Seeking normality from bariatric surgery

Introduction: Eligibility for bariatric surgery (BS) is assessed using medical criteria. Body Mass Index (BMI) is the main condition for selection. Primary outcomes of success for BS are weight loss and reductions of comorbidities e.g. diabetes. Psychosocial outcomes are not consistently monitored in the UK. Associated service provision of BS varies and do not always contain a strong psychological component offering support pre or post BS. Obese patients may have faced a lifetime of psychosocial and physical challenges which influence their expectations of BS. Failure to address unrealistic expectations prior to surgery may undermine any promising clinical outcomes.

Methods: A qualitative study using in-depth semi-structured interviews, Photovoice and Framework Analysis techniques. 18 participants interviewed pre bariatric surgery.

Results: Patients have high expectations of how their lives will change following BS. Whilst patients have weight loss and health goals, seeking to be 'normal' can override their desire to become a healthy weight. Participants described feelings of shame, stigma and low self-esteem linked to anger at themselves and others. Space in the home offered them a form of protection from the outside world but often increased social isolation. Navigating the physical space inside and outside the home was challenging and often negative experiences exacerbated feelings of shame and humiliation. Patients felt they did not belong to the 'normal' world and anticipated they would regain this place following surgery.

Conclusion: Patients weight loss expectation maybe achievable from BS. However services need to identify and address unrealistic psychosocial expectations of normality after BS.