An Interpretative Phenomenological analysis

Method:

Reflexivity

Throughout the whole research process, I’ve acknowledged all of the biases I’ve held prior to my research, my knowledge on this topic is relatively limited most of information I have has been acquired from undergoing my undergraduate psychology degree. I understand the importance in holding a neutral standpoint when administering research. The data used in this research was sourced from YouTube therefore, I had no direct affiliation with any of the participants and thus no biases towards any of them. My existing knowledge of bariatric surgery led to me making assumptions which did not align with the data I extracted. For example, I expected to find that participants would frequently report negative attitudes towards their surgery but, this was not the case. This enabled me to re evaluate my thoughts and opinions and take on a more unbiased approach as my preconceptions had been challenged.

Analytic process

Using Interpretive Phenomenological Analysis five video diaries on each individuals accounts with bariatric surgery were observed (Smith et al., 2009). Each video file was translated into written transcripts and, read through thoroughly and coded. A table was created for each participant to which, general themes were generated in relation to the transcripts. These themes were then used to create a master table of superordinate themes in which, the common themes amongst majority or all the participants were used and then analysed.

Analysis:

Table 1. Master table of superordinate themes and themes

Table:

Each participant reported their own unique experience of their surgery experiences. However, there were many recurring themes that presented themselves across each transcript (see Table 1, above). For example, many of the participants reported their weight loss journey as a last resort. Some participants shared their journey in the process of the surgery and generally all participants shared their aspirations and hopes for the future as well as, sharing some of the coping mechanisms they adopted to help them overcome the feelings of this process.

Surgery as a last resort:

Many participants viewed bariatric surgery as their last resort. They had tried many other means to lose weight such as exercising and dieting, but they were not as effective as the participants desired them to be. Therefore, they considered this weight loss surgery to be a last hope for them to achieve their goals. Many of these participants were pushed to this solution due to the way their condition negatively impacted their lives for some, causing them pain, fearing for their future health quality, the stigma they face from society and, their loss of control over their situation.

Throughout the accounts, participants often mentioned how physically restricted they felt due to their weight problems. They emphasised the pain and health implications they experienced as shown in Mike’s account,

“years with constant back ache, problem with my joints, knees and ankles. Sleeping is a complete nightmare” (Mike: 1/6 17)

Mike is clearly suffering due to his condition to the point where it is now affecting his daily life. The combination of his deteriorating health and poor sleep conditions seems to be severely impacting Mike’s mental state, where he refers to sleep as a ‘complete nightmare’. Other participants reported similar physically painful experiences where they were unable to do certain activities due to the pain or embarrassment it caused.

In all of the accounts participants reported feelings of concern over their future health and that was a fundamental reason in trying to adopt a lifestyle change. However, some participants were already facing the onset of their symptoms to which that was a major deciding factor as their weight issue was causing them health difficulties as reported in Roberta’s account,

“health is always in warranty I’m just fortunate I don’t have any major health issues, but there are signs that they are coming” (Roberta: 4/143 144)

Roberta is anxious about her health and understands that if she does not implement action immediately, in this case addressing her weight issue, it may lead to her suffering in the near future at the cost of her doing nothing. Some of the other participants expressed similar concerns, stating that they would not like to face any weight related illnesses in their future.

Some of the participants reported feelings of social stigma received due to being overweight. These accounts were almost always negative, and participants seemed to be harmfully impacted by their experiences as demonstrated in Amelia’s account,

“the stares and the laughs and all that and yeah its horrible and it, it bothers me” (Amelia: 1/29 30)

Amelia is reporting her experiences with bullying, it clearly ‘bothers’ her and impacts her self esteem therefore, she may want to lose weight to prevent being labelled by society. Many other participants relate to being stigmatised such as being called ‘fat’ or experiencing ‘cruel’ behaviour from other individuals.

Throughout the accounts there was a recurring theme of participants reporting their feelings of loss of control over their weight and although they may have tackled other life challenges this was one, they particularly struggled with as reported in Roberta’s account,

“unfortunately my weight is the one thing I haven’t been able to conquer” (Roberta: 4/171 172)

Roberta feels helpless at the fact she hasn’t been ‘able to conquer’ her weight therefore, she feels a lack of control over her condition and has explored alternative methods to lose weight. It is clear that this surgery was not one of her first options yet a final decision after many failed attempts of losing weight.

