Jo Gilmartin

Body image concerns amongst massive weight loss patients

AIMS AND OBJECTIVES To explore body image matters amongst patients following massive weight loss. BACKGROUND In contemporary health care, a growing number of morbidly obese patients are seeking surgical solutions such as bariatric surgery or in other cases engaging with radical lifestyle changes. Massive weight loss can leave patients with a huge excess of lax overstretched skin that in some cases can trigger major body image dissatisfaction or depression. There is a scarcity of research about the needs of this group of patients and this is important for nursing practice. DESIGN A qualitative design using in-depth interviews was employed. METHODS Twenty white adults (18 women and two men) were recruited retrospectively amongst patients who had massive weight loss by undergoing bariatric surgery or radical lifestyle changes, aged 29-63 years. All of the participants gave signed informed consent. Face-to-face in-depth interviews were conducted and transcribed verbatim. The data were analysed using thematic analysis. RESULTS One core theme focusing on body image ugliness and three associated subthemes were identified: the subthemes included feeling socially marginalised, feeling depressed and sexual and intimacy difficulties. CONCLUSION Body image matters are hugely significant and appear to have a lasting effect on emotional well-being and function, contributing to psychological distress and social isolation. Greater sensitivity is required in enabling patients to work through emotional isolation and shame that has been a part of their childhood. Furthermore more, treatments need to be accessible to this growing patient population such as reconstructive surgery. RELEVANCE TO CLINICAL PRACTICE Nurses who care for massive weight loss patients need to be mindful of their psychodynamic needs and be non-judgemental and accepting. Moreover, nurses need to be aware of treatment options and be able to assess body image matters and implement quality care for this particular patient group including body image acceptance programmes and support groups.

Teachers’ understanding of facilitation styles with student nurses

The notion of reflective, problem-based and experiential learning has become a significant phenomenon within nurse education. This paper will explore the general philosophies that seem to influence the interactional competences employed by 20 nurse teachers teaching pre-registration student nurses human skills. A qualitative approach was adopted using the in-depth interview for data collection. The intention was to emphasise the four types of teacher that emerged from the data, ranging from type 1, who displayed a striking negative attitude towards interpersonal skills work, to type 4, who was creative and enthusiastic. The major characteristics in the different types will be outlined in this paper. For the purpose of discussion, factors that influence the learning climate will be addressed and the implications for nurse education and study limitations will be considered.

Quality of life among adults following bariatric and body contouring surgery: a systematic review.

BackgroundWeight loss following bariatric surgery is associated with significant improvements in obesity-related comorbidities, body satisfaction and psychosocial outcomes, at least in the short term. However, in the context of extreme weight loss, body image and appearance may worsen again because the “excess” or “loose” skin can lead to both functional and profound dissatisfaction with appearance. These concerns have led to an increasing uptake of post-bariatric surgery, “body-contouring” procedures but the implications for quality of life (QoL) have not been thoroughly considered. Objective/purposeThe objective was to identify the best available evidence regarding the QoL outcomes for adults following bariatric and body contouring surgery. Inclusion criteria Types of participantsThe review considered studies involving people aged 18 years and beyond who underwent bariatric surgery and body contouring surgery. Types of interventionsThe review considered studies that evaluated bariatric surgery as well as body contouring surgery. Types of studiesThe review considered both experimental and epidemiological study designs. OutcomesThe primary outcomes were QoL as measured by validated tools at less than two years, two to five years and more than five years following body contouring surgery. The secondary outcomes were adverse events, unsatisfactory aesthetic appearance and weight gain. Search strategySix databases were searched, including Cochrane Central, MEDLINE, Embase, Web of Science, PsycINFO and CINAHL. Studies published from 1954 to 2014 were considered. Additional searches for unpublished studies were undertaken in BIOSIS citation index, Register of Current Controlled Trials and Global Health Observatory. Methodological qualityThe methodological quality of eligible studies was assessed independently by two reviewers using the Joanna Briggs Institute quality assessment tool. Data extractionData extraction from the included studies was undertaken and summarized independently by two reviewers using the standardized Joanna Briggs Institute data extraction tool. Data synthesisStudies were too heterogeneous and could not be pooled in statistical meta-analysis. Therefore, the data results are presented as a narrative summary in relation to the outcomes of interest. ResultsNine quantitative studies (four comparable cohort studies, including two group design and two four-group designs and five descriptive or case-series studies) were included in the review. The included studies reported significant clinical improvements in appearance, wellbeing and QoL. These included primary outcomes pointing to body image satisfaction, improved self-esteem and confidence, improved physical function/pain and improved social function. The secondary outcomes were related to adverse events in the early postoperative period and reported wound healing problems, including seromas, partial necrosis, dehiscence, hematoma and anemia because of blood loss. Also, some data sets shed light on appearance-related distress and body dysphoria post surgery associated with visible scars and contour deformities. ConclusionBody contouring surgery has been shown to have positive benefits, especially in relation to improved wellbeing, function and QoL. However, adjustment to changing body image following body contouring is both challenging and empowering and seems to be a transitional process.

