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A Qualitative Exploration of Patients’ Experiences with Lifestyle Changes After Sleeve Gastrectomy in China

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Abstract

Purpose

Sleeve gastrectomy (SG) is the most widely used surgical treatment for severe obesity worldwide. Individuals who have undergone SG usually need to change lifestyle behaviors as a response to the anatomical changes imposed by SG, and patients need to sustain lifestyle changes for long-term surgical success. Little is known about how patients experience and manage lifestyle changes following SG. In China, where SG comprises over 70% of bariatric surgical procedures, there have been no reports addressing this issue. This study aimed to describe individuals’ experiences related to lifestyle changes after SG in China.

Materials and Methods

Semi-structured interviews were conducted at the Shanghai Huashan Hospital in China with adults who had undergone SG between 2012 and 2018. Two independent researchers used an interpretive thematic approach to analyze transcripts for themes and sub-themes.

Results

Interviews (N = 15) revealed three major themes of participants’ experiences with postoperative lifestyle changes: advantages outweigh disadvantages; developing self-management strategies (i.e., adopting new behaviors and developing habits, continuing self-monitoring, focusing on health over weight, staying determined); and experiencing culture-specific difficulties in adherence to follow-up visits and lifestyle recommendations.

Conclusion

The data from this study provided a rich description of the postoperative experiences of patients in China. Participants reported that surgical benefits supersede the surgery-related side effects, and participants were able to develop self-management strategies in order to achieve success. However, personal and social barriers, such as the challenges of applying postoperative dietary guidelines into daily practice, may impede patients making and sustaining recommended behavioral changes.

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References

  1. NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96.

    Article  Google Scholar 

  2. Clapp B, Wynn M, Martyn C, et al. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis. 2018;14(6):741–7.

    Article  PubMed  Google Scholar 

  3. Yang K, Zhou Y, Wang M, et al. Status of the field of bariatric surgery: a national survey of China in 2018. Obes Surg. 2019;29(6):1911–21.

    Article  PubMed  Google Scholar 

  4. American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011-2018. 2018; Available at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed January 30, 2020.

  5. Kim JJ, Rogers AM, Ballem N, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis. 2016;12(5):955–9.

    Article  PubMed  Google Scholar 

  6. Tewksbury C, Wu J, Allison KC, et al. Prebariatric surgery care and postoperative outcomes: increased number of visits associated with smaller weight losses over first 2 postoperative years. Surg Obes Relat Dis. 2019;15(9):1548–53.

    Article  PubMed  Google Scholar 

  7. Kalarchian MA, Marcus MD, Courcoulas AP, et al. Preoperative lifestyle intervention in bariatric surgery: a randomized clinical trial. Surg Obes Relat Dis. 2016;12(1):180–7.

    Article  PubMed  Google Scholar 

  8. Tewksbury C, Williams NN, Dumon KR, et al. Preoperative medical weight management in bariatric surgery: a review and reconsideration. Obes Surg. 2017;27(1):208–14.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis. 2016;12(4):731–49.

    Article  PubMed  Google Scholar 

  10. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175–247.

    Article  PubMed  Google Scholar 

  11. Du X, Dai R, Zhou HX, et al. Bariatric surgery in China: how is this new concept going? Obes Surg. 2016;26(12):2906–12.

    Article  PubMed  Google Scholar 

  12. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94.

    Article  PubMed  Google Scholar 

  13. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.

    Article  Google Scholar 

  14. Liu J, Zheng C. Obesity and type 2 diabetes surgical treatment guideline (2014) (in Chinese language). Chinese J of Prac Surg. 2014;34(11):1005–10.

    Google Scholar 

  15. Liang H, Liu Y, Miao Y, et al. The effect of socioeconomic and individual factors on acceptance levels of bariatric surgery among Chinese patients. Surg Obes Relat Dis. 2014;10(2):361–5.

    Article  PubMed  Google Scholar 

  16. Tang S, Yu S, Wang C, et al. Factors influence the acceptance of surgical treatment in Chinese bariatric surgery candidates. Obes Surg. 2018;28(9):2767–73.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Al-Najim W, Docherty NG, le Roux CW. Food intake and eating behavior after bariatric surgery. Physiol Rev. 2018;98(3):1113–41.

