Academic journal article American Journal of Health Education

A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program

Academic journal article American Journal of Health Education

A Qualitative Assessment of the My True Body Bariatric Surgery Preparation Program

Article excerpt

Background: The My True Body (MTB) group intervention incorporates cognitive restructuring and social support into bariatric surgery preparation. Purpose: To identify and describe program components that support long-term behavioral modifications and influence confidence in healthy weight maintenance. Methods: Semistructured telephone interviews exploring motivations for participation, advantages, disadvantages, and differentiating characteristics of MTB were conducted among participants who completed MTB between March 2010 and December 2011. Qualitative data analysis was performed to identify emergent themes. Results: Four primary themes emerged: (1) the value of interpersonal support and shared experiences, (2) possibilities for psychological transformations, (3) MTB's philosophy as an alternative to dieting, and (4) increased capacity for healthy weight maintenance. All study participants identified at least one psychosocial benefit. Key cognitive benefits included clarified motivations for weight loss surgery and changed attitudes toward food and eating. Discussion: Support and shared experiences and adoption of MTB's philosophical orientation provide pathways to psychological transformation; such transformation appears to be prerequisite to increasing capacity for healthy weight maintenance through increased self-efficacy. Translation to Health Education Practice: Integrating psychological self-exploration, social support, and behavior modification training into presurgical education might enhance weight loss and stress management, with or without bariatric surgery, among obese individuals.

BACKGROUND

Obesity continues to be an important and confounding public health issue in the United States. Between 1988-1994 and 2005-2008, the nationwide obesity prevalence rose from 23% to 34%, demonstrating a significant shift away from the Healthy People 2010 target of 15%. (1,2) Though increases in obesity prevalence appear to be leveling off, (3) more than one third of US adults are classified as obese and more than 15% have a body mass index (BMI) of 35 kg/[m.sup.2] or greater. (3) Further, recent findings suggested that excess mortality occurs at greater levels of obesity (BMI of 35 kg/[m.sup/2] or greater) compared to grade 1 obesity (BMI of 30kg/[m.sup.2] to < 35kg/[m.sup.2]), overweight (BMI of 25 kg/[m.sup.2] to < 30 kg/[m.sup.2]), and normal weight status (BMI of 18.5 kg/[m.sup.2] to < 25 kg/[m.sup.2)]

The National Institutes of Health identified 5 primary evidence-based approaches to treating obesity, supported by the current body of literature:

1. dietary modification (e.g., caloric and fat restriction) (5-7);

2. increased physical activity (5,6,8);

3. behavioral therapy, including self-monitoring, stress management, stimulus control, problem solving, contingency management, cognitive restructuring, and social support (5,6,8);

4. medication (5,6,8-10); and

5. surgical procedures. (5,6,11)

A combination of the first 3 methods is appropriate throughout the spectrum of obesity treatment, whereas pharmacotherapy and surgery should be considered only for individuals with greater degrees of obesity when dietary, physical activity, and behavioral treatments fail to achieve adequate weight loss. (5,6) Food and Drug Administration--approved medications for long-term obesity treatment work through effects on appetite and fat absorption, (6,9) though medication therapy does not work for all patients. (6,10) Bariatric (weight loss) surgery is an appropriate option for adults with clinically severe obesity (BMI [greater than or equal] 40 kg/[m.sup.2] or BMI [greater than or equal to] 35 kg/[m.sup.2] with related comorbidities) for whom other treatments have failed. (5,6,11)

Though obesity prevalence in the United States increased by 45% between 1998 and 2008, (1) bariatric surgeries per 100,000 adults increased more than eight-fold in that same period. …

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