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      Understanding the psychosocial impact of weight loss following bariatric surgery: a qualitative study

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          Abstract

          Background

          Bariatric surgery leads to changes in mental health, quality of life and social functioning, yet these outcomes differ among individuals. In this study, we explore patients’ psychosocial experiences following bariatric surgery and elucidate the individual-level factors that may drive variation in psychosocial outcomes.

          Methods

          Eleven semi-structured focus groups with Michigan Bariatric Surgery Collaborative (MBSC) patients ( n = 77). Interviews were audio recorded, transcribed verbatim, and analyzed using a grounded theory approach. Data on participant demographic characteristics were abstracted from the MBSC clinical registry.

          Results

          Most focus group participants were female (89%), white (64%), and married (65%). We identified three major themes: (1) change in self-perception; (2) change in perception by others; and (3) change in relationships. Each theme includes 3 sub-themes, demonstrating a range of positive and negative psychosocial experiences. For example, weight loss led to increased self-confidence among many participants while others described a loss of self-identity. Some noted improved relationships with family or friends while others experienced worsening or even loss of relationships due to perceived jealousy.

          Conclusion

          Weight loss following bariatric surgery leads to complex changes in self-perception and inter-personal relationships, which may be proximal mediators of commonly assessed mental health outcomes such as depression. Individuals considering bariatric surgery may benefit from anticipatory guidance about these diverse experiences, and post-surgical longitudinal monitoring should include evaluation for adverse psychosocial events.

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          Most cited references28

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          Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory.

          The purpose of this article is to compare three qualitative approaches that can be used in health research: phenomenology, discourse analysis, and grounded theory. The authors include a model that summarizes similarities and differences among the approaches, with attention to their historical development, goals, methods, audience, and products. They then illustrate how these approaches differ by applying them to the same data set. The goal in phenomenology is to study how people make meaning of their lived experience; discourse analysis examines how language is used to accomplish personal, social, and political projects; and grounded theory develops explanatory theories of basic social processes studied in context. The authors argue that by familiarizing themselves with the origins and details of these approaches, researchers can make better matches between their research question(s) and the goals and products of the study.
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            Morbid obesity rates continue to rise rapidly in the United States.

            Clinically severe or morbid obesity (body mass index (BMI) >40 or 50 kg m(-2)) entails far more serious health consequences than moderate obesity for patients, and creates additional challenges for providers. The paper provides time trends for extreme weight categories (BMI >40 and >50 kg m(-2)) until 2010, using data from the Behavioral Risk Factor Surveillance System. Between 2000 and 2010, the prevalence of a BMI >40 kg m(-2) (type III obesity), calculated from self-reported height and weight, increased by 70%, whereas the prevalence of BMI >50 kg m(-2) increased even faster. Although the BMI rates at every point in time are higher among Hispanics and Blacks, there were no significant differences in trends between them and non-Hispanic Whites. The growth rate appears to have slowed down since 2005. Adjusting for self-report biases, we estimate that in 2010 15.5 million adult Americans or 6.6% of the population had an actual BMI >40 kg m(-2). The prevalence of clinically severe obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.
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              Obesity and discrimination - a systematic review and meta-analysis of observational studies.

              Research on obesity has shown that stigma often accompanies obesity and impacts many life domains. No previous research has systematically reviewed published literature about the prevalence and the nature of perceived weight discrimination in individuals with obesity. This systematic review and meta-analysis aims to fill that gap.
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                Author and article information

                Contributors
                734-845-5129 , dhafez@med.umich.edu
                iandrew@med.umich.edu
                brownnat@med.umich.edu
                aoreilly@med.umich.edu
                rachacoo@med.umich.edu
                aghaferia@med.umich.edu
                Journal
                BMC Obes
                BMC Obes
                BMC Obesity
                BioMed Central (London )
                2052-9538
                3 December 2018
                3 December 2018
                2018
                : 5
                : 38
                Affiliations
                [1 ]Ann Arbor VA Health System, Ann Arbor, MI USA
                [2 ]ISNI 0000000086837370, GRID grid.214458.e, Department of Internal Medicine, , University of Michigan, ; 2800 Plymouth Road, Building 16, Room 16-278C, Ann Arbor, MI 48109-2800 USA
                [3 ]ISNI 0000000086837370, GRID grid.214458.e, Department of Surgery, , University of Michigan, ; Ann Arbor, MI USA
                [4 ]ISNI 0000000086837370, GRID grid.214458.e, Institute for Healthcare Policy & Innovation, University of Michigan, ; Ann Arbor, MI USA
                Author information
                http://orcid.org/0000-0002-2260-0299
                Article
                215
                10.1186/s40608-018-0215-3
                6276134
                30524743
                c5526483-7b30-4489-8444-dfbe5c1b8ee5
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 January 2018
                : 2 October 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                obesity,weight loss surgery,psychosocial
                obesity, weight loss surgery, psychosocial

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