title: Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis.
abstract: Although bariatric surgery is the most effective treatment for severe and complex obesity, less is known about its psychosocial impact. This systematic review synthesizes qualitative studies investigating the patient perspective of living with the outcomes of surgery. A total of 2,604 records were screened, and 33 studies were included. Data extraction and thematic synthesis yielded three overarching themes: control, normality and ambivalence. These were evident across eight organizing sub-themes describing areas of life impacted by surgery: weight, activities of daily living, physical health, psychological health, social relations, sexual life, body image and eating behaviour and relationship with food. Throughout all these areas, patients were striving for control and normality. Many of the changes experienced were positive and led to feeling more in control and 'normal'. Negative changes were also experienced, as well as changes that were neither positive nor negative but were nonetheless challenging and required adaptation. Thus, participants continued to strive for control and normality in some aspects of their lives for a considerable time, contributing to a sense of ambivalence in accounts of life after surgery. These findings demonstrate the importance of long-term support, particularly psychological and dietary, to help people negotiate these challenges and maintain positive changes achieved after bariatric surgery.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Karen D
authors.identifier: 0000-0003-0510-4290
authors.initials: KD
authors.lastname: Coulman
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: MacKichan
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.|Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Owen-Smith
mesh_terms: D050110:Bariatric Surgery; D006801:Humans; D009765:Obesity / Q000523:psychology* / Q000601:surgery*; D017060:Patient Satisfaction; D016896:Treatment Outcome
keywords: bariatric surgery; patient experience; qualitative; synthesis