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  • Original Article
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Clinical Nutrition

Patients’ strategies for eating after gastric bypass surgery: a qualitative study

Abstract

Background/Objectives:

There is considerable variation in the amount of weight patients lose after gastric bypass surgery, and this may be related to the way they adjust to the operation in their daily eating practices. Little is known about how this varies. On the basis of a qualitative research design, this study therefore explores how patients deal with gastric bypass surgery in their daily lives.

Subjects/Methods:

The study is based on interviews with 24 men and women in Denmark diagnosed with morbid obesity who have had, Roux-en-Y gastric bypass surgery. The interviews were transcribed, coded and analysed using ‘grounded theory’ methodology.

Results:

Three strategies used by patients to cope with postoperative changes were identified. In the first strategy, patients treat surgery as time-out, using the operation to facilitate a change in their ordinary habits of daily life, but not as a solution to overweight in itself. Patients adopting the second strategy of surgery as solution would expect their smaller stomach to hinder excess food intake automatically. The third strategy of abstaining was adopted by patients who were afraid to experience negative side effects, or who believed they might 'ruin the operation'.

Conclusions:

Patients adjust to their postoperative condition in very different ways. The variation in the ways patients comprehend and cope with the operation and in its effects on their eating routines and practices needs to be further investigated and compared more systematically with the outcomes of the operation in terms of weight loss and overall well-being.

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References

  1. Nguyen NT, Slone JA, Nguyen XMT, Hartman JS, Hoyt DB . A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs. Ann Surg 2009; 250: 631–641.

    Google Scholar 

  2. O'Brien PE . Controversies in bariatric surgery. Br J Surg 2015; 102: 611–618.

    Article  CAS  Google Scholar 

  3. Thivel D, Brakonieki K, Duche P, Morio B, Boirie Y, Laferrère B . Surgical weight loss: impact on energy expenditure. Obes Surg 2013; 23: 255–266.

    Article  Google Scholar 

  4. Sjöstrom L, Lindroos A, Peltonen M, Torgerson J, Bouchard C, Carlsson C et al. Lifestyle, Diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2007; 357: 741–752.

    Article  Google Scholar 

  5. Biron S, Hould FS, Lebel S, Marceau S, Lescelleur O, Simard S et al. Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg 2004; 14: 160–164.

    Article  Google Scholar 

  6. Christou NV, Didier L, MacLean LD . Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 2006; 244: 734–740.

    Article  Google Scholar 

  7. Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009; 13: 1–190.

    Article  CAS  Google Scholar 

  8. Münzberg H, Laque A, Yu S, Rezai-Zadeh K, Berthoud HR . Appetite and body weight regulation after bariatric surgery. Obes Rev 2015; 16 (Suppl 1), 77–90.

    Article  Google Scholar 

  9. Hofmann B . Stuck in the middle: the many moral challenges with bariatric surgery. Am J Bioethics 2010; 10: 3–11.

    Article  Google Scholar 

  10. Gelinas BL, Delparte CA, Hart R, Wright KD . Unrealistic weight loss goals and expectations among bariatric surgery candidates: the impact on pre-and postsurgical weight outcomes. Bariatr Surg Patient Care 2013; 8: 12–17.

    Article  Google Scholar 

  11. da Silva SSP, da Costa Maia A . Obesity and treatment meanings in bariatric surgery candidates: a qualitative study. Obes Surg 2012; 22: 1714–1722.

    Article  Google Scholar 

  12. Moldovan AR, David D . Effect of obesity treatment on eating behavior: psychosocial interventions versus surgical interventions. A systematic review. Eating Behav 2011; 12: 161–167.

    Article  Google Scholar 

  13. Wood KV, Ogden J . Patients’ long-term experiences following obesity surgery with a focus on eating behaviour: a qualitative study. J Health Psychol 2015, ; e-pub ahead of print 13 April 2015; doi:10.1177/1359105315578304.

    Article  Google Scholar 

  14. Natvik E, Gjengedal E, Moltu C, Råheim M . Re-embodying eating. Patients’ experiences 5 years after bariatric surgery. Qual Health Res 2014; 24: 1700–1710.

    Article  Google Scholar 

  15. de Zwaan M, Hilbert A, Swan-Kremeier L, Simonich H, Lancaster K, Howell LM et al. Comprehensive interview assessment of eating behavior 18-35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis 2010; 6: 79–85.

    Article  Google Scholar 

  16. Ogden J, Avenell S, Ellis G . Negotiating control: Patients’ experiences of unsuccessful weight loss surgery. Psychol Health 2011; 26: 949–964.

