Carrying the weight of uncertainty: Patients' long-term experiences after bariatric surgery

Abstract

The prevalence of obesity and severe obesity has increased rapidly in Norway since the 1980’s. Severe obesity is a medically introduced term for large body weight that is connected to health risk and impaired quality of life. The health care services can offer people with severe obesity an interdisciplinary assessment and possibly a weight loss intervention, although not necessarily bariatric surgery. Bariatric surgery is an option in severe obesity, and seems to be the most efficient intervention in terms of providing sustainable weight loss and reduction in comorbidities for the majority of patients. However, surgery involves risk and long-term outcomes, and complications beyond 1- 2 years are currently scarcely reported in research. The aim of this study is to explore patients’ long-term experiences with bariatric surgery. The study has a qualitative design and is grounded in phenomenology. Data was produced by in-depth interviews more than five years after surgery. Seven women and 13 men with different backgrounds participated. The participants were aged 28-60 at the time of the interview. All of them had undergone a combined surgical procedure, called Duodenal Switch, which provides most substantial weight loss and carries a somewhat higher risk of complications when compared to other surgical procedures. The data consists of the patients’ experiences after bariatric surgery processes, as recalled and described in the interviews. The analysis was inspired by Giorgi’s phenomenological method. The process of reflexivity has been emphasised throughout the whole research process. The findings are presented in three separate articles. The first article presents findings based on the first eight interviews. The article concentrates on the intertwining of change and altered social encounters and negotiation of embodied identity after surgery. In the second article, findings based on the first 14 interviews describe eating as an existential and situated practice which remained a sensitive issue after surgery. The third article reports the 13 male participants’ experiences after bariatric surgery, and describes agency as pivotal for the men’s self-understanding. Thus, bariatric surgery was experienced as a radical intervention, yet deeply meaningful because it gave access to actively engage with the world and others. “Carrying the weight of uncertainty” constitutes a common and essential theme of the long-term experiences, across the presented findings. Despite sufficient weight loss and comorbidities in remission, the patients lived with health problems, illness, complications and worries about the future connected to body weight and health.