title: Patient experiences of a bariatric group programme for managing obesity: A qualitative interview study.
abstract: OBJECTIVE
  People with obesity experience a range of physical and psychological ill-health outcomes. This study examined patients' experiences of a group-based programme for the management of morbid obesity delivered within the UK National Health Service. The focus of the study was on the emerging dynamic of the group and patients' perceptions of its impact on health outcomes.
  
  
  METHODS
  A qualitative interview study was conducted and involved patients recruited from a Tier 3 bariatric service in South West England. Verbatim transcripts were analysed using thematic analysis.
  
  
  METHODS
  Twenty patients (12 females) with a BMI ≥ 35 kg/m2participated in a semi-structured one-to-one interview. Participants had been registered with the bariatric service for at least 6 months. None of the participants had had bariatric surgery.
  
  
  RESULTS
  Most participants felt that they had benefited from participating in the group programme and talked about the group as a resource for lifestyle change. Participants' narratives centred on the emergence of a sense of self based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, was regarded as a key mechanism through which the programme's educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight 'problem' through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change.
  
  
  CONCLUSIONS
  Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients with morbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in group programmes. Statement of contribution What is already known on this subject? Services for people with obesity who require specialist care are often supported by group-based bariatric programmes. There are no specific guidelines for the organization of bariatric groups beyond the recommendation for lifestyle interventions delivered by a multidisciplinary care team. Research with other health conditions suggests that the psychological connections formed between participants in bariatric programmes may play an important role in structuring programme effectiveness. What does this study add? Establishing psychological connections with other patients underpins bariatric patients' group experience. Shared social identity structures behaviour change in patients on bariatric programmes. Nurturing shared social identity should be a core aim of the bariatric care pathway.
authors.affiliation: University of Exeter Medical School, University of Exeter, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Tarrant
authors.affiliation: University of Exeter Medical School, University of Exeter, UK.|School of Psychology, Keele University, UK.
authors.forename: Sammyh S
authors.initials: SS
authors.lastname: Khan
authors.affiliation: School of Health & Life, Aston University, Birmingham, UK.
authors.forename: Claire V
authors.initials: CV
authors.lastname: Farrow
authors.affiliation: University of Exeter Medical School, University of Exeter, UK.
authors.forename: Pooja
authors.initials: P
authors.lastname: Shah
authors.affiliation: University of Exeter Medical School, University of Exeter, UK.|Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Daly
authors.affiliation: University of Exeter Medical School, University of Exeter, UK.
authors.forename: Katarina
authors.initials: K
authors.lastname: Kos
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D049088:Bariatrics; D004035:Diet Therapy; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing; D009767:Obesity, Morbid / Q000628:therapy*; D010353:Patient Education as Topic; D011615:Psychotherapy, Group; D036301:Qualitative Research; D012933:Social Identification; D012944:Social Support; D061217:Weight Reduction Programs
keywords: bariatric care; groups; lifestyle; psychological connections; social identity; support; surgery