Bariatric Surgery Recipients' Needs and Perspectives on Maintaining Long-Term Health and Well-Being

Barriers to and enablers of modifying diet after metabolic bariatric surgery: A systematic review of published literature

This is a qualitative systematic review in which we investigated barriers and enablers influencing dietary behavior change after metabolic bariatric surgery (MBS). Database searches retrieved publications reporting perceived factors influencing dietary behavior change post-MBS. Data (quotes, survey results, interpretative summaries) were extracted and analyzed using combined deductive and inductive thematic analyses. The generated barrier/enabler themes mapped to the Theoretical Domains Framework and then behavior change techniques to identify potential strategies to improve post-operative dietary behavior. Thirty-four publications were included. Key barriers fell within the domains of 'Environmental Context and Resources' (e.g., insufficient and unreliable healthcare services), 'Behavioral Regulation' (e.g., lack of self-discipline), 'Emotions' (e.g., eating as a strategy to overcome negative emotions), 'Beliefs about Consequences' (e.g., the extent of realistic expectations from MBS), and 'Social Influences' (e.g., challenge of eating at social events). Key enablers were also identified within 'Environmental Context and Resources' (e.g. self-access internet-based resources), 'Behavioral Regulation' (e.g. learning how to develop new dietary strategies), 'Beliefs about Consequences' (e.g., positive impacts of surgery-induced food intolerances), and 'Social Influences' (e.g., support from social/group sessions). Potential strategies to change postoperative dietary behavior include social support, problem-solving, goal setting, and self-monitoring of behavior. This provides insight into the targets for future post-operative nutrition-focused interventions.

Primary care practitioner and patient perspectives on care following bariatric surgery: A meta-synthesis of qualitative research

Primary care is central to ongoing health care following bariatric surgery and patients indicate a preference for receiving follow-up support by their primary care practitioner (PCP). This meta-synthesis investigates the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs. The aim was to synthesize themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings. Systematic searches of Scopus, Medline, EMBASE, PsycINFO, the Cochrane Library, and Google Scholar resulted in the inclusion of eight papers in the meta-synthesis. Papers were critiqued using the Critical Appraisal Skills Program (CASP) and thematically coded in Quirkos Cloud. Seven themes were reached by author consensus including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery. PCPs reported barriers including poor communication and guidance from bariatric surgery centers, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy. Patients seek comprehensive care from their PCP, however, barriers hindering the provision of this care include adverse surgical outcomes, a poor relationship with their PCP, and limited and short-term follow-up care from the PCP. Insights from this meta-synthesis offer actionable recommendations for PCPs and bariatric surgery centers to enhance patient care immediately.

Can a brief assessment of social support predict outcomes after bariatric surgery?

Social support is important to optimize bariatric surgery outcomes, but limited tools exist for brief and effective assessment preoperatively. The aims of the study were to determine the extent to which two ratings of social support can predict bariatric surgery outcomes, and to examine any associations between these two methods.In this retrospective study, patients were included for whom the Cleveland clinic behavioral rating system (CCBRS) and Flanagan quality of life scale (FQoLS) scores were obtained as part of their preoperative psychosocial evaluation. They were followed up for 6 to 24 months after bariatric surgery. Linear and logistic regressions were performed with patients' CCBRS and FQoLS scores as independent variables, and percent excess weight loss (%EWL), length of stay (LOS), complications, readmissions and loss to follow-up as dependent variables. The prediction of CCBRS ratings from FQoLS social support items was also evaluated. A total of 415 patients were included in the analysis. There were significant associations between the CCBRS and three of the four relevant FQoLS self-ratings. As CCBRS and FQoLS scores increased, complications decreased significantly. The CCBRS alone additionally predicted decreased length of hospital stay and approached significance for predicting decreased readmission rates. There were no associations between %EWL and behavior ratings. The degree of patients' social support is associated with important bariatric surgery outcomes. It is possible to obtain this valuable information via the administration of brief assessments prior to bariatric surgery.

Facebook groups provide effective social support to patients after bariatric surgery

BACKGROUND

Social support after bariatric surgery is considered essential. Unfortunately, patient participation in such groups tends to be limited threatening their effectiveness. Facebook groups may provide a social support option that attracts more participation. The aim of this study was to describe our experience with the administration of a Facebook social support group and evaluate its perceived value by our bariatric patients.

METHODS

After IRB approval, all Facebook group posts since its establishment in 2015 were reviewed and a thematic analysis was undertaken. Group members also completed a survey related to their Facebook group experience and its perceived value. Responses were collected using 5-point Likert scales. In addition, 30 members were phone interviewed using open-ended questions and their responses were analyzed.

RESULTS

Over 4 years, the group accumulated 12,507 posts, 104,053 comments, and 197,594 reactions. On average, members check the group page more than once per day. Ten common themes were identified in the submitted posts: questions, motivation related, education related, diet related, physical activity related, current status updates, sharing failures, social, random/humorous and other. Members reported that the group helped them do well with their procedure (3.3/5) particularly due to the motivation of others' successful stories (3.5/5) and made them feel understood (3.9/5) even though it offered limited help controlling their eating habits (2.7/5). The phone interviews suggested that the Facebook group offered constant support, was simple to use, and provided the sole social support for many patients. They most appreciated the motivational posts that kept them on track and the assistance/comments of clinical staff. In contrast, they disliked repeated questions/spam and negative stories shared by some members.

CONCLUSIONS

Facebook groups can provide effective social support to patients after bariatric surgery. Peers educate, answer questions, and motivate patients by sharing their positive experiences. Whether this online connectedness also positively impacts patient outcomes requires further study.