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Råheim M, Moltu C, Natvik E. Living the dream - but not without hardship: stories about self-directed weight transformation from severe obesity. Psychol Health 2024; 39:631-650. [PMID: 35765935 DOI: 10.1080/08870446.2022.2090562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
DESIGN In-depth interviews were conducted with eight women and two men, aged 27 to 59 years, who had carried out self-directed WL from SO for 5 years or more. TWO THEMES RAN ACROSS THE STORIES fear of weight-regain, and food and emotion. We performed a case-based narrative analysis of especially rich interviews that illustrate these. Results pointed to persistently cultivating new competencies, establishing new eating habits, re-establishing old physical-training habits, and forming new relational bonds. Participants reinvented themselves and their lives. However, the stories are not all about transformation, but also about new and old health problems. CONCLUSION The study directs attention to 'different obesities', not only to initial weight from which WL takes place, but also linked to the experiential horizons that the persons embody from childhood on. Furthermore, there was no way back in the present stories, always haunted in the wake of the lost weight. A double burden imposed on the person with obesity related to meta-stories in society deepens the understanding of this imperative: being vulnerable health-wise and exposed to stigmatization.
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Affiliation(s)
- M Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - C Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Center of Health Research, District General Hospital of Førde, Førde, Norway
| | - E Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Center of Health Research, District General Hospital of Førde, Førde, Norway
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. Caregiving for frail home-dwelling older people: A qualitative study of family caregivers' experiences. Int J Older People Nurs 2024; 19:e12586. [PMID: 38009411 DOI: 10.1111/opn.12586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/22/2023] [Accepted: 10/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND The increasing frailty of home-dwelling older people can lead to rising expectations from their family caregivers due to various demographic developments and political guidelines. European data show that 60% of home-dwelling older people receive informal care. Frailty among older people is a state of vulnerability, increasing the risk of adverse health outcomes, declining daily activities and needing long-term care. AIM To explore family caregivers' lived experiences with caring for frail, home-dwelling older people. METHODS We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed nine family caregivers, five men and four women between 52 and 90 years old, in-depth in their homes. We used a hermeneutical phenomenological approach described by van Manen and followed the COREQ checklist. RESULTS The phenomenon's essential meaning is described as striving to adapt throughout the caring relationship. The interrelated themes describe different caring relationships, caring for a family member and letting go of the primary caring responsibility. CONCLUSIONS Family caregivers describe care as meaningful yet demanding. In our study, the varying condition of frailty was an additional challenge in care. By addressing these challenges, healthcare providers can better support and help family caregivers to withstand their caring relationships. The Norwegian Centre for Research Data approved the study (Ref.61202).
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Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eli Natvik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Jorunn Drageset
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Moltu C, Kverme B, Veseth M, Natvik E. How people diagnosed with borderline personality disorder experience relationships to oneself and to others. A qualitative in-depth study. Int J Qual Stud Health Well-being 2023; 18:2152220. [DOI: 10.1080/17482631.2022.2152220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring sciences, Western Norway University of Applied Science, Førde, Norway
| | - Britt Kverme
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Borgestadklinikken, Blue Cross Resource Centre for Substance Dependence Problems, Skien, Norway
| | - Marius Veseth
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Eli Natvik
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring sciences, Western Norway University of Applied Science, Førde, Norway
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Berg KH, Natvik E, Eik-Nes TT. Patient experiences of a 10-weeks weight-neutral treatment program for clinical binge eating disorder in a higher weight population. J Eat Disord 2023; 11:228. [PMID: 38111023 PMCID: PMC10729388 DOI: 10.1186/s40337-023-00955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Weight based stigma might drive the development of both higher weight and binge eating disorder (BED). To improve treatment and outcomes, a deeper understanding of how stigma and shame are correlated in clinical encounters is needed. The current study was designed to gain insight into how participating in a 10-weeks weight-neutral treatment program for patients with binge eating disorder and higher weight was experienced. METHODS Semi-structured interviews were conducted with 10 patients who had completed the BED treatment. The intervention was group based, addressing stigma and shame, using models of attachment and affect regulation in the presentation of BED. Interviews were analyzed guided by van Manen's hermeneutic-phenomenological approach. RESULTS A profound feeling of inferiority due to weight stigma and adverse childhood experiences appeared to have kept the participants stuck in a shame driven carousel of dieting, weight loss, bingeing, and weight regain. Participants and health care professionals' mutual acknowledgement of driving elements of binge eating appeared to support participants feeling more equal. Feeling equal was described as facilitating increased awareness and tolerance of bodily sensations and emotions, and a deeper understanding and self-caring attitude towards themselves. Feeling less shame was described as important for self-disclosure in family relationships, leading to increased understanding and support from others. Simultaneously, unchanged stigmatizing surroundings were described to relate to challenges with eating patterns and weight after end of treatment. CONCLUSION Our findings indicate that relational symmetry, by patients experienced as being met with recognition, compassionate acceptance, and mutual investigation of subjective experience, can contribute to reduction of weight stigma and shame, and the burdensome notion of inferiority experienced by the participants in everyday life, hence improving treatment outcomes. Trail registration The study was approved and registered by the Data Access Committee at Nord-Trøndelag Hospital Trust August 8th, 2019, registration number 2019_2335.
