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Understanding the Bariatric Patient Perspective in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study



In 2016, the Patient-Centered Outcomes Research Institute funded the National Patient Centered Clinical Research Network (PCORnet) Bariatric Study (PBS). Understanding the experience of postoperative patients was a key component of this study.


Nine focus groups were conducted in Southern California, Louisiana, Pennsylvania, and Ohio and in a national advocacy conference for patients with obesity. Participants were identified and recruited in both clinical and community settings. Focus group transcripts were analyzed using an iterative inductive-deductive approach to identify global overarching themes.


There were 76 focus group participants. Participants were mostly women (81.4%), had primarily undergone gastric sleeve (47.0%), were non-Hispanic white (51.4%), had some college education (44.3%), and made $100,000 annual income or less (65.7%). Qualitative findings included negative reactions patients received from friends, family, and co-workers once they disclosed that they had bariatric surgery to lose weight; and barriers to follow-up care included insurance coverage, emotional and situational challenges, and physical pain limiting mobility.


These findings confirm the other qualitative findings in this area. The approach to bariatric surgery should be expanded to provide long-term comprehensive care that includes in-depth postoperative lifetime monitoring of emotional and physical health.

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  • 16 February 2020

    In the original article the list of author names and affiliations were incorrect


  1. 1.

    Khosravi-Largani M, Nojomi M, Aghili R, et al. Evaluation of all types of metabolic bariatric surgery and its consequences: a systematic review and meta-analysis. Obes Surg. 2019;29:651–90.

  2. 2.

    Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.

  3. 3.

    Gasoyan H, Tajeu G, Halpern MT, et al. Reasons for underutilization of bariatric surgery: the role of insurance benefit design. Surg Obes Relat Dis. 2019;15:146–51.

  4. 4.

    Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310:2416–25.

  5. 5.

    Ortega E, Morinigo R, Flores L, et al. Predictive factors of excess body weight loss 1 year after laparoscopic bariatric surgery. Surg Endosc. 2012;26:1744–50.

  6. 6.

    Aguera Z, Garcia-Ruiz-de-Gordejuala A, Vilarrasa N, et al. Psychological and personality predictors of weight loss and comorbid metabolic changes after bariatric surgery. Eur Eat Disord Rev. 2015;23:509–19.

  7. 7.

    Coleman KJ, Huang YC, Hendee F, et al. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis. 2014;10:396–403.

  8. 8.

    Coleman KJ, Huang YC, Koebnick C, et al. Metabolic syndrome is less likely to resolve in Hispanics and non-Hispanic blacks after bariatric surgery. Ann Surg. 2014;259:279–85.

  9. 9.

    Fisher D, Coleman KJ, Arterburn DE, et al. Mental illness in bariatric surgery: a cohort study from the PORTAL network. Obesity. 2017;25:850–6.

  10. 10.

    Admiraal WM, Celik F, Gerdes VE, et al. Ethnic differences in weight loss and diabetes remission after bariatric surgery: a meta-analysis. Diabetes Care. 2012;35:1951–8.

  11. 11.

    Toussi R, Fujioka K, Coleman KJ. Pre- and postsurgery behavioral compliance, patient health, and postbariatric surgical weight loss. Obesity. 2009;17:996–1002.

  12. 12.

    Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22:70–89.

  13. 13.

    Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2014;8:e299–313.

  14. 14.

    Livhits M, Mercado C, Yermilov I, et al. Exercise following bariatric surgery: systematic review. Obes Surg. 2010;20:657–65.

  15. 15.

    Sheets CS, Peat CM, Berg KC, et al. Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg. 2015;25:330–45.

  16. 16.

    Clark SM, Saules KK, Schuh LM, et al. Associations between relationship stability, relationship quality, and weight loss outcomes among bariatric surgery patients. Eat Behav. 2014;15:670–2.

  17. 17.

    Livhits M, Mercado C, Yermilov I, et al. Patient behaviors associated with weight regain after laparoscopic gastric bypass. Obes Res Clin Pract. 2011;5:e169–266.

  18. 18.

    Livhits M, Mercado C, Yermilov I, et al. Is social support associated with greater weight loss after bariatric surgery? A systematic review. Obes Rev. 2011;12:142–8.

