Towards an understanding of what changes and how people cope following bariatric surgery
Introduction Bariatric surgery (BS) is currently the most effective treatment for morbid obesity. However, many individuals fail to lose or maintain adequate weight loss. It is a challenge to understand why some individuals can make the required changes following BS and some cannot. Evidence suggests that emotional eating (EE) may be associated with poorer outcome. However, there is as yet no conclusive research or review of the research in this area. Method A systematic review was conducted with the aim to examine how EE relates to BS outcome. This review was complimented by a qualitative research project examining the experiences of individuals following weight loss surgery, with a particular focus on what changes and emotional coping. Results Systematic review results suggest that EE is associated to poorer weight loss following BS. Six superordinate themes emerged from the qualitative research project; Surgery Outcome, Changing Views of the Self, Coping with Emotions, Being Judged Negatively, Being Obese is a Barrier to Living and It’s a Different Addiction. Discussion The overall results suggest that EE is an ongoing issue following bariatric surgery. BS seems to initiate various changes in behaviour, and cognition, together with increased sense of control. However, such changes seem to be attributed to BS, which is suggestive of an underestimation of self efficacy. Perceptions of obesity being the result of an addiction and emphasis on the difficulties associated with losing weight further highlight the issue of reduced self efficacy. This study also highlights that for many, having surgery does not cure all difficulties associated with eating. There are possibly underlying difficulties associated with obesity, such as neurocircuitry pathways that increase desire for food, whilst reducing control and attachment difficulties that reduce emotion regulation capacity. However, much work is required to understand such explanations and develop appropriate psychological interventions. Conclusion The overall results from this thesis provide support for the view that EE and associated emotion regulation difficulties are related to poorer BS outcome. What seems clear from this research is that, although BS provides many positive changes, the battle against obesity continues for most and services are currently limited in their resources to intervene.