"I don't want them to think that what they said matters": How treatment - seeking adolescents with severe obesity cope with weight-based victimization

"Your own pace, your own path": perspectives of adolescents navigating life after bariatric surgery

INTRODUCTION

Bariatric surgery, an established weight-loss tool, may be offered to some adolescents with severe obesity. However, few studies explore adolescents' postoperative experiences beyond physical and metabolic outcomes and quality-of-life measures.

METHODS

Between 2016 and 2021, 45 semi-structured interviews were conducted with adolescents (16-20 years) at 6 months (N = 15), 12 months (N = 15), and 24 months (N = 15) following bariatric surgery. A deductive thematic analysis framework was applied by two independent coders (Cronbach's α = 0.84). Themes were identified and refined iteratively, and discrepancies were resolved through discussion.

RESULTS

Five major themes emerged related to: (1) weight-loss expectations vs. reality, (2) social landscape, (3) body image, (4) eating and moving, and (5) challenges for long-term success. The pace of and satisfaction with weight loss and side effects was heterogenous among participants, with most changes occurring early and stabilizing by 24 months. Adolescents adapted over time to their new social landscapes (e.g., relationships) and reported improved body image and confidence, yet persistently struggled to reconcile their internal identity with evolving external perceptions and discomfort with new attention. Participants experienced changes to lifestyle routines after surgery (e.g., eating, moving, habits), which introduced distress at 6 months but resolved over time. Life transitions in early adulthood (e.g., moving away, university/college, employment), concurrent with their evolving and increasing autonomy, physical, social, and financial independence, imposed unexpected challenges to postoperative routines and support systems. Participants unanimously reaffirmed that bariatric surgery is a lifelong journey and that they were committed to long-term success.

CONCLUSION

Our findings provide insight into optimizing adolescent selection for bariatric surgery and perioperative support. Specifically, important life transitions during this developmental period impact postoperative experiences and outcomes and adolescents may benefit from postoperative counseling focused on managing weight-loss expectations and adapting to evolving nutritional needs and changing social circumstances.

"I don't want them to think that what they said matters": How treatment - seeking adolescents with severe obesity cope with weight-based victimization

Adolescents with severe obesity are subject to a high prevalence of weight-based victimization that may lead to pervasive mental health symptoms. However, different coping strategies could potentially modulate these psychological consequences. This study aims to explore how treatment-seeking adolescents with severe obesity cope with weight-based victimization. This was a qualitative research study using an interpretive phenomenological analytic approach. One-on-one semi structured interviews were completed with 19 adolescents (63% female) enrolled in a weight management program. The interviews were transcribed and sequentially analysed until data saturation was attained. The majority of participants (89.5%) described being a victim of weight-based victimization and highlighted a significant emotional toll. Two key themes were identified that captured the various coping strategies used by participants. Over half (52.9%) described approach coping strategies where they acted on the source to invoke change by standing up for themselves, helping others in similar situations or becoming a bully themselves. Whilst the majority (94.1%) used avoidant coping strategies such as feigning a strong exterior façade, denial, isolation and self-harm. Nearly half (47.1%) used both strategies. Treatment-seeking adolescents with severe obesity commonly use avoidant coping strategies to deal with weight-based victimization. These strategies are associated with negative mental health outcomes and should be evaluated when counselling adolescents with obesity who have experienced weight-based victimization.