  19. 19.

    Mitchell JE, Christian NJ, Flum DR, et al. Postoperative behavioral variables and weight change 3 years after bariatric surgery. JAMA Surg. 2016;151:752–7.

  20. 20.

    Toh S, Rasmussen-Torvik LJ, Harmata EE, et al. The national patient-centered clinical research network (PCORnet) bariatric study cohort: rationale, methods and baseline characteristics. JMIR Res Protoc. 2017;6:e222–40.

  21. 21.

    Coulman KD, MacKichan F, Blazeby JM, et al. Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis. Obes Rev. 2017;18:547–59.

  22. 22.

    Successful Focus Groups. In: Morgan DL, editor. Advancing the State of the Art. Newbury Park: Sage Publications, Inc.; 1993.

  23. 23.

    Goodenough W. Describing a culture: description and comparison in cultural anthropology. Cambridge: Cambridge University Press; 1970.

  24. 24.

    Absalom E, Chambers R, Francis S, et al. Sharing our concerns and looking to the future. PLA Notes. 1995;22:5–10.

  25. 25.

    Elder JP, Ayala GX, Harris S. Theories and intervention approaches to health-behavior change in primary care. Am J Prev Med. 1999;17:275–84.

  26. 26.

    Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20:275–90.

  27. 27.

    Wykowski K, Krouse HJ. Self-care predictors for success post-bariatric surgery: a literature review. Gastroenterol Nurs. 2013;36:129–35.

  28. 28.

    Michie S, Abraham C, Whittington C, et al. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28:690–701.

  29. 29.

    Wing RR, Papandonatos G, Fava JL, et al. Maintaining large weight losses: the role of behavioral and psychological factors. J Consult Clin Psychol. 2008;76:1015–21.

  30. 30.

    Wing RR, Tate DF, Gorin AA, et al. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355:1563–71.

  31. 31.

    Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S–5S.

  32. 32.

    Metzgar CJ, Preston AG, Miller DL, et al. Facilitators and barriers to weight loss and weight loss maintenance: a qualitative exploration. J Hum Nutr Diet. 2015;28:593–603.

  33. 33.

    Trainer S, Benjamin T. Elective surgery to save my life: rethinking the “choice” in bariatric surgery. J Adv Nurs. 2016;73:8934–04.

  34. 34.

    Koball AM, Jester DJ, Domoff SE, et al. Examination of bariatric surgery Facebook support groups: a content analysis. Surg Obes Relat Dis. 2017;13:1369–75.

  35. 35.

    Liebl L, Barnason S, Hudson DB. Awakening: a qualitative study on maintaining weight loss after bariatric surgery. J Clin Nurs. 2016;25:951–61.

  36. 36.

    American Society for Metabolic and Bariatric Surgery (ASMBS). About the ASMBS Integrated Health Section. https://asmbs.org/integrated-health/about. Accessed on 7/15/19.

  37. 37.

    Lauti M, Stevenson S, Hill AG, et al. Patient perspectives about follow-up care and weight regain following sleeve gastrectomy. Obes Surg. 2016;26:2724–31.

  38. 38.

    Khorgami Z, Shoar S, Andalib A, et al. Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates. Surg Obes Relat Dis. 2017;13:774–9.

  39. 39.

    American College of Surgeons. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. https://www.facs.org/quality-programs/mbsaqip. Accessed on 7/15/19.

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The PCORnet Study reported in this article was conducted using PCORnet, the National Patient-Centered Clinical Research Network, an initiative funded by the Patient-Centered Outcomes Research Institute (PCORI). The study was funded by PCORI through PCORI Award OBS-1505-30683. The views expressed in this manuscript are solely those of the authors and do not reflect the views of PCORnet or PCORI.

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Correspondence to Karen J. Coleman.

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Informed consent was obtained from all participants in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review boards involved in the study and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Coleman, K.J., Schlundt, D.G., Bonnet, K.R. et al. Understanding the Bariatric Patient Perspective in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study. OBES SURG (2020). https://doi.org/10.1007/s11695-020-04404-8

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  • Qualitative
  • Healthcare