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Affiliation(s)
- Kjersti Hognes Berg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Stjørdal Community Mental Health Centre, Nord-Trøndelag Hospital Trust, Levanger, Norway.
| | - Eli Natvik
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Trine Tetlie Eik-Nes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stjørdal Community Mental Health Centre, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Natvik E, Lavik KO, Ogden J, Strømmen M, Moltu C. The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study. Disabil Rehabil 2023; 45:4440-4449. [PMID: 36484620 DOI: 10.1080/09638288.2022.2152876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The patient-practitioner relationship is fundamental to rehabilitation practice and patients' health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study. MATERIALS AND METHODS We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis. RESULTS We identified relational states and shifts in the clinical encounter 2-3 years post-surgery, described in themes: a) Playing by the Book - Making it Easier for Each Other, b) Down the Blind Alley - Giving up on Each Other, and c) Opposite Poles - Towards and Away from Each Other. CONCLUSIONS The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter's benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.IMPLICATIONS FOR REHABILITATIONIllness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly "notice, name and validate" emotions can promote the patient's capacity to sustain self-care, lifestyle change, weight loss and health gains.Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter.
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Affiliation(s)
- Eli Natvik
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Kristina Osland Lavik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Jane Ogden
- Department of Psychology, University of Surrey, Guildford, England
| | - Magnus Strømmen
- Centre for Obesity Research, Clinic of Surgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness. Int J Qual Stud Health Well-being 2022; 17:2082125. [DOI: 10.1080/17482631.2022.2082125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, NORWAY
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen Faculty of Medicine, BERGEN, Norway
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Bergen, Bergen, Norway
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Solberg Kleiven G, Hjeltnes A, Natvik E, Moltu C. Engaging with difficult topics and emotional experiences in psychotherapy: A study of helpful therapist acts. Psychother Res 2022; 33:428-441. [PMID: 36345614 DOI: 10.1080/10503307.2022.2132889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study was to explore moments during psychotherapy sessions in which clients experience that they have an opportunity to approach and engage with difficult topics and emotional experiences, with the aim of describing therapists' acts that support clients' in-session engagement. METHODS Two treatment sessions of 11 participants were videotaped and immediately followed by an in-depth semi-structured interview, using the interpersonal process recall (IPR) interview method. A follow-up interview was conducted 3 months after the final IPR interview. Participants' accounts were analyzed using thematic analyses. RESULTS Five themes of engagement-supportive acts resulted from our analyses: 1. inviting the client by showing acceptance; 2. recognizing the clients' hints and try-out signs; 3. providing information on the process and evaluating clients' expectations; 4. actively helping the clients to notice and stay with difficult experience and 5. showing sensitivity to the client's needs for micropauses. We discuss these themes as acts of recognition. CONCLUSION Clients found it was engagement-supportive when therapists implicitly and explicitly recognized the challenges of being in psychotherapy. This recognition could be achieved through the engagement-supportive acts described in the five themes. Therapists should continually make space for and seek a balance between different engagement-supportive acts.