Process of preparing for treatment:

While preparing for surgery participants engaged in certain activities such as documenting their process, losing weight beforehand, and gaining as much knowledge as they could about the treatment to ensure they are as educated as they can be on the surgery.

A portion of participants stated that they were going to document their experiences of the procedure. In order to track and regulate their mental and physical progress as reported in Mrs. Lola’s account.

“I am going to document umm just any thoughts or feelings that I have got about the procedure that am actually going to sort about to go through” (Mrs. Lola: 7/300 302)

Mrs. Lola reported her current ‘thoughts and feelings’ as a way of mentally preparing for her surgery. She may have found that recording her shifts in feelings will enable her to understand herself in an introspective manner that could help her in her weight loss transitioning. Other participants documented their journey and aspired to give regular updates at each stage of their journey.

As part of the participants preparation, some of them dieted, in an attempt to prepare for their lifestyle changes as reported in Betty’s account.

“I’ve made some pretty positive changes already, lost eleven and a half pounds” (Betty: 5/203 204)

Betty explained her attempts to lose weight in which she was successful and ‘lost eleven and a half pounds’. There is a clear image of participants preparing to lose weight in attempt to make their treatment as ideal as they can. Other participants also reported their attempts of losing weight pre op some, depicting that they feel somewhat in control of their condition even if it’s not entirely.

Many participants described their process in researching about bariatric surgery. It seemed to give participants a sense of security in being educated about the treatment they were going to undergo as reported in Mrs. Lola’s account,

“I’ve done.an awful lot of reading I’ve looked at lot of people on YouTube I have sort of made, err  spent time researching these things and I have bought the book ‘weightloss for dummies’ and err stuff like that so I have sort of done a lot of investigation into this” (Mrs. Lola: 7/309 313)

Here she demonstrates the extensive research process she underwent to educate herself. There is a strong sense of control emerging through the participants, they have taken accountability to educate themselves as far as they can finding various platforms to research into.

Looking into the future:

Throughout the accounts participants it was evident that each of the participants had clear insights of what they desired for the future, some being of an altruistic nature to help others. Some aspired to feel a sense of belonging with other individuals going through the same process as them. There are mentions of future life plans and hopes for new experiences across the accounts of many participants.

Throughout some of the account’s participants were hopeful that sharing their journey with others could help individuals looking to undergo this surgery in the future. Amelia aimed to encourage others as reported in the transcript,

“I just hope maybe it could encourage to see that they can do it, we can do it, we can do it together” (Amelia: 3/102 103)

Amelia’s strong desire to help others translates in her words of encouragement. She states that if others ‘see they can do it’ it may help them make their decision about this journey. She wants her experience to aid others in the future and wants to provide support and knowledge to others like her as she can directly emphasise with them. This desire to help others after their surgery is prominent across many accounts.

Many of the accounts emphasise their hope for feelings of togetherness among their community of people. This is so they are able to create a future network where support and knowledge is being shared as reported in Betty’s account,

“I hope to be part of that community because I think we do need to help each other out” (Betty: 3/117 118)

Betty is looking into the future and hoping to be ‘part of a community’  as she may feel alienated after her surgery because she does not know anyone directly who has shared the same experiences as her. She wants to ‘help’ others out and seek relationships with others to feel a sense of togetherness and belonging.

A recurring theme presented across some of the accounts included participants wanting to have new experiences in the future and create plans for their life after surgery as Betty reported in her account,

‘I’m really looking to having a new body and doing activities I haven’t been able to do in years’ (Betty: 5/190 191)

Betty reported her eagerness to ‘having a new body’ suggesting that her experience of her current self is not satisfying her, and she is waiting for the future to ‘do activities’ to which she had not been able to embody for a prolonged period of time. She is delaying her experiences according to the temporality of her life experiences.

Support systems:

Participants often reported their forms of support they have across their accounts. Many of them made mention of their social relationships and how people around them have supported their journey. Some used religion as a way to support them through life and difficulties and others had support networks in which, they experienced support via online networks.

Throughout most of the account’s participants mentioned their social relationships, particularly how they offered them a form of support with their journey as reported in Amelia’s account,

“Dating a guy named Joe for almost four years now and he is wonderful and very supportive of me and my journey” (Amelia: 1/7 8)

Amelia appreciates her partner by acknowledging ‘how supportive’ he has been over her journey. Her partner offers her consistency to which she is able to be supported by him. Many participants emphasise how their relationship with others supported them during their weightloss journey.

