Changing Bodies, Changing Habits: Women's Experiences of Interval Training Following Gastric Bypass Surgery

Dietary experiences after bariatric surgery in patients with obesity: A qualitative systematic review

This systematic review evaluated the dietary experience of patients with obesity post-bariatric surgery. Scopus, CINAHL, Medline, Psych INFO, and Embase databases were searched and JBI Critical Appraisal Tool was used for quality assessment. Thomas and Harden's three-stage thematic synthesis was undertaken using the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement for reporting. Of the 24 studies extracted, we coded and developed 34 descriptive themes into 7 categories, which were then categorized to 3 analytical themes. The number of all the participants in the 24 articles is 383 people. The results revealed most patients can control their diet for a short period post-surgery. However, this was a matter of gradual self-consciousness as patients also required support and dietary management in postoperative recovery. CLINICAL TRIAL REGISTRATION NUMBER: The protocol for this qualitative systematic review has been registered with PROSPERO (registration number CRD42021229083).

The Ethical Work of Weight Loss Surgery: Creating Reflexive, Effortless, and Assertive Moral Subjects

While higher-weight bodies have been radically medicalized in modern Western discourse, they are also culturally conceived as a moral project. In clinical settings aimed at transforming the body, the consultation sessions between bariatric professionals and patients reveal nuanced moral deliberations. I suggest that bariatric surgery becomes a site of a "moral breakdown," where professionals direct patients to morally recuperate not only through technologies of the self, such as intensive bodywork and diets, but through "moral laboratories," which invite moments of experimentation in everyday life. Drawing on ethnographic inquiry in a bariatric clinic, I argue that this moral project is understood through new relationships within various registers of patients' subjectivity. First, patients are instructed to "listen to their bodies" and to reconnect to their embodied sensations. They are further guided to cognitively imitate an effortless "thin state of mind." And finally, they are instructed to "put themselves first" by reorganize their interactions with significant others. Professional guidance encourages dialog and reflexivity within the patient that are consonant with neoliberal understandings of the self-disciplined subject, yet they expand, and at times undermine these neoliberal notions by attending to other body ethics and contesting elements of fat stigma.

To be or not to be active - a matter of attitudes and social support? Women's perceptions of physical activity five years after Roux-en-Y Gastric Bypass surgery

Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric surgery patients, the majority is not sufficiently physically active. The aim was to explore women’s perceptions and experiences concerning PA five years after Roux-en-Y Gastric Bypass (RYGB) surgery.

Methods: Eleven women were interviewed five years post-surgery. Grounded Theory approach was applied.

Results: The core-category “Attitudes and surrounding environment influence activity levels” includes three attitudes towards PA: “Positive attitudes”, “Shifting attitudes” and “Negative attitudes”. Participants with a positive attitude were regularly physically active, felt supported and proud of their achievements. Contrary, participants with a negative attitude didn’t prioritize PA, didn’t feel supported and saw no need or benefit of PA. Some participants revealed an on-off behaviour, hovering between the attitudes of vigorous PA and sedentary lifestyle, without sustainable balance. The majority mostly viewed PA as a mean to lose weight.

Conclusion: The level of perceived post-surgery PA was related to the participants’ attitudes towards PA and whether or not they had a supportive environment. These findings might explain why bariatric surgery patients often fail to be sufficiently active post-surgery, and highlight the need for prolonged support and motivational interventions to promote sustainable PA post-bariatric surgery.