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Affiliation(s)
| | - Aslak Hjeltnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Førde, Norway
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Natvik E, Råheim M, Sviland R. The hamster wheel: a case study on embodied narrative identity and overcoming severe obesity. Med Health Care Philos 2021; 24:255-267. [PMID: 33439383 PMCID: PMC8128800 DOI: 10.1007/s11019-021-10002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Based in narrative phenomenology, this article describes an example of how lived time, self and bodily engagement with the social world intertwine, and how our sense of self develops. We explore this through the life story of a woman who lost weight through surgery in the 1970 s and has fought against her own body, food and eating ever since. Our narrative analysis of interviews, reflective notes and email correspondence disentangled two storylines illuminating paradoxes within this long-term weight loss process. Thea's Medical Weight Narrative: From Severely Obese Child to Healthy Adult is her story in context of medicine and obesity treatment and expresses success and control. Thea's Story: The Narrative of Fighting Weight is the experiential story, including concrete examples and quotes, highlighting bodily struggles and the inescapable ambiguity of being and having one's body. The two storylines coexist and illuminate paradoxes within the weight loss surgery narrative, connected to meaningful life events and experiences, eating practices and relationships with important others. Surgery was experienced as lifesaving, yet the surgical transformation did not suffice, because it did not influence appetite or, desire for food in the long run. In the medical narrative of transforming the body by repair, a problematic relationship with food did not fit into the plot.
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Affiliation(s)
- Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway.
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Randi Sviland
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Søvde BE, Sandvoll AM, Natvik E, Drageset J. In the borderland of the body: How home-dwelling older people experience frailty. Scand J Caring Sci 2021; 36:255-264. [PMID: 33939195 DOI: 10.1111/scs.12984] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/14/2021] [Indexed: 01/10/2023]
Abstract
RATIONALE The increasing number of frail home-dwelling older people has sharpened the focus on discovering and implementing suitable treatment and care in clinical practice, aiming to prevent loss of physical functioning and preserve their autonomy and well-being. People's embodied experiences may yield rich descriptions to help to understand frailty. Thoroughly understanding older people's individual perceptions is especially relevant because the numbers of home-dwelling older people are increasing, and people tend to develop more health problems and become frailer as they age. Their perspectives are important to develop knowledge and high-quality care. AIM To explore the lived experiences of frail home-dwelling older people. METHODS We conducted a phenomenological study to obtain in-depth descriptions of the phenomenon. We interviewed 10 home-dwelling older adults (seven women and three men, 72-90 years old) in depth about their lived experience of frailty. We analysed the data using a hermeneutic phenomenological approach described by van Manen. FINDINGS The lived experience of frailty is described in one essential theme: frailty as being in the borderland of the body, including three interrelated subthemes: (1) the body shuts down; (2) living on the edge; and (3) not giving up. CONCLUSIONS Our study gives insight into lived experiences with frailty among home-dwelling older people related to their own body. Older people's experience of meaningful activities strengthened their feeling of being themselves, despite their frail and deteriorating body. Healthcare providers must consider the strategies of frail older people to consider both their vulnerabilities and self-perceived strengths. The resources and deficits of frail older people present in the state of being frail need to be recognised.
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Affiliation(s)
- Bente Egge Søvde
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Marie Sandvoll
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Jorunn Drageset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Ellingsen S, Moi AL, Gjengedal E, Flinterud SI, Natvik E, Råheim M, Sviland R, Sekse RJT. "Finding oneself after critical illness": voices from the remission society. Med Health Care Philos 2021; 24:35-44. [PMID: 33029693 DOI: 10.1007/s11019-020-09979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants' lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants' narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger's concept of homelikeness and Arthur Frank's typologies of illness narratives. In conclusion listening to and acknowledging the patients' lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients' lived experience of critical illness and its aftermaths.
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Affiliation(s)
- S Ellingsen
- Faculty of Health Studies, VID Specialized University, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - A L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
| | - E Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - S I Flinterud
- Centre of Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
| | - E Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - M Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Sviland
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - R J T Sekse
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Pedersen JH, Thornquist E, Natvik E, Råheim M. Physical education classes - a double-edged sword: a qualitative study of Norwegian high-school students' experiences. Physiother Theory Pract 2019; 37:1404-1418. [PMID: 31885299 DOI: 10.1080/09593985.2019.1709232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: The aim of this study was to explore students' experiences of physical education (PE) and to gain insight into what contributes to engaging them in PE.Methods: A total of 316 second-year high-school students from five schools participated by completing a school assignment. The data were analyzed according to content analysis. Findings: Two main themes were developed. The first was One-sided emphasis on performance, bodily skills, and assessment with the corresponding sub-themes: Skills and performance; and Assessment, tests, and grading. The second was Wish for play, respite, co-determination, and togetherness with the sub-themes: Play and spontaneity; Respite, Togetherness and cooperation; and Co-determination and engagement. Our findings reveal a wide range of student experiences with PE classes, from a welcome respite in an otherwise sedentary and theoretically dominated day at school and enjoying being physically active with classmates, to frustration about extensive use of tests, lack of mastery, and feelings of exclusion.Conclusion: To be consistent with the values of the Ministry of Education in Norway, we conclude that the content and mode of delivery of PE in schools would benefit from being rethought if the intent is to facilitate children to stay physically active. Norwegian physiotherapists are promoters of health and physical activity across the lifespan. As part of health services in schools, they are in a prime position to optimize the PE experience for students.