Some accounts mentioned religion as a supporting factor throughout their weightloss journey, and showed their immense gratitude towards these religious figures for supporting them as shown in Roberta’s account,

“I love the Lord with all my heart, and without him I’m nothing” (Roberta: 3/111 112)

Roberta places high importance on her religious beliefs and states that ‘without him (God) (she’s) nothing) which demonstrates that she has feelings of an external locus of control. She feels that she is not fully responsible for her fate and puts her trust into external sources for support.

Some accounts made mention of how they received a lot support from online networks, despite interacting with each other physically they were still able to find support through these mediums as Amelia’s account portrays,

“the best place I’ve found for support, products, information and all that stuff, so go there when you get a chance, bariatric eating. Com” (Amelia: 2/68 70)

Amelia found support within these systems without physically connecting with it, she was able to do this as she found an online community who shared their lived experiences with each other and were able to help others experiencing the same as them. Essentially, their commonality is their weightloss journey and thus, they have been able to connect on the basis of this.

Conclusion:

The study aimed to explore the experiences of people undergoing bariatric surgery for weight loss. Results achieved using IPA methods showed that there was a combination of themes that interrelated to understand participants journey with bariatric surgery. These include surgery as a last resort, process of preparing for surgery, looking into the future and, support systems which were also sub divided into more specific themes.

Participants experiencing physical restrictiveness, both feelings of pain and being unable to complete certain physical tasks without difficulty, health concerns to which they often feared for their deteriorating health, social stigma in that they were treated unfairly by society and, loss of control, as participants felt that their weight was an external locus of control, all contribute to the feelings that surgery was a last resort for the participants. In preparation for their treatment, participants documented their process, attempted to lose some weight, and seeked knowledge on the surgery. Some of the goals of the participants were to help others especially those experiencing the same as them, feeling a sense of togetherness in a community, making life plans, and seeking new experiences. Participants found many different support systems throughout their journey, for example, their social relationships, religious beliefs, and online support groups.

Social stigma individuals with obesity face can be problematic, obesity in itself is underrepresented in media and given negative connotations majority of the time. This can lead to the discrimination of these individuals and hence heavily influence them when deciding to change their physical appearance. Research has shown that obese individuals are less likely to receive adequate care from a medical standpoint therefore, due to these inequalities these individuals may feel as if there’s no other choice but to change (Rubino et al., 2020). Occasionally, individuals may end up in a state of obesity due to their loss of control over themselves and choose weight loss surgery as a last resort to regain control. Research on the association of obesity and eating disorders found that many obese individuals also suffered from an eating disorder. Therefore, they may require medical help to reach their health goals (Villarejo et al., 2014).

Religion is associated with an individual’s desire to lose weight as research has demonstrated that religion influences behaviour. In terms of health, religion was found to encourage pro health behaviours and obesity prevention. Therefore, the presence of religious beliefs amongst participants may have supported them when making their decision to proceed with weight loss surgery as it is in alignment with their core beliefs (Horton 2015). A practical implication of this study is that it is difficult to generalise this data to the wider population as there was a small sample size used. In addition, out of the five participants used within our data only one of the accounts was of a male, research has shown that there are clear differences in the experiences each gender has on obesity. For example, the implications of obesity on a female may be more severe such as, effecting their fertility levels. Also, women typically have a higher body fat percentage than men which, can affect their weight loss journey. Therefore, more gender specific research is needed in this area of research (Legato 1997).

Reference:

Horton, S. E. (2015). Religion and health promoting behaviors among emerging adults. Journal of Religion and Health, 54(1), 20 34.

Legato, M. J. (1997). Gender specific aspects of obesity. International journal of fertility and womens medicine, 42(3), 184 197.

Rubino, F., Puhl, R. M., Cummings, D. E., Eckel, R. H., Ryan, D. H., Mechanick, J. I., ... & Dixon, J. B. (2020). Joint international consensus statement for ending stigma of obesity. Nature medicine, 26(4), 485 497.

Smith, J., Flowers, P. & Larkin, M. (2009) Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage.

Villarejo, C., Jiménez?Murcia, S., Álvarez?Moya, E., Granero, R., Penelo, E., Treasure, J., ... & Fernández?Aranda, F. (2014). Loss of control over eating: a description of the eating disorder/obesity spectrum in women. European Eating Disorders Review, 22(1), 25 31.