An exploration of psychological factors that contribute to weight maintenance after weight loss surgery

Abstract

Research indicates that weight loss surgery (WLS) is the most effective and cost-effective treatment for obesity and weight-related comorbidities. However, twenty percent of individuals who have undergone WLS are not deemed successful. This study explores the subjective experience of individuals who had WLS to determine which factors contribute to weight maintenance after the surgery. In addition, the potential role of specific psychological factors namely locus of control, self-efficacy, sense of coherence and quality of life were investigated with regards to weight maintenance after WLS. A mixed method convergent design was used with purposive and snowball sampling. The qualitative section made use of semi-structured interviews which was analysed using reflexive thematic analysis (N=6). The quantitative section made use of: a biographical questionnaire, the Generalised Self-efficacy Scale (GSE), Rotter’s Locus of Control Scale, Sense of Coherence Scales (SOC-13) and the Impact of Weight on Quality of Life Questionnaire (IWQOL-Lite). The quantitative data was analysed using the Wilcoxon signed-ranked test. chi-square test for independence and the Spearman’s Rho (N=12). Qualitative findings indicated that factors that could contribute to weight maintenance were trepidations, area of residence, active lifestyle, quality of life, pre-operative education and keeping to postoperative requirements. Other factors identified that might impact weight maintenance were unexpected challenges such as discrimination after WLS from medical professionals, relationship breakdown and loneliness. The quantitative results indicated that only locus of control had an association with weight maintenance. Quality of life improved significantly in all domains after WLS. In addition, significant positive correlations were found between sexual functioning and self-esteem; public distress and self-esteem; public distress and sexual life; and work and public distress before WLS. After WLS significant positive correlations were indicated between physical functioning and public distress; work and physical functioning and between work before and after WLS. A significant inverse correlation was further found between locus of control and self-esteem after WLS. A further significant positive correlation was indicated between self-efficacy and sense of coherence. To provide individuals who had WLS the best opportunity to succeed with weight maintenance various strategies should be addressed. The first is thorough pre-operative education which should also include information on possible loneliness after WLS, importance of postoperative requirements and dumping syndrome. On therapeutic level, focus should be on improving quality of life and enhancing intrapersonal strengths, specifically locus of control and self-esteem. In addition, unexpected challenges after WLS such as loneliness, relationship breakdown and the impact of new health-related factors, that might compromise weight maintenance success should be addressed as soon as possible. Sense of coherence and religion should also be considered for therapeutic intervention strategies. Support systems are crucial to successful weight maintenance, which include loved ones, psychologists and support groups. An active lifestyle should be encouraged as it contributes to weight maintenance and acts as an effective coping mechanism. Geographic area of residence was also identified to facilitate weight maintenance. It is suggested that these area characteristics should be investigated and replicated by the various WLS centres and support groups.