"It's a tool, not a cure": the preoperative teen perspective on bariatric surgery.


Li MK(1), Regina A(2), Strom M(3), Kim MS(4), Philipp-Muller N(5), Hamilton JK(6).
Author information:
(1)Department of Medicine, University of Toronto, Toronto, Canada.
(2)Department of Psychology, The Hospital for Sick Children, Toronto, Canada; Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.
(3)Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.
(4)Department of Family Medicine, McMaster University, Hamilton, Canada.
(5)Department of Psychology, University of Windsor, Windsor, Canada.
(6)Department of Medicine, University of Toronto, Toronto, Canada; Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada. Electronic address: [Email]


BACKGROUND: Bariatric surgery is well established in adults as the most effective tool for sustained weight loss and reduction of obesity-related co-morbidities, and is an emerging option for adolescents in whom conservative approaches have failed. Narratives are vital in understanding the motivating reasons and psychosocial profiles of adolescents considering bariatric surgery during a developmental period of evolving self-concept, body image sensitivity, peer pressure, and increased opportunity for risky behaviors. OBJECTIVES: To explore preoperative adolescent patient perspectives on their decision to pursue bariatric surgery, anticipated physical and psychosocial effects, and preparation process. SETTINGS: The Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada. METHODS: We conducted 14 semi-structured interviews with adolescents (16-18 yr old) 2-4 months before bariatric surgery. A theoretical thematic analysis was conducted with 3 independent reviewers (interrater reliability, Cronbach's α= .81) and conflicts were resolved through discussion. RESULTS: Patients' perspectives are captured in 4 themes: motivation for surgery, effects on health and habits, psychosocial changes, and support systems during preparation. Participants perceived surgery as a tool but not a solution for weight loss. Most were motivated for health and daily functional improvement rather than aesthetic reasons, and some anticipated improved social interactions while maintaining their self-identity. Participants were selective in sharing news of their surgery, and received varying levels of support from families, friends, and healthcare teams. CONCLUSION: Adolescents seem generally prepared for and informed about surgery, with expectations for weight loss and psychosocial improvements, although uncertainty and contradictory thoughts were prevalent. Insights provided by these adolescent patients will help optimize bariatric surgery assessments and support from clinical teams and inform preoperative education for future patients and families.