Obesity Surgery

, Volume 22, Issue 11, pp 1714–1722 | Cite as

Obesity and Treatment Meanings in Bariatric Surgery Candidates: A Qualitative Study

  • Susana Sofia Pereira da Silva
  • Ângela da Costa MaiaEmail author
Allied Care



This study used a qualitative approach to comprehend how the morbid obese conceptualize and deal with obesity and obesity treatment, with the particular aim of exploring the expectations and beliefs about the exigencies and the impact of bariatric surgery.


The study population included 30 morbid obese patients (20 women and 10 men) with a mean age of 39.17 years (SD = 8.81) and a mean body mass index of 47.5 (SD = 8.2) (reviewer #2, comment #9) interviewed individually before surgery using open-ended questions. The interviews were audiotaped, transcribed, and then coded according to grounded analysis methodology.


Three main thematic areas emerged from the data: obesity, eating behavior, and treatment. Obesity is described as a stable and hereditary trait. Although participants recognize that personal eating behavior exacerbates this condition, patients see their eating behavior as difficult to change and control. Food seems to be an ever-present dimension and a coping strategy, and to follow an adequate diet plan is described as a huge sacrifice. Bariatric surgery emerges as the only treatment for obesity, and participants highlight this moment as the beginning of a new life where health professionals have the main role. Bariatric surgery candidates see their eating behavior as out of their control, and to commit to its demands is seen as a big sacrifice. For these patients, surgery is understood as a miracle moment that will change their lives without requiring an active role or their participation.


According to these results, it is necessary to validate them with qualitative and quantitative studies (reviewer #2, comment #3); it is necessary to promote a new awareness of the weight loss process and to empower patients before and after bariatric surgery.


Bariatric surgery Grounded theory Morbid obesity Qualitative studies 



Acknowledgement is due to the Foundation for Science and Technology for financial support (SFRH/BD/37069/2007) for the study; to Dra. Aline Fernandes, Dra. Maria Lopes Pereira, and Dr. Maia da Costa, members of the Multidisciplinary Evaluation Team for the Treatment of Obesity; and to the Hospital of Braga for their collaboration.

Conflict of interest

The authors declared that there are no conflicts of interest.


  1. 1.
    Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011;377(9765):557–67.PubMedCrossRefGoogle Scholar
  2. 2.
    Fried M, Hainer V, Basdevant A, et al. Interdisciplinary european guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17(2):260–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Van Gemert W, Severeijins R, Greve J, et al. Psychological functioning of morbidly obese patients after surgical treatment [Internet]. 1998; Available from:
  4. 4.
    Engstrom M, Wiklund M, Olsén M, et al. The meaning of awaiting bariatric surgery due to morbid obesity. Open Nurs J. 2011;5:1–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Makara-Studzińska M, Zaborska A. Obesity and body image. Psychiatr Pol. 2009;43(1):109–14.PubMedGoogle Scholar
  6. 6.
    Fischer S, Chen E, Katterman S, et al. Emotional eating in a morbidly obese bariatric surgery-seeking population. Obes Surg. 2007;17(6):778–84.PubMedCrossRefGoogle Scholar
  7. 7.
    Guerdjikova A, West-Smith L, McElroy S, et al. Emotional eating and emotional eating alternatives in subjects undergoing bariatric surgery. Obes Surg. 2007;17(8):1091–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Heatherton T, Baumeister R. Binge eating as escape from self-awareness. Psychol Bull. 1991;110(1):86–108.PubMedCrossRefGoogle Scholar
  9. 9.
    Troop N. Eating disorders as coping estrategies: a critique. Eur Eat Disord Rev. 1998;6:229–37.CrossRefGoogle Scholar
  10. 10.
    Walfish S, Brown TA. Self-assessed emotional factors contributing to increased weight in presurgical male bariatric patients. Bariatr Nurs Surg Patient Care. 2009;4(1):49–52.CrossRefGoogle Scholar
  11. 11.
    Bocchieri LE, Meana M, Fisher BL. Perceived psychosocial outcomes of gastric bypass surgery: a qualitative study. Obes Surg. 2002;12(6):781–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Petry N, Barry D, Pietrzak R, et al. Overweight and obesity are associated with psychiatric disorders: results from the national epidemiologic survey on alcohol and related conditions. Psychosom Med. 2008;70(3):288–97.PubMedCrossRefGoogle Scholar
  13. 13.
    Ogden J, Clementi C, Aylwin S. The impact of obesity surgery and the paradox of control: a qualitative study. Psychol Heal. 2006;21(2):273.CrossRefGoogle Scholar
  14. 14.
    Ogden J, Clementi C, Aylwin S, et al. Exploring the impact of obesity surgery on patients’ health status: a quantitative and qualitative study. Obes Surg. 2005;15(2):266–72.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaly P, Orellana S, Torrella T, et al. Unrealistic weight loss expectations in candidates for bariatric surgery. Surg Obes Relat Dis. 2008;4(1):6–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Glaser BG. Basics of grounded theory analysis: emergence vs. forcing. Mill Valley, CA: Sociology Pr; 1992.Google Scholar
  17. 17.
    Corbin JM, Strauss AC. Basics of qualitative research: techniques and procedures for developing grounded theory. 3rd ed. Thousand Oaks, CA: Sage Publications, Inc; 2007.Google Scholar
  18. 18.
    Strauss AC, Corbin JM. Basics of qualitative research: grounded theory procedures and techniques. 2nd ed. Thouasnd Oaks, CA: Sage Publications, Inc; 1990.Google Scholar
  19. 19.
    Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research. Chicago, IL: Aldine Transaction; 1967.Google Scholar
  20. 20.
    Richards PL. Handling qualitative data: a practical guide. Second Edition. Thousand Oaks, CA: Sage Publications Ltd; 2009.Google Scholar
  21. 21.
    Jeffery RW, Drewnowski A, Epstein LH, et al. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19(1 Suppl):5–16.PubMedCrossRefGoogle Scholar
  22. 22.
    Kitsantas A. The role of self-regulation strategies and self-efficacy perceptions in successful weight loss maintenance. Psychol Heal. 2000;15(6):811.CrossRefGoogle Scholar
  23. 23.
    Wadden T, Stunkard A. Handbook of obesity treatment. London: The Guildford Press; 2006.Google Scholar
  24. 24.
    Rydén A, Karlsson J, Persson LO, et al. Obesity-related coping and distress and relationship to treatment preference. Br J Clin Psychol. 2001;40(Pt 2):177–88.PubMedCrossRefGoogle Scholar
  25. 25.
    Epstein LH, Paluch R, Coleman KJ. Differences in salivation to repeated food cues in obese and nonobese women. Psychosom Med. 1996;58(2):160–4.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2012

Authors and Affiliations

  • Susana Sofia Pereira da Silva
    • 1
  • Ângela da Costa Maia
    • 2
    • 3
    Email author
  1. 1.Granted by Foundation for Science and Technology (SFRH/BD/37069/2007), Center for Research in Psychology, School of PsychologyUniversity of MinhoBragaPortugal
  2. 2.Center for Research in Psychology, School of PsychologyUniversity of MinhoBragaPortugal
  3. 3.Escola de Psicologia-Campus de Gualtar Universidade do MinhoBragaPortugal

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