Space perception, movement, and insight: attuning to the space of everyday life after major weight loss

Physiotherapists are well placed to help people adjust and engage meaningfully with the world following major weight loss. Recent research indicates that the body size a patient has lived with for years can continue to affect movement and perception even after largescale weight loss. This article explores this discrepancy in depth from the perspective of phenomenology and space perception and through the concepts of body image, body schema, and affordances. It draws on an empirical example in which a nautical engineer described his lived experience of returning to work following bariatric surgery and the discrepancies he experienced while adjusting to his new situation, particularly when moving his smaller body around the ship's engine room, previously inaccessible to him. Analysis of this empirical example suggests that transitions in weight and size following bariatric surgery are both highly explicit in awareness (i.e., body image) and outside awareness (i.e., body schema). Major weight loss can open up new affordances and possibilities of being in the world, but only after adjustments in body image and body schema. The article suggests ways in which such insights can contribute to physiotherapists' clinical development and practice when working with patients undergoing major weight loss.

Physiotherapists' encounters with "obese" patients: Exploring how embodied approaches gain significance

BACKGROUND

Obesity is regarded as a modern lifestyle problem, causing illness, stigma, discrimination, and psychological problems. To help patients avoid these problems, physiotherapists increasingly engage in lifestyle programs specialized in weight loss.

OBJECTIVE

To explore how physiotherapists' encounters with patients diagnosed as "obese" acquire significance for their development as clinicians.

METHOD

The material draws on semi-structured interviews with eight physiotherapists. We conducted a thematic analysis inspired by van Manen's hermeneutic-phenomenological approach combined with Kvale and Brinkman's critical approach.

FINDINGS

The analysis identified the following four themes: 1) Striving to find one's own style of communication; 2) Relating to bodily discrepancies; 3) Developing clinical competence through bodily encounters; and 4) Gaining insight into the dilemmas of group-based lifestyle programs. Taken together, our findings highlight bodily encounters between patients and physiotherapists as an invaluable source of insight. Such insight can shape physiotherapists' development as clinicians inspiring them to develop their unique ways of communicating so that patients diagnosed as obese can feel empowerment rather than failure and shame. At the same time, our findings point to the need of critically reflecting on ones' own approach entering a double role of both controller and supporter. As such, our findings complicate and extend previous work on stigma and shame.

CONCLUSION

Our research leads us to conclude that more emphasis on critical thinking in physiotherapy is necessary. We suggest that this should be given more priority in research, education, as well as in clinical practice.

Severe Obesity and the Ambivalence of Attending Physical Activity: Exploring Lived Experiences

Physical activity is considered fundamental in lifestyle interventions. We explore experiences of physical activity prior to, during, and following a 10- to 14-week inpatient lifestyle modification program, including high volume of physical activity, for the treatment of severe obesity. Eight participants from a prospective clinical trial were selected to participate in a complementary qualitative study. The participants' experiences with physical activity during and following the treatment program represented different opposites: "pain and pleasure," "desire and duty," and "bubble and battle." We summarized the findings into one overall theme: "the ambivalence of attending physical activity." The ambivalence is experienced as a shift in how participants experience physical activity during the intervention period and as an ongoing, dynamic, and constantly shifting experience during such activity. To address and reflect upon such experiences with the participants, and acknowledge ambivalence as a legitimate part of being physically active, might be important within obesity treatment.

Translating weight loss into agency: Men's experiences 5 years after bariatric surgery

Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences.

"They think surgery is just a quick fix"

Background

To prevent weight regain, patients undergoing weight loss surgery are encouraged to change their exercise and dietary habits. Building on previous research, the aim of this study was to explore women's experiences of changing exercise habits – focusing on women participating in a group based rehabilitation program including surgical as well as non-surgical participants.

Findings

Based on interviews with the 11 women included in this study, as well as participant observation, two themes were identified; 1) Pushing ones tolerance limits, and 2) Rebutting the “quick fix” fallacy. Taken together, the findings showcase how being a part of this mixed group involved having to relate to social stigmas, as well as notions regarding successful and non-successful surgical outcomes. Although such notions may be useful in identifying potential challenges related to changing exercise habits, they do not illuminate the complexity of undergoing such changes following weight loss surgery.

Conclusion

The findings point to the need of acknowledging patients' own exceriences to determine how successful they are after surgery. Given the findings, I argue for the need to reconsider the notion of success in relation to group based interventions.