    Article  CAS  PubMed  Google Scholar 

  18. Celio A, Bayouth L, Burruss MB, et al. Prospective assessment of postoperative nausea early after bariatric surgery. Obes Surg. 2019;29(3):858–61.

    Article  PubMed  Google Scholar 

  19. Sun W, Zhang Y, Shen Q, et al. Prevalence and risk factors for symptoms suggestive of hypoglycemia and early dumping syndrome after sleeve gastrectomy. Surg Obes Relat Dis. 2019;15(9):1439–46.

    Article  PubMed  Google Scholar 

  20. Nance K, Acevedo MB, Pepino MY. Changes in taste function and ingestive behavior following bariatric surgery. Appetite. 2020;146:104423.

    Article  PubMed  Google Scholar 

  21. Braghetto I, Cortes C, Herquinigo D, et al. Evaluation of the radiological gastric capacity and evolution of the BMI 2-3 years after sleeve gastrectomy. Obes Surg. 2009;19(9):1262–9.

    Article  PubMed  Google Scholar 

  22. Vinolas H, Barnetche T, Ferrandi G, et al. Oral hydration, food intake, and nutritional status before and after bariatric surgery. Obes Surg. 2019;29(9):2896–903.

    Article  PubMed  Google Scholar 

  23. Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy-a systematic review. Obes Surg. 2016;26(6):1326–34.

    Article  PubMed  Google Scholar 

  24. Vidal P, Ramon JM, Goday A, et al. Lack of adherence to follow-up visits after bariatric surgery: reasons and outcome. Obes Surg. 2014;24(2):179–83.

    Article  PubMed  Google Scholar 

  25. Schiavo L, Scalera G, Pilone V, et al. Patient adherence in following a prescribed diet and micronutrient supplements after laparoscopic sleeve gastrectomy: our experience during 1 year of follow-up. J Hum Nutr Diet. 2017;30(1):98–104.

    Article  CAS  PubMed  Google Scholar 

  26. Ouellette KA, Mabey JG, Eisenman PA, et al. Physical activity patterns among individuals before and soon after bariatric surgery. Obes Surg. 2020;30(2):416–22.

    Article  PubMed  Google Scholar 

  27. Liebl L, Barnason S, Brage HD. Awakening: a qualitative study on maintaining weight loss after bariatric surgery. J Clin Nurs. 2016;25(7–8):951–61.

    Article  PubMed  Google Scholar 

  28. Opozda M, Wittert G, Chur-Hansen A. Patients’ expectations and experiences of eating behaviour change after bariatric procedures. Clin Obes. 2018;8(5):355–65.

    Article  CAS  PubMed  Google Scholar 

  29. da Silva SS, Maia AC. Patients’ experiences after bariatric surgery: a qualitative study at 12-month follow-up. Clin Obes. 2013;3(6):185–93.

    Article  PubMed  Google Scholar 

  30. Lin HC, Tsao LI. Living with my small stomach: the experiences of post-bariatric surgery patients within 1 year after discharge. J Clin Nurs. 2018;27(23–24):4279–89.

    Article  PubMed  Google Scholar 

  31. Han S, Agostini G, Brewis AA, et al. Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery. BMC Obes. 2018;5(1):18.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Abiles V, Abiles J, Rodriguez-Ruiz S, et al. Effectiveness of cognitive behavioral therapy on weight loss after two years of bariatric surgery in morbidly obese patients. Nutr Hosp. 2013;28(4):1109–14.

    CAS  PubMed  Google Scholar 

  33. 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(5):547–59.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ma G. Food, eating behavior, and culture in Chinese society. J Ethn Foods. 2015;2:195–9.

    Article  Google Scholar 

  35. Zang J, Ng SW. Age, period and cohort effects on adult physical activity levels from 1991 to 2011 in China. Int J Behav Nutr Phys Act. 2016;13:40–52.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  37. Sarwer DB, Wadden TA, Spitzer JC, et al. 4-year changes in sex hormones, sexual functioning, and psychosocial status in women who underwent bariatric surgery. Obes Surg. 2018;28(4):892–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ivezaj V, Grilo CM. The complexity of body image following bariatric surgery: a systematic review of the literature. Obes Rev. 2018;19(8):1116–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Perdue TO, Schreier A, Swanson M, et al. Evolving self view and body image concerns in female postoperative bariatric surgery patients. J Clin Nurs. 2018;27(21–22):4018–27.

