The patient experience of bariatric surgery: a longitudinal qualitative study

Morbid obesity is a major public health concern. It is associated with a range of physical and psychological comorbidities including cardiovascular disease, stroke, depression and experiences of psychological distress and stigma. In the UK, treatment for morbid obesity is provided through a tiered pathway of services including bariatric surgery. Outcomes of surgery are not universally positive, with some regaining weight following surgery or experiencing unintended outcomes. This study explored what influences outcomes of bariatric surgery from the patients’ perspective. It aimed to identify how patients measure the success of bariatric surgery, the support needs and mechanisms which influence success and the implications for clinicians, commissioners and policy makers. Using qualitative interviews and modified Photovoice methodology alongside validated quality of life (QoL) measures this longitudinal study explored the expectations and experiences of patients undergoing bariatric surgery. Data was collected in five cycles across the bariatric patients' journey: pre-surgery (n=18); three months post-surgery (n=16); nine months post-surgery (n=15); 18 months post-surgery (QoL measures only) (n=10); and, two years post-surgery (n=13). This is the first study to investigate the experience of more than one service of a tiered obesity pathway. It found that the burdens of living with obesity and expectation of life post-surgery affected the way in which patients determined the success of bariatric surgery. Achieving normality was as important as the standard clinical measures of weight loss and reduced comorbidities. Psychological, physical and social support needs influence the potential for success in these terms. There was clear evidence of temporality, as the measures of success and support needs changed along participants’ bariatric surgery journey. Mechanisms which could address or hinder these support needs included: what participants believed to be a successful outcome; the obesity service pathway; support networks; physical activity and exercise; and excess skin. The findings inform the understanding of what influences the success of bariatric surgery. They are then used to develop practice and policy recommendations including: measures of success should be determined by individual patients and revisited across the journey; health care professionals supporting people living with morbid obesity to lose weight require training to understand the physiological and psychological impacts of bariatric surgery; specialist input from psychological and exercise specialists needs to be available and accessible across the pathway; and clinicians, commissioners and policy makers need to consider the levels of the socio ecological system and respond to the changing support needs in order to maximise chances of long-term successful outcomes for patients.