery.

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          Most cited references35

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          Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018

          Since 2014, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has produced an annual report of all bariatric surgery submitted to the Global Registry. We describe baseline demographics of international practice from the 4th report.
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            • Article: not found

            Management of obesity: improvement of health-care training and systems for prevention and care.

            Although the caloric deficits achieved by increased awareness, policy, and environmental approaches have begun to achieve reductions in the prevalence of obesity in some countries, these approaches are insufficient to achieve weight loss in patients with severe obesity. Because the prevalence of obesity poses an enormous clinical burden, innovative treatment and care-delivery strategies are needed. Nonetheless, health professionals are poorly prepared to address obesity. In addition to biases and unfounded assumptions about patients with obesity, absence of training in behaviour-change strategies and scarce experience working within interprofessional teams impairs care of patients with obesity. Modalities available for the treatment of adult obesity include clinical counselling focused on diet, physical activity, and behaviour change, pharmacotherapy, and bariatric surgery. Few options, few published reports of treatment, and no large randomised trials are available for paediatric patients. Improved care for patients with obesity will need alignment of the intensity of therapy with the severity of disease and integration of therapy with environmental changes that reinforce clinical strategies. New treatment strategies, such as the use of technology and innovative means of health-care delivery that rely on health professionals other than physicians, represent promising options, particularly for patients with overweight and patients with mild to moderate obesity. The co-occurrence of undernutrition and obesity in low-income and middle-income countries poses unique challenges that might not be amenable to the same strategies as those that can be used in high-income countries.
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              • Record: found
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              • Article: not found

              Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review

              To summarize the associations between weight stigma and physiological and psychological health for individuals who are overweight or obese.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                6 February 2020
                : 10
                : 2
                : e035013
                Affiliations
                [1 ] departmentPopulation Health Sciences, Bristol Medical School , University of Bristol , Bristol, UK
                [2 ] departmentDivision of Surgery, Head and Neck , University Hospitals Bristol NHS Foundation Trust , Bristol, UK
                [3 ] departmentNIHR CLAHRC West , University Hospitals Bristol NHS Foundation Trust , Bristol, UK
                Author notes
                [Correspondence to ] Dr Karen D Coulman; Karen.Coulman@ 123456bristol.ac.uk
                Author information
                http://orcid.org/0000-0003-0510-4290
                http://orcid.org/0000-0002-5911-8172
                Article
                bmjopen-2019-035013
                10.1136/bmjopen-2019-035013
                7045271
                32034030
                7032edaa-9009-4ac7-babe-44a0f27c6554
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                : 15 October 2019
                : 13 December 2019
                : 02 January 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000659, Research Trainees Coordinating Centre;
                Award ID: DRF-2011-04-032
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: ConDuCT-II Hub (Collaboration and innovation for D
                Categories
                Qualitative Research
                Original Research
                1506
                1725
                Custom metadata
                unlocked

                Medicine
                organisation of health services,quality in health care,qualitative research,adult surgery

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