Is Pre-operation Social Connectedness Associated with Weight Loss up to 2 Years Post Bariatric Surgery?

The Role of Informal Social Support for Patients Undergoing Bariatric Surgery

BACKGROUND

Bariatric surgery is underutilized as a treatment for metabolic disease and its associated comorbidities. While social support is known to play a crucial role in outcomes following bariatric surgery, little is known about the role of social support prior to surgery, which may impact preparedness for and willingness to undergo surgery. The study's objective was to examine the role of informal social support prior to bariatric surgery, the types of support received, and patient attitudes toward different demonstrations of support.

METHODS

We conducted semi-structured interviews with patients who had previously undergone bariatric surgery (n = 20) from two high-volume bariatric surgery centers. Interviews focused on patient engagement with and attitudes about social support during the preoperative process. Transcripts from each interview were iteratively analyzed through steps informed by deductive and inductive thematic analysis.

RESULTS

Four major themes emerged characterizing social support among patients undergoing bariatric surgery: (1) emotional support, (2) instrumental support, (3) informational support, and (4) self-support. Examples of meaningful support participants received included "cheerleading" (i.e., unconditional encouragement), advice from role models who had previously undergone surgery (e.g., receiving information on the process), shared experiences with loved ones regarding dietary and activity modifications (e.g., exercising with friends), and self-support measures (e.g., seeking therapy).

CONCLUSIONS

A comprehensive understanding of how patients receive informal social support can offer valuable insights for individuals considering surgery. Further, such knowledge may enable providers to effectively counsel patients through the decision-making process and to ensure the establishment of support systems both pre- and post-surgery.

The complexity of obesity-related health problems after bariatric surgery: The patient perspective

Background

Bariatric surgery aims to improve quality of life by means of weight loss. Obesity-related physical and psychological health problems should improve, but long-term data are scarce.

Objectives

To evaluate preoperative physical and mental health problems perceived by the patient and the association with weight loss and quality of life, 5 years after bariatric surgery.

Methods

101 persons (response rate 67%) who had had bariatric surgery an average of 4.6 years before this study completed a written survey on obesity-related physical and psychological health problems and three psychological questionnaires collecting information on eating behavior and quality of life. Over half of the participants (55%) had had a laparoscopic adjustable gastric banding.

Results

Preoperatively reported health problems improved but were not necessarily associated with weight loss. Minimal improvement in tiredness, shame and weight instability were associated with significantly less weight loss. Preoperative type 2 diabetes mellitus (T2D) improved but participants had significantly less weight loss and more dissatisfaction regarding the bariatric trajectory than participants without T2D. Eating concerns, emotional eating and external eating improved but not restrained eating. Compared to the Dutch population reference, most quality of life scores of the participants were lower.

Conclusion

In this analysis, participants did report satisfaction although from a patients' perspective, improvements of weight and health did not necessarily lead to satisfaction regarding the bariatric trajectory. Participants with postoperative reported fatigue and shame as well as participants with preoperative T2D showed significant less weight loss. More long-term research is necessary to close the current knowledge gap.

Social History of Bariatric Surgery: Relationship to Patient and Associations with Postoperative Outcomes

PURPOSE

There is limited research about the prevalence of patients initiating metabolic and bariatric surgery (MBS) who also know someone who had MBS, referred to as having a social history of MBS. Evidence about the specific relationship of these individuals to the patient, how having a social history of MBS is associated with patients' choice of surgical procedure, and how having a social history of MBS is associated with patients' postoperative outcomes can be used to inform future preoperative assessments. The objective was to (a) define the number of people patients knew who had MBS and relationship to patient, (b) assess congruence between those who had MBS with patients' procedure selection, and (c) explore associations between social history of MBS and postoperative outcomes.

MATERIALS AND METHODS

The sample included 123 patients who had MBS in 2021 (83.7% female; 44.7% Sleeve Gastrectomy, 55.3% Gastric Bypass). For up to 5 people, patients provided their relationship and surgical procedure, and completed the Family Assessment Device (FAD). Bivariate analyses assessed congruence in type of procedure, and social history of MBS with complications, readmissions, and %TWL. Three mixed multilevel models were conducted with (1) close friend, (2) coworker, and (3) close family history of MBS including the FAD on change in %TWL over 12 months with surgical procedure as a covariate.

RESULTS

Ninety-one percent of patients knew someone who had MBS, average 2.66±1.45. Patients reported a close friend (56.1%), close family member (43.9%), and coworker (19.5%) who had MBS. Patients with a close family member who had MBS and reported healthy vs impaired family functioning had greater %TWL over 12 months (p=0.016). Patients with a close friend who had MBS had less %TWL (p=0.015), and patients with a coworker who had MBS had greater %TWL (p=0.012), which did not change over time.

