Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 8/2020

01-08-2020 | Sleeve Gastrectomy | Original Contributions

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

Authors: Yang Yu, Lora E. Burke, Qiwei Shen, Christopher C. Imes, Ran Sun, Susan Groth, Wen Zhang, Melissa A. Kalarchian

Published in: Obesity Surgery | Issue 8/2020

Login to get access

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.
Literature
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.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
4.
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedPubMedCentralCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.CrossRef
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.
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.PubMedCrossRef
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.PubMedPubMedCentralCrossRef
17.
Al-Najim W, Docherty NG, le Roux CW. Food intake and eating behavior after bariatric surgery. Physiol Rev. 2018;98(3):1113–41.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
20.
Nance K, Acevedo MB, Pepino MY. Changes in taste function and ingestive behavior following bariatric surgery. Appetite. 2020;146:104423.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
23.
Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy-a systematic review. Obes Surg. 2016;26(6):1326–34.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedPubMedCentralCrossRef
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.PubMed
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.PubMedPubMedCentralCrossRef
34.
Ma G. Food, eating behavior, and culture in Chinese society. J Ethn Foods. 2015;2:195–9.CrossRef
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.PubMedPubMedCentralCrossRef
36.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
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.PubMedPubMedCentralCrossRef
38.
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedPubMedCentralCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
44.
Ogden J, Avenell S, Ellis G. Negotiating control: patients’ experiences of unsuccessful weight-loss surgery. Psychol Health. 2011;26(7):949–64.PubMedCrossRef
45.
Knutsen IR, Terragni L, Foss C. Empowerment and bariatric surgery: negotiations of credibility and control. Qual Health Res. 2013;23(1):66–77.PubMedCrossRef
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.CrossRef
47.
Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49(3):182–5.CrossRef
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.PubMedPubMedCentralCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedPubMedCentralCrossRef
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.PubMedPubMedCentralCrossRef
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 passimCrossRef
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.PubMedCrossRef
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.PubMedPubMedCentralCrossRef
Metadata
Title
A Qualitative Exploration of Patients’ Experiences with Lifestyle Changes After Sleeve Gastrectomy in China
Authors
Yang Yu
Lora E. Burke
Qiwei Shen
Christopher C. Imes
Ran Sun
Susan Groth
Wen Zhang
Melissa A. Kalarchian
Publication date
01-08-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04653-7

Other articles of this Issue 8/2020

Obesity Surgery 8/2020 Go to the issue

Correction

Correction to: Preoperative Upper-GI Endoscopy Prior to Bariatric Surgery: Essential or Optional?

Original Contributions

Sleeve Gastrectomy Attenuates Diabetic Nephropathy by Upregulating Nephrin Expressions in Diabetic Obese Rats

Original Contributions

Outcomes of Duodenal Switch with a Moderate Common Channel Length and Roux-en-y Gastric Bypass: Does One Pose More Risk?

Original Contributions

Body Composition, Serum Sclerostin and Physical Function After Bariatric Surgery: Performance of Dual-Energy X-ray Absorptiometry and Multifrequency Bioelectrical Impedance Analysis

Letter to the Editor

The Impact of COVID-19 Pandemic on Obesity and Bariatric Surgery

Brief Communication

An Effective Way to Treat Hyperammonemic Encephalopathy Complicated Post-Distal Roux-en-Y Gastric Bypass Surgery