Hege Friberg had an operation to help her lose weight seven years ago. It changed her life, but not quite in the way she had imagined beforehand. (Photo: private)

Is optimism the key to making weight loss surgery a success?

A new Norwegian study compares people who underwent bariatric surgery with those who tried to lose weight using traditional dieting and exercise. One difference was optimism in the surgery group that they would succeed.

Seven years ago, Hege Friberg lay on an operating table, ready to change her life. She had been obese, but now bariatric surgery offered her a chance to get control of her weight— and her life.

“I was determined to succeed. For me that was necessary—I’m the kind of person who does better if I think positively,” she said. 

A new Norwegian study shows that Friberg’s expectations are fairly typical. People who undergo bariatric surgery are more optimistic about their chances of succeeding than an obese person who relies on traditional lifestyle approaches to control their weight.

“They are extremely motivated,” said Ingela Lundin Kvalem, an associate professor of psychology at the University of Oslo.

Researcher Ingela Lundin Kvalem wants to find out whether expectations match reality in the years after bariatric surgery. (Photo: University of Oslo)

Kvalem and her colleagues studied 301 Norwegian patients who were offered bariatric surgery and compared them to 261 obese people who were treated with lifestyle changes such as diet and exercise.

Those who were offered the operation were confident that they would lose weight. Kvalem said this confidence is justified, since surgery is much more likely to give better results than traditional interventions.

But the group offered surgery also had great faith in their own ability to change their lifestyle after the operation. This may be a more difficult job than they realize, the researcher said.

“The operation gives them a fantastic start, but then they have to take control. After a few years the old habits come back. The operation does not mean you can simply refuse to exercise and eat in a healthy way,” says Kvalem.

The disappointment can be huge

Kvalem says it is important to have realistic expectations about what the surgery can and cannot do.

But scientists disagree about how important it is that people believe their life will be better after surgery. Strong determination may be necessary for patients make the extra effort needed to fight old habits, even as some grapple with the side effects of the surgery.

On the other hand, patients may find that the difficulties of life after the surgery are far greater than they had imagined.

“I am afraid that the disappointment can be so great that some people may lose the motivation to improve their lifestyle,” says Kvalem.

Friberg, who underwent the surgery seven years ago, says that she was unprepared for how hard aspects of her new life would be.

“I didn’t think that I would have to have such a rigid relationship with food so long after the operation,” she said. She now exercises a lot and completely changed her life, yet even after seven years, she knows that if she eats too much, she will gain weight.

But she disagrees with Kvalem about the need for optimism.

“I think you need all the optimism you can get when you are going to go through such a huge operation—both the surgery, and with your life in general,” she said.

Clear plans for change

It is not easy to compare the two groups in Kvalem’s study. Those who are offered the operation have already tried to lose weight by changing their lifestyle. The Norwegian health care system, which pays for the surgery, first requires patients to try non-surgical approaches to weight loss.

The bariatric surgery patients were also younger, more obese, and more likely to be female than the non-surgical group in Kvalem’s study.

After taking all these factors into account, the researchers found that compared to the non-surgical study participants, the surgery group had greater confidence that they would be able to cope with changes, more positive expectations for weight loss, and clearer plans for changing their eating patterns, including when and where to eat, and what they do if they slip up.

Habits hard to break

At the same time, the group offered bariatric surgery also had more unhealthy eating habits than those who were relying on lifestyle changes to lose weight. Before their surgery, the surgery group was more likely than the non-surgical group to drink soda and have tried several unhealthy diet habits, like skipping meals and using laxatives.

Although the bariatric surgery group was more optimistic that they would manage to change their diets, other Norwegian research suggests that those who have had bariatric surgery tended to eat in a less healthy manner than those who relied on lifestyle changes to lose weight.

“They have a lifetime of unhealthy habits, and it takes a lot to follow the recommendations about what they should eat,” says Kvalem.

More support needed

In spite of the general success of bariatric surgery, it doesn’t work for everyone.

Between 20-30 per cent of those who undergo the operation will gain weight a few years after their surgery, and a few will even return to their pre-surgery weight.

Kvalem’s goal is to figure out if there is something special about the group that struggles after surgery, so that the health care system can do a better job helping.

One question is whether patients should be better prepared before surgery and be offered closer follow-up in the years after. One University of Oslo study of individuals who underwent bariatric surgery found that patients would have liked help from a psychologist in the aftermath of the operation.

“It is very important to offer people additional support, so they get the best possible result,” says Kvalem. “It would be terrible to go through such a big operation without it working the way it is supposed to.”


Read the Norwegian version of this article at forskning.no

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