Decision making in patients choosing to undergo bariatric surgery

Background Worldwide increases in obesity present significant health and socio-economic challenges with weight loss strategies of dieting and exercise appearing to have minimal impact. Concomitantly, the choice to have bariatric surgery is becoming more prevalent, although little is known about how and why people choose this option to address their obesity issues. Aim To explore and understand the experiences involved in the decision making of the obese person choosing to have bariatric surgery so as to better inform the support required for those seeking a surgical option. Method The study design used an interpretive methodology within the qualitative paradigm to investigate the obese person’s values, attitudes and beliefs in shaping their decision to have bariatric surgery. Eight English speaking participants, having had either laparoscopic gastric band, laparoscopic sleeve gastrectomy or roux-en Y surgery, were recruited via an Australian facebook site to participate in a phone interview and provide online demographic and genogram data. Data was analysed using thematic analysis. The Health Belief Model (HBM) provided a lens through which data was collected and analysed with the supposition that individuals are understood as being able to process information, and with this cognitive understanding then decide what behaviours they wish to undertake to effect change. Findings The participants, aged between 28 and 58 years, reported struggling with their weight either since adolescence (n=5) or following childbirth (n=3). Most (n=7) had identified the internet, inclusive of social forums, as their primary information source when deciding to have surgery. Most participants (n=7) within this study autonomously decided to opt for bariatric surgery prior to consultation with a health professional, the majority of participants (n=7) also having already decided the actual bariatric procedure prior their surgical consult. Five themes were identified from the analysis of the qualitative data, ‘standing outside the circle’, ‘finding obesity all-consuming’, ‘struggling to live life’, ‘travelling the road to surgery’ and lastly ‘the good, the bad and the unsightly’. These themes identify the emotional and health roller coaster that the obese individual experienced in trying to achieve weight loss and the factors that lead to the decision to opt for a surgical procedure to ensure that their weight loss would be sustained. Conclusion Areas identified as needing further attention include: (i) the provision of information sources and patient supports that are altruistic, valid and reliable, inclusive of current data regarding bariatric surgery and efficacy (ii) design of public health promotions and support that target prevention and early treatment of obesity in high risk groups, and (iii) a comprehensive investigation into the economic costs and funding arrangements for bariatric surgery and follow up care, addressing the disparity of individuals who are uninsured