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Affiliation(s)
- Janiche Helen Pedersen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Public Health and Primary Care, City of Bergen, Bergen, Norway
| | - Eline Thornquist
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eli Natvik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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12
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Natvik E, Råheim M, Andersen JR, Moltu C. An Experientially Derived Model of Flexible and Intentional Actions for Weight Loss Maintenance After Severe Obesity. Front Psychol 2019; 10:2503. [PMID: 31798491 PMCID: PMC6863797 DOI: 10.3389/fpsyg.2019.02503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Knowledge about non-surgical weight loss (WL) is scarce among people with severe obesity (SO). Lifestyle changes are primarily self-driven, occasionally accompanied by professional guidance and weight-management support. Weight regain and intervention discontinuation are common challenges among guidance and support programmes. In the current study, we describe a model of meaningful strategies for maintaining WL after SO based on the experiences of successful cases. METHODS Aiming to investigate the experiences of WL and weight loss maintenance (WLM) (≥5 years) following SO, we designed a qualitative study. Ten adults of Norwegian ethnicity, eight women and two men aged from 27 to 59, participated in individual in-depth interviews. We recruited participants living in rural districts and cities across all four regions of Norway. The interviews concentrated on participants' experiences of losing weight and maintaining a lower weight over the long term. The transcripts were analysed with a rigorous method for thematic cross-case analysis, namely, systematic text condensation (STC). RESULTS Participants identified four experiential themes at the core of long-term WLM: (a) Owning the decision, (b) Creating self-reinforcement, (c) Sustaining a lifestyle-forming identity, and (d) Selecting support appropriate to one's own situation. These core themes represent the intentional level, functioning both as the foundation of and the momentum for sustaining WL. On the behavioural level, participants continued to take action for change, obtain results, record and reflect on their efforts and milestones, observe what worked and felt good, and receive recognition from others, thereby realising changes. CONCLUSION Based on these results, we propose a model of WLM after SO, suggesting that practices toward WLM on the behavioural level achieve meaning and sustainability through their relationship with a core intentional level found across participants' experiences. One implication is that the relationship between the intentional and behavioural levels might be more meaningful when discussing long-term WLM than the behaviours themselves.
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Affiliation(s)
- Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Målfrid Råheim
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - John Roger Andersen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Division of Psychiatry, District General Hospital of Førde, Førde, Norway
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Gjengedal E, Sviland R, Moi AL, Ellingsen S, Flinterud SI, Sekse RJT, Natvik E, Råheim M. Patients’ quest for recognition and continuity in health care: time for a new research agenda? Scand J Caring Sci 2019; 33:978-985. [DOI: 10.1111/scs.12696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Eva Gjengedal
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - Randi Sviland
- Department of Health and Functioning Western Norway University of Applied Sciences Bergen Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
- Department of Plastic Surgery and Burn Center Haukeland University Hospital Bergen Norway
| | - Sidsel Ellingsen
- Faculty of Health Studies VID Specialized University Bergen Norway
| | - Stine Irene Flinterud
- Centre of Diaconia and Professional Practice VID Specialized University Bergen Norway
| | - Ragnhild Johanne Tveit Sekse
- Department of Clinical Science University of Bergen Bergen Norway
- Department of Obstetrics and Gynaecology Haukeland University Hospital Bergen Norway
| | - Eli Natvik
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Førde Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
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Eldal K, Veseth M, Natvik E, Davidson L, Skjølberg Å, Gytri D, Moltu C. Contradictory experiences of safety and shame in inpatient mental health practice – a qualitative study. Scand J Caring Sci 2019; 33:791-800. [DOI: 10.1111/scs.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/03/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Kari Eldal
- Department of Health and Care Sciences Western Norway University of Applied Sciences Førde Norway
| | - Marius Veseth
- Department of Clinical Psychology University of Bergen Bergen Norway
| | - Eli Natvik
- Department of Health and Care Sciences Western Norway University of Applied Sciences Førde Norway
| | - Larry Davidson
- Program for Recovery and Community Health School of Medicine and Institution for Social and Policy Studies Yale University New Haven CT USA
| | - Åse Skjølberg
- Department of Health and Care Sciences Western Norway University of Applied Sciences Førde Norway
- Center for Health Research in Sogn og Fjordane District General Hospital of Førde Førde Norway
| | - Dorte Gytri
