A Qualitative Analysis of Post-operative Nutritional Barriers and Useful Dietary Services Reported by Bariatric Surgical Patients.

BACKGROUND: Outcomes studies show many bariatric patients fail to lose optimal weight or regain significant weight post-surgery. One reason for weight regain may be difficulty adhering to the postoperative diet.

METHODS: Cross-sectional survey methodology collected text data on perceived postoperative nutritional barriers and helpful dietary services reported by bariatric patients. Participants were solicited from an online obesity support website, and 440 responses related to perceived barriers and 330 responses regarding postoperative services were examined using inductive content analysis.

RESULTS: Barriers were categorized as being Internal, External, and None. Internal barriers were classified as Psychological, Physiological, and Psychophysiological, with Psychophysiological being the most commonly reported (85.9 %). Helpful services reported included categories of None, Provided, and On their Own. Sixty-two percent of participants reported receiving at least one Provided service that was helpful, including knowledge and support from professionals like registered dietitian nutritionists (RDNs). However, 22 % of participants reported seeking out at least one service On their Own such as through the Internet, and 27 % of participants reported not receiving or not using any helpful services.

CONCLUSIONS: The physiological nature of post-surgical changes and the mental stamina required of positive eating habits contribute to postoperative adherence difficulties. Many patients likely exhibit poor habits pre-surgery, and without added help to change these behaviors may regain weight. Participants in this study indicated that convenient access to an RDN was helpful. Bariatric facilities should include staff well-trained in the specific nutritional barriers patients face and provide availability of staff beyond the initial postoperative phase.