Background

Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity and related co-morbidities. However, despite high US prevalence rates of severe obesity and related comorbidities, especially among ethnic minority groups, only 50% of referred patients complete MBS. Therefore, the purpose of this qualitative study was to gain a deeper understanding of the (1) determinants of; and (2) barriers to successful MBS completion; and (3) role of social support in the MBS decision process.

Methods

A qualitative study was conducted (2019) among 24 ethnically diverse (non-Hispanic black and white, Hispanic, multi-ethnic) MBS patients (75% female) and 7 social support members (57% female). Iterative analysis was conducted via Dedoose software until no new concepts emerged and the resulting themes were saturated.

Results

Barriers among MBS completers included fears about the possibility of death during MBS, and uncertainty about their ability to adhere to dietary modifications post-MBS. Facilitators included co-morbidity resolution and increased mobility. Social support members expressed concerns about (1) safety of MBS; (2) post-MBS chronic conditions and medication regimen management. However, social support network members provided post-MBS emotional and physical support and altered their eating behavior to accommodate the dietary restrictions to support the patient.

Conclusions

Family and social support was specifically identified as being a critical determinant of successful MBS completion, and adoption to post-operative lifestyle changes. Conversely, judgement of MBS consideration by family/friends was a barrier. This information can inform future interventions targeting severely obese adults who would benefit from MBS, and their social support networks.