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Abstract
Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery.Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings.Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis.Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance.Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could enhance dietary adherence, regardless of time since patient's weight-loss surgery.
Highlights
Bariatric surgery is on the rise in the US and globally (Angrisani et al, 2015)
The Food Frequency Questionnaire (FFQ)-DA score indicates that patients reported adhering moderately well to avoiding “forbidden foods/beverages” listed by their dietitians as foods not to consume after surgery (M = 31.2 ± 5.0)
The average disordered Eating Behaviors (DEBS) score shows that post-bariatric surgery patients do not exhibit high disordered eating habits after surgery (M = 8.7 ± 6.1); 16% of 279 cases exhibited high disordered eating habits based on the criteria of 1 SD above the mean DEBS score
Summary
Bariatric surgery is on the rise in the US and globally (Angrisani et al, 2015). The surgery typically triggers massive weight loss, and can immediately and dramatically diminish incidence of morbidities like diabetes (Buchwald and Williams, 2004; Sjöström et al, 2004; Maggard et al, 2005; Dixon et al, 2008; Kalarchian and Marcus, 2015). Long-term success at maintaining weight loss after bariatric surgery is multifactorial; research has shown that one important contributor is the ability to adhere voluntarily to strict dietary guidelines (Elkins et al, 2005; Kalarchian and Marcus, 2015). These include eating very small, regular portions of food, with an emphasis on lean proteins, fluids, and vegetables; and avoiding high fat/sugar foods (Elkins et al, 2005; Weineland et al, 2012).
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