- Center for Health Research in Sogn og Fjordane District General Hospital of Førde Førde Norway
| | - Christian Moltu
- Department of Health and Care Sciences Western Norway University of Applied Sciences Førde Norway
- Department of Psychiatry District General Hospital of Førde Førde Norway
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15
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Kverme B, Natvik E, Veseth M, Moltu C. Moving Toward Connectedness - A Qualitative Study of Recovery Processes for People With Borderline Personality Disorder. Front Psychol 2019; 10:430. [PMID: 30873097 PMCID: PMC6403141 DOI: 10.3389/fpsyg.2019.00430] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/12/2019] [Indexed: 11/29/2022] Open
Abstract
Borderline personality disorder (BPD) is a mental health disorder estimated to affect 1–2% of the general population. As a group, people with BPD endure a high degree of suffering, often leading to suicide attempts, self-harm, and suicide. Comparatively few studies explore the first person perspective of the person suffering from any mental health disorder. This might be especially problematic for people diagnosed with BPD, as this particular diagnosis is followed by stigma potentially making help seeking harder and helping relationships more vulnerable. We interviewed 12 female participants recently diagnosed with BPD in-depth about their experiences with recovery and treatment, and used a stepwise reflective approach to rigorously analyze the data. Results show an overarching theme of working toward connectedness, with four constituent sub-themes. We discuss the findings with regard to empirical work, recovery and autonomy, and the risk of epistemic injustice that people with BPD risk facing.
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Affiliation(s)
- Britt Kverme
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
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Eldal K, Natvik E, Veseth M, Davidson L, Skjølberg Å, Gytri D, Moltu C. Being recognised as a whole person: A qualitative study of inpatient experience in mental health. Issues Ment Health Nurs 2019; 40:88-96. [PMID: 30845858 DOI: 10.1080/01612840.2018.1524532] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient-professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one's self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance.
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Affiliation(s)
- Kari Eldal
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway
| | - Eli Natvik
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway
| | - Marius Veseth
- b Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | - Larry Davidson
- c Program for Recovery and Community Health, School of Medicine and Institution for Social and Policy Studies , Yale University , New Haven , Connecticut , USA
| | - Åse Skjølberg
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway.,d Center for Health Research in Sogn og Fjordane, District General Hospital of Førde , Førde , Norway
| | - Dorte Gytri
- d Center for Health Research in Sogn og Fjordane, District General Hospital of Førde , Førde , Norway
| | - Christian Moltu
- a Department of Health and Care Sciences , Western Norway University of Applied Sciences , Førde , Norway.,e Department of Psychiatry, District General Hospital of Førde , Førde , Norway
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Albertsen MN, Natvik E, Råheim M. Patients' experiences from basic body awareness therapy in the treatment of binge eating disorder -movement toward health: a phenomenological study. J Eat Disord 2019; 7:36. [PMID: 31641506 PMCID: PMC6802330 DOI: 10.1186/s40337-019-0264-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Binge Eating Disorder (BED) is the most common eating disorder. Patients with BED are often not diagnosed, nor offered adequate specific treatment. A great number of those who receive recommended treatment do not recover over time. More knowledge about central aspects of BED, and treatments that specifically target such aspects is needed. Previous research has linked body experience to the development and maintenance of eating disorders, as well as influencing treatment results and the risk of relapse. The aim of this study was to explore how patients with BED experience Basic Body Awareness Therapy (BBAT), which is a psychomotor physiotherapy treatment addressing body experience. METHOD In this phenomenological study, we interviewed two patients with BED in depth during and after treatment. Video observations of treatment sessions and logs written by the patients were used as supporting data. The analysis was guided by Van Manen's hermeneutic phenomenology. RESULTS A meaning structure was identified: "On the way from the body as a problem to the body as a possibility." The two participants that besides BED also had a history of childhood trauma, perceived BBAT as a process of getting to know their own bodies in new ways, and described that the way they related to their own body changed as did aspects of their way of being. These changes were prominent when the participants described emotions, movement, pain, calmness, and self-experience, and interwoven with relational aspects as well as practices in everyday life. CONCLUSION The present results indicate that BBAT stimulated body experience in a way that opened new possibilities for two participants with BED, and hence that BBAT can improve the health status of BED patients also suffering from childhood trauma.