CONCLUSION

Patients with coworkers or close family members with healthy family functioning with a history of MBS had more weight loss, whereas those with close friends with a history of MBS had less weight loss.

Sabotage, Collusion, and Being a Feeder: Towards a New Model of Negative Social Support and Its Impact on Weight Management

PURPOSE OF REVIEW

Whilst research indicates the positive impact of social support across a number of health domains, including weight management, not all social support is beneficial.

RECENT FINDINGS

This paper reviews the evidence for both positive and negative social support in the context of behavioural interventions and surgery for obesity. It then presents a new model of negative social support focusing on sabotage ('active and intentional undermining of another person's weight goals'), feeding behaviour ('explicit over feeding of someone when they are not hungry or wishing not to eat'), and collusion ('passive and benign negative social support to avoid conflict') which can be conceptualised within the context of relationships as systems and the mechanisms of homeostasis. There is increasing evidence for the negative impact of social support. This new model could form the basis of further research and the development of interventions for family, friends, and partners to maximise weight loss outcomes.

Social Support for People with Morbid Obesity in a Bariatric Surgery Programme: A Qualitative Descriptive Study

Background-Morbid obesity (MO) is a chronic metabolic disease affecting physical, psychological and social wellbeing. Bariatric surgery is a reliable method for losing weight in the long term, improving the quality of life, body image and social life of people with MO. Current literature recognises the importance of social support in controlling weight and coping with MO. The objective of this study was to describe and understand experiences related to social support for patients with MO included in a bariatric surgery programme. Methods-A qualitative descriptive study, where data collection included thirty-one interviews with people diagnosed with MO involved in a bariatric surgery programme. Results-Three main themes emerged from the analysis: (1) accepting the problem in order to ask for help, (2) the need for close support and (3) professional support: opposing feelings. Conclusions-A partner, family and friends are the key pillars of social support for those with MO included in a bariatric surgery programme. Healthcare professionals gave formal support; the bariatric surgery team provided information, trust and assurance. Nurses provided healthcare 24 h a day, making them the main formal support for people in the bariatric surgery programme.

Impaired Family Functioning Affects 6-Month and 12-Month Postoperative Weight Loss

PURPOSE

Prior cross-sectional research details the high rate of impaired family functioning, a measure of the overall family environment, among adult bariatric surgery patients; however, family functioning has not been explored in relation to adult patient's postoperative outcomes. The objective of this study was to determine how family functioning affects postoperative patient outcomes including readmission rates, early complications, and 6- and 12-month percent total weight loss (%TWL).

MATERIALS AND METHODS

An observational design at a single-academic medical center was employed. The sample comprised 98 patients, living with ≥1 family member, who enrolled in one of two concurrent studies at the Center. Patients were followed from their surgical intake through 12 months postsurgery; family functioning was assessed within 2 months of their date of surgery. Chi-square and independent t tests determined significant associations between family functioning with readmission and complication rates. Average family functioning was an independent variable in multivariate linear regression models to determine significant correlates of %TWL at 6 and 12 months postsurgery. Patient age, race, and insurance status were included as covariates.

RESULTS

Patients with higher impaired family functioning had significantly less %TWL at 6 (p=.004) and 12 months (p=.030). Black patients also had significantly lower %TWL at 6 (p=.003) and 12 months (p=.009).

CONCLUSION

Family functioning and patient race were both correlates of weight loss at 6 months and 12 months. Future research should explore additional family factors as correlates of patient outcomes following bariatric surgery.

Rationale and design of a feasibility and acceptability RCT of romantic partner and support figure attendance during bariatric surgery visits

As US obesity rates increase, more patients, particularly females, are seeking out bariatric surgery. As bariatric surgery patients' social supports have been vastly understudied, clinicians and researchers have limited information about how to include support figures, including romantic partners, in the surgery process. To address this gap in knowledge, we are conducting a four-arm randomized controlled trial to assess the feasibility, acceptability and preliminary efficacy for the inclusion of romantic partners and support figures throughout the bariatric surgery process for a group of 110 women age 18 years or older. Patients will be randomized based upon their cohabitating romantic relationships at baseline. Female patients who have a cohabitating romantic partner will be randomized to one of two arms: partner attended (PA), and partner attended treatment as usual (PA-TU). To provide greater detail about social support during the bariatric process, interested patients (female or male) not in cohabitating romantic relationships will be randomized into support figure attended (SFA) and SFA-TU arms. Four data collection points are planned, including 4-months pre-surgery, 2 weeks pre-surgery, 2 weeks and 2-months post-surgery. Feasibility and acceptability of support figure/partner attendance collected at the final data point. Patients and support figures/partners will complete weight status, health behaviors, support for behavior change and relationship quality assessments at each time point. The rationale, design, theoretical framework, and methodology for the study are described. The results of this study will identify how support figures/partners influence patients’ health behavior change and weight loss, and how relationships change over the surgery process.