    Article  PubMed  Google Scholar 

  40. Sarwer DB, Steffen KJ. Quality of life, body image and sexual functioning in bariatric surgery patients. Eur Eat Disord Rev. 2015;23(6):504–8.

    Article  PubMed  Google Scholar 

  41. Pearl RL, Wadden TA, Walton K, et al. Health and appearance: factors motivating the decision to seek bariatric surgery. Surg Obes Relat Dis. 2019;15(4):636–42.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Chang SH, Freeman NLB, Lee JA, et al. Early major complications after bariatric surgery in the USA, 2003-2014: a systematic review and meta-analysis. Obes Rev. 2018;19(4):529–37.

    Article  PubMed  Google Scholar 

  43. Chou JJ, Lee WJ, Almalki O, et al. Dietary intake and weight changes 5 years after laparoscopic sleeve gastrectomy. Obes Surg. 2017;27(12):3240–6.

    Article  PubMed  Google Scholar 

  44. Ogden J, Avenell S, Ellis G. Negotiating control: patients’ experiences of unsuccessful weight-loss surgery. Psychol Health. 2011;26(7):949–64.

    Article  PubMed  Google Scholar 

  45. Knutsen IR, Terragni L, Foss C. Empowerment and bariatric surgery: negotiations of credibility and control. Qual Health Res. 2013;23(1):66–77.

    Article  PubMed  Google Scholar 

  46. Zheng Y, Klem ML, Sereika SM, et al. Self-weighing in weight management: a systematic literature review. Obesity (Silver Spring). 2015;23(2):256–65.

    Article  Google Scholar 

  47. Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49(3):182–5.

    Article  Google Scholar 

  48. Penney TL, Kirk SF. The health at every size paradigm and obesity: missing empirical evidence may help push the reframing obesity debate forward. Am J Public Health. 2015;105(5):e38–42.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Liu SY, Wong SK, Lam CC, et al. Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese Chinese population. Obes Surg. 2015;25(10):1901–8.

    Article  CAS  PubMed  Google Scholar 

  50. Parretti HM, Hughes CA, Jones LL. ‘The rollercoaster of follow-up care’ after bariatric surgery: a rapid review and qualitative synthesis. Obes Rev. 2019;20(1):88–107.

    Article  CAS  PubMed  Google Scholar 

  51. Wong WCW, Jiang S, Ong JJ, et al. Bridging the gaps between patients and primary care in China: a nationwide representative survey. Ann Fam Med. 2017;15(3):237–45.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Sun J, Lin Q, Zhao P, et al. Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study. BMC Public Health. 2017;17(1):668.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Jin XW, Slomka J, Blixen CE. Cultural and clinical issues in the care of Asian patients. Clev Clin J Med. 2002;69(1):50. 53–4, 56–8 passim

    Article  Google Scholar 

  54. Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258–71.

    Article  PubMed  Google Scholar 

  55. Macniven R, Bauman A, Abouzeid M. A review of population-based prevalence studies of physical activity in adults in the Asia-Pacific region. BMC Public Health. 2012;12:41.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This study was based on Yang Yu’s doctoral dissertation, and it was supported by Jayne F. Wiggins Memorial Scholarship and Sigma Theta Tau Eta Chapter Research Award.

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Authors and Affiliations

  1. Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Victoria Building 3500 Victoria Street, Pittsburgh, PA, 15261, USA

    Yang Yu

  2. School of Nursing & Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Lora E. Burke

  3. Department of Bariatric and Metabolic Surgery, Huashan Hospital, Fudan University, Shanghai, China

    Qiwei Shen & Wen Zhang

  4. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Christopher C. Imes & Ran Sun

  5. School of Nursing, University of Rochester, Rochester, NY, USA

    Susan Groth

  6. School of Nursing, Duquesne University, Pittsburgh, PA, USA

    Melissa A. Kalarchian

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  1. Yang Yu
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  4. Christopher C. Imes
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  5. Ran Sun
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  7. Wen Zhang
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Correspondence to Yang Yu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Yu, Y., Burke, L.E., Shen, Q. et al. A Qualitative Exploration of Patients’ Experiences with Lifestyle Changes After Sleeve Gastrectomy in China. OBES SURG 30, 3127–3134 (2020). https://doi.org/10.1007/s11695-020-04653-7

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