Identity transformation and a changed lifestyle following dramatic weight loss and body-contouring surgery: An exploratory study

This article reports on two major quality-of-life perception changes for patients who had undergone plastic surgery following dramatic weight loss. The exploratory, qualitative study was undertaken with 20 patients from one teaching hospital. In-depth interviews were conducted, and a thematic analysis of the data was undertaken. The results provide unique glimpses of surgical consumption empowering and facilitating ‘identity transformation’, embracing improved physical function and enhanced self-esteem, confidence and quality of life, and a ‘changed lifestyle’. For a minority, identity transformation was sometimes interrupted by ‘identity lag’, posing the need for additional health-care support throughout the adjustment process. The study provides additional insight into existing quantitative studies, adding to the body of knowledge in this area.

Changing Body Image and Well-Being: Following the Experience of Massive Weight Loss and Body Contouring Surgery

This paper reports on the perception of changing body image and well-being for patients who had undergone plastic surgery following massive weight loss. The exploratory, qualitative study was undertaken with 20 patients from one teaching hospital in the south of England. Semi-structured interviews were carried out and a thematic analysis of the data undertaken. The results provide important insights regarding body contouring influencing body image change and the adjustment process involved. The ability to pursue self-esteem and the accruing social benefits is emphasized in the interrelated sub themes including social acceptance, undoing depression and sexual vitality. Body contouring surgery following massive weight loss appears to facilitate improvement in body image and well-being. Adjustment to the changing body image is both empowering and challenging. Supportive educational programmes need to be developed to assist this transition to a more positive body image and appreciation; these could usefully include access to and involvement with patient support groups.

The effects of contemporary behavioural weight loss maintenance interventions for long term weight loss: a systematic review

Background A major challenge in the treatment of obesity is the long term maintenance of weight loss and prevention of weight regain. The Department of Health in England has recommended that health professionals should consider behavioural weight loss interventions. Objective To evaluate the effectiveness of behavioural weight loss interventions in maintaining long term weight loss. Methods Using the PRISMA statement we performed a systematic review of randomised controlled trials. Data sources involved in the study are the Cochrane Library, MEDLINE, EMBASE, psycINFO, CINAHL and the Web of Science. Studies were assessed independently by two authors to provide inter-rater reliability. Results This review presents the findings from 13 randomised controlled trials of weight loss maintenance utilising interventions that include diet strategies, behavioural strategies, lifestyle counselling and drug therapy, group therapy and the Internet. The sample population included adult participants of 18 years+ with a BMI > 30 kg/m2. The results revealed that lifestyle interventions targeting diet and physical activity are effective in sustaining weight loss up to two years with extended care. Moreover, pharmacology combined with lifestyle interventions was effective. Conclusion There is important evidence that the use of behavioural weight loss interventions are effective in sustaining long term weight loss, albeit limited. There was high heterogeneity among the studies; hence caution is required when interpreting the findings. Also, intentions to treat principles and methods to handle missing data are not clearly reported across some studies. Blinding of participants and outcome assessors is very limited.