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Affiliation(s)
- Marit Nilsen Albertsen
- 1Department of Global Health and Primary Care, University of Bergen, Bergen, Norway.,Present address: Department of Eating Disorders, Division of Psychiatry, Haukeland University Hospital, Institute of Psychological Counselling , Bergen, Norway
| | - Eli Natvik
- 3Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Målfrid Råheim
- 4Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
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Abstract
PURPOSE Losing weight and keeping it off for the long term is difficult. Weight regain is common. Experiences of successful non-surgical weight loss after severe obesity are largely unexplored. We know little about long-term weight loss processes, and how health care services can be of help to those living them. METHODS Drawing on in-depth interviews of 8 women and 2 men, the aim of this phenomenological study is to describe the experiences of adults who have been severely obese, who have lost weight and maintained weight loss for the long term (>5 years). RESULTS Findings show that after severe obesity, sustained weight loss has no endpoint, yet is always easy to end. Keeping weight off means committing to oneself, continuing profound changes and cultivating sensitivity towards oneself and others. A phenomenological understanding of sustained weight loss can inform professionals who deal with health issues and challenges occurring in the life of people leaving severe obesity.
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Affiliation(s)
- Eli Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Center for Health Research, District General Hospital of Førde, Førde, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - John Roger Andersen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Center for Health Research, District General Hospital of Førde, Førde, Norway
| | - Christian Moltu
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- Division of Psychiatry, District General Hospital of Førde, Førde, Norway
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Natvik E, Groven KS, Råheim M, Gjengedal E, Gallagher S. Space perception, movement, and insight: attuning to the space of everyday life after major weight loss. Physiother Theory Pract 2018; 35:101-108. [PMID: 29485300 DOI: 10.1080/09593985.2018.1441934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Eli Natvik
- a Faculty of Health Studies, Department of Health and Caring Sciences , Western Norway University of Applied Sciences , Førde , Norway
| | - Karen Synne Groven
- b Faculty of Health, Institute of Physiotherapy , Oslo Metropolitan University, Oslo, Norway
| | - Målfrid Råheim
- c Faculty of Medicine and Dentistry, Department of Global Health and Primary Care , University of Bergen , Bergen, Norway
| | - Eva Gjengedal
- c Faculty of Medicine and Dentistry, Department of Global Health and Primary Care , University of Bergen , Bergen, Norway
| | - Shaun Gallagher
- d Department of Philosophy , University of Memphis , Memphis , TN , USA.,e Faculty of Law, Humanities and the Arts , University of Wollongong , Wollongong , Australia
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Affiliation(s)
- Berit Gjessing
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Beitostolen Helsesportsenter, Beitostolen, Norway
| | - Reidun Birgitta Jahnsen
- Beitostolen Helsesportsenter, Beitostolen, Norway
- Department of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Eli Natvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Sogn og Fjordane University College, Norway, Forde, Norway
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Natvik E. [Obesity in new Norwegian]. Tidsskr Nor Laegeforen 2016; 136:50. [PMID: 26757663 DOI: 10.4045/tidsskr.15.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Natvik E, Gjengedal E, Moltu C, Råheim M. Translating weight loss into agency: Men's experiences 5 years after bariatric surgery. Int J Qual Stud Health Well-being 2015; 10:27729. [PMID: 26066518 PMCID: PMC4462825 DOI: 10.3402/qhw.v10.27729] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Eli Natvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Division of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Abstract
Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life-a part that is not necessarily healed by surgery. Empirical research on patients' experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery.
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Abstract
Bariatric surgery provides sustainable weight loss and increased quality of life for most, but not all patients. To increase the knowledge of this complex patient group and their needs during follow-up, we aimed to describe the essential meaning of bariatric surgery patients' long-term experiences by using a phenomenological lifeworld approach. Eight patients were interviewed between 5 and 7 years after bariatric surgery. Life after bariatric surgery was described as living with tension, ambivalence, and reinforced attention toward one's own body. The tension was related to embodied change and altered relations to the social world. The patients express an ongoing demand for control of health-related habits and practices, and to not lose control over the body again. Surgical weight loss and improved physical function do not necessarily mean changed health-related habits and practices in the long term. Experiencing weight regain is connected with emotional stress, shame, and self-contempt.
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