    Article  Google Scholar 

  17. de Zwaan M, Mitchell JE . Eating disorders and eating behavior pre- and post-bariatric surgery. In: Still CD, Sarwer DB, Blankenship J (eds), The ASMBS Textbook of Bariatric Surgery. Springer: New York, NY, USA, 2014, pp 25–32.

    Google Scholar 

  18. Konttinen H, Peltonen M, Sjöström L, Carlsson L, Karlsson J . Psychological aspects of eating behavior as predictors of 10-y weight changes after surgical and conventional treatment of severe obesity: results from the Swedish Obese Subjects intervention study. Am J Clin Nutr 2015; 101: 16–24.

    Article  CAS  Google Scholar 

  19. Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg 2012; 22: 70–89.

    Article  Google Scholar 

  20. Wedin S, Madan A, Correll J, Crowley N, Malcolm R, Byrne TK et al. Emotional eating, marital status and history of physical abuse predict 2-year weight loss in weight loss surgery patients. Eating Behav 2014; 15: 619–624.

    Article  Google Scholar 

  21. Marino JM, Ertelt TW, Lancaster K, Steffen K, Peterson L, de Zwaan M et al. The emergence of eating pathology after bariatric surgery: A rare outcome with important clinical implications. FOCUS 2014; 12: 470–475.

    Article  Google Scholar 

  22. Throsby K . Obesity surgery and the management of excess: exploring the body multiple. Sociol Health Illness 2012; 34: 1–15.

    Article  Google Scholar 

  23. 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.

    Article  Google Scholar 

  24. Gomm R, Hammersley M, Foster P . Case Study Method. Sage: London, UK, 2000, pp 98–115.

    Google Scholar 

  25. Patton MQ . Qualitative Research and Evaluation Methods. Sage Publications: Thousands Oaks, CA, USA, 2001.

    Google Scholar 

  26. Nguyen N, Root J, Zainabadi K, Sabio A, Chalifoux X, Stevens C et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 2005; 140: 1198–1203.

    Article  Google Scholar 

  27. Goetz JP, LeCompte MD . Ethnographic research and the problem of data reduction. Anthropol Educ Q 1981; 12: 51–70.

    Article  Google Scholar 

  28. Strauss AC, Corbin JM . Basics of Qualitative Research: Grounded Theory Procedures and Techniques, 2nd edn. Sage Publications: Thousand Oaks, CA, USA, 1990.

    Google Scholar 

  29. Crossley N . Reflexive Embodiment in Contemporary Societies. Open University Press: Buckingham, UK, 2006.

    Google Scholar 

  30. Mauss M . Body Techniques, in Sociology and Psychology. RKP: London, UK, 1979, pp 95–123.

    Google Scholar 

  31. Jackson J . Stigma, liminality, and chronic pain: mind-body borderlands. Am Ethnologist 2005; 32: 332–353.

    Article  Google Scholar 

  32. Kleinman A . The Illness Narratives: Suffering, Healing, and the Human Condition. Basic Books: New York, NY, USA, 1988.

    Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. Natvik E, Gjengedal E, Molfrid R . Totally changed, yet still the same: Patients’ lived experiences 5 years beyond bariatric surgery. Qual Health Res 2013; 23: 1202–1214.

    Article  Google Scholar 

  35. Rusch MD, Andris D . Maladaptive eating patterns after weight loss surgery. Nutr Clin Pract 2007; 22: 41–49.

    Article  Google Scholar 

  36. Benson-Davies S, Quigley D . Food aversions and taste changes following Roux-en-Y bypass surgery. Top Clin Nutr 2008; 23: 357–363.

    Article  Google Scholar 

  37. Conrad P . The experience of illness: recent and new directions. Res Sociol Health Care 1987; 6: 1–31.

    Google Scholar 

  38. Sarwer DB, Dilks RJ, West-Smith L . Dietary intake and eating behavior after bariatric surgery: threats to weight loss maintenance and strategies for success. Surg Obes Relat Dis 2011; 7: 644–651.

    Article  Google Scholar 

  39. Marshall C, Rossman GB . Designing Qualitative Research, 5th edn. Sage Publications: Thousand Oaks, CA, USA, 2014.

    Google Scholar 

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Correspondence to L Hillersdal.

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Hillersdal, L., Christensen, B. & Holm, L. Patients’ strategies for eating after gastric bypass surgery: a qualitative study. Eur J Clin Nutr 70, 523–527 (2016). https://doi.org/10.1038/ejcn.2015.212

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