Paper short abstract:

NHS funded bariatric surgery (BS) in England is increasing, as are interventions to support patients. Little research exists about the experience of BS or how pre-operative expectations may influence outcomes. This longitudinal study explored patient's narratives pre and post BS.

Paper long abstract:

Bariatric surgery rates in England have nearly doubled, increasing from 4200 (2008/09) to over 8000 (2012/13) (HSCIC 2014). Many patients access NHS funded surgery via a tiered model consisting of lifestyle intervention through to specialist clinical services to manage complex obesity. The tiered model aims to assess whether patients are physically and psychologically prepared for surgery and manage expectations of the surgery. The narratives of an obese person's journey to bariatric surgery and the experience of life in the first months after surgery are rarely investigated.

This study took a qualitative longitudinal approach using in-depth semi-structured interviews, modified Photovoice techniques and framework analysis. Patients were interviewed pre-surgery (n=18), three months (n=16) and nine months post-surgery (n=15).

The social and emotional burdens of obesity were major motivating factors to patients seeking bariatric surgery. Aspirations included improved health and appearance and feeling 'normal'. Three months post-surgery, most participants were rejoicing in their weight loss, had improved confidence and hoped for a better future. Coping with dietary changes, excess skin and comorbidities were outweighed by positive changes participants experienced. For many, reduced social isolation, increased self-esteem and contentment with appearance and life were evident at nine months. For others, dissatisfaction with the levels of weight loss and health, seemingly impacted on compliance with lifestyle change. The benefit to quality of life was prominent throughout. However the discourse in which participants reframed normality throughout their journey indicates how pre-surgery expectations may not be fully realised.