Mood regulation in obesity surgery patients A qualitative study

1. Mood regulation in obesity surgery patients A qualitative study Valerie Todd, David Mcilroy Liverpool John Moores University Background The incidence of obesity surgery performed within the NHS has increased year on year, in line with the rise in severe obesity prevalence in the UK (H. M. Government, 2004). This is considered to be cost effective because obesity surgery has a high degree of clinical efficacy for weight loss and offers a long-term reduction in mortality when compared to traditional weight loss approaches based on diet and exercise (Wilding, 2007). However, the psychological impact of obesity surgery remains largely unknown. This study This project comprises a small element of a larger study exploring the psychological drivers and outcomes of obesity surgery. Preliminary analysis of cross sectional data suggested a trend of post surgical euphoria followed by a period low mood during the 3-9 months following surgery. Diagram illustrating mood fluctuation This mood fluctuation is not unexpected because food has been identified as a preferred mood regulator in obese populations (Byrne, Cooper & Fairburn, 2003) and obesity surgery patients can only eat small amounts of food post-surgery, so cannot use food as a mood regulator. The aim of this study is to explore post-surgical mood fluctuations from the participants perspective and identify the coping mechanisms employed by obesity surgery patients to regulate mood. Results Post-surgical mood fluctuations consistently followed a cycle of euphoria, despair, coping and recovery. Examples of how this cycle manifests in the dialogue are demonstrated in the quotations below. Euphoria “I feel fantastic, there’s no other word for it, I feel fantastic.” “ I was like a kid. It was like Christmas for me. I was like a kid at Christmas.” “I can’t believe it’s actually happened, I've waited years for this surgery and now I’ve had it I’m on top of the world.” “It’s amazing, I’m gonna be thin for the first time in my life and I can’t wait. I’d happily give up the next year so I could be thin now.” Despair “ I feel a bit anxious sometimes, yeah a bit empty.” “I’m mourning for food, I’m really mourning, food was my best friend and I thought it would never leave me.”. “Well the psychological stuff has hit me like a bat out of hell.” “There’s-there’s still an emptiness inside me that needs to be filled, I just feel empty.” “I have a feeling of malaise, just can’t explain it.” “I eat when I’m not happy and when I can’t eat I just don’t know what to do with myself.” Coping “Even if I’m not hungry I will eat because it’s just something I’ve always done, but it really hurts when it stretches, I try to distract myself now to stop me from doing it. Sometimes I vomit.” “I sometimes have to make myself sick and occasionally I don’t get the choice, but I can fit more food in after.” “I like to binge but now the food won’t go into the stomach, so it stays on top and then I have to put my knife and fork down. It helps to go for a walk or have loads of ciggies instead.” “I’ve turned to alcohol instead of food, I binge on alcohol and I could take it or leave it before.” “Ice-cream and chocolate still go down, so that’s what I have when I need to binge.” Recovery “You know, things have changed, life-life’s changed immeasurably, I’m feeling much more confident, feeling happier about myself.” “We’re getting out, we’re doing things, we’re getting out together, and that’s what I wanted, because you know, essentially I wanted to live a life.” “I’m good now, I’m basically happy, I’m pleased I had it done.” “The world’s a brighter place now, that black cloud that was always following me around has finally gone and everything just seems easier somehow. It’s like I’ve spent my whole life in a wheelchair and now I can walk for the first time.” “I’ve existed for years but now I’m living.” • Conclusion • Mood fluctuation in this small cohort appears to be closely related to the time elapsed since surgery. Participants all reported a state of euphoria in the time immediately after surgery, followed by a period of uncertainty during the time that their eating was severely restricted. • This cohort habitually used food to regulate mood, so tested a number of alternative mood regulation behaviours during the post-surgery period when they could only eat very small quantities of food. The alternative mood regulation behaviours were typically but not exclusively orally based, including • smoking • bingeing and purging • consuming foods that melt (chocolate) • consuming alcohol. • Participants reported confidence in their decision to opt for obesity surgery, believing it was the best option available to them at the time, but lamented the lack of post-surgical psychological provision. • Results therefore suggest implications for health psychology in respect of building post-surgical psychological support into health care packages for obesity surgery patients. • For further in-depth discussion of this research project, attend the oral presentation on Friday morning. Alternatively, please contact the first author at v.j.todd@ljmu.ac.uk Pre-surgery Positive mood Post-surgery Low mood Time elapsed since surgery Method A longitudinal qualitative design using thematic analysis of unstructured interviews was employed to establish psychological coping mechanisms used to regulate mood over time. Repeated in-depth unstructured interviews were conducted with eight post–operative obesity surgery patients (2 males, 6 females) over a 2 year period. Interviews took place at 6-9 month intervals. Participantswere recruited from Weight-Loss Surgery Support Groups across Merseyside and were all post-surgery (time elapsed since surgery varied from 1week to 18months at start of project) and had undergone a bariatric surgical procedure (gastric band, roux-en-y or duodenal switch). All participants had, at some point, recorded a BMI >50 kg m². A qualitative broad thematic analysis was carried out on the data, with particular attention paid to mood fluctuation and mood regulation behaviours. References Byrne, S., Cooper, S. & Fairburn, C. (2003). Weight maintenance and relapse in obesity: A qualitative study. International Journal of Obesity, 27, 955-962. Wilding, J.P.H. (2007). Treatment Strategies for Obesity. Obesity Reviews, 8(1), 137-144. Acknowledgements Many thanks to Ken Clare and the members of the Liverpool and Wirral Weight Loss Surgery Support Groups for their participation in this study.