Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery
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ORIGINAL CONTRIBUTIONS
Exploring the Experiences of Women Who Develop Restrictive Eating Behaviours After Bariatric Surgery Charlotte Watson 1
&
Afsane Riazi 1 & Denise Ratcliffe 2
# The Author(s) 2020
Abstract Objective This study aimed to explore the experiences of women who had developed excessively restrictive eating behaviours following bariatric surgery. Method Five female participants, who were at least nine months post-bariatric surgery and exhibiting restrictive eating behaviours, were recruited from Bariatric Surgery Psychology Services and asked to complete qualitative face-to-face semi-structured interviews. The data was analysed using interpretative phenomenological analysis (IPA). Results Three super-ordinate themes emerged: (1) experiences of weight stigma and weight history on self, (2) the impact of loose skin, (3) thoughts about food and disordered eating patterns. These captured the impact of past weight-related experiences—including weight stigma, intense fears of weight gain, negative cognitions about the self, the impact of excess skin, changes in the way the women thought about food and restrictive eating behaviours. Discussion This study is one of the first to specifically explore restrictive eating disorders after bariatric surgery using a qualitative approach. The findings of this study may offer helpful aspects for professionals to hold in mind when identifying individuals with problematic restrictive eating behaviours following bariatric surgery. Body contouring surgery, internalised weight bias and weight stigma are explored in relation to the post-bariatric surgery treatment pathway. The current diagnostic criterion for anorexia nervosa are discussed to highlight difficulties in diagnosing this presentation in the post-bariatric surgery population, where people can have BMIs over 25 kg/m2 but are severely restricting energy intake. Keywords Bariatric medicine . Bariatric surgery . Eating disorders . Anorexia nervosa . Obesity . Body image . Weight stigma . Post-surgery eating disorders . Eating pathology
Introduction Bariatric surgery is regarded as the most effective treatment for severe obesity [1]. Bariatric surgery procedures are not without risk and research attention is being given to post-
* Charlotte Watson [email protected] Afsane Riazi [email protected] Denise Ratcliffe [email protected] 1
Department of Psychology, Royal Holloway, University of London, London, UK
2
Bariatric Surgery Psychology Department, Chelsea and Westminster NHS Foundation Trust, Fulham, London, UK
surgery maladaptive eating patterns due to their influence on outcomes [2, 3]. However, there has been limited focus on the increasing number of people who are developing more restrictive eating disorder patterns. Increasingly, clinicians are seeing post-surgery clients who are starved, defined by evidence of malnutrition, but have a BMI over 17.5 kg/m2 and 18.5 kg/m2 [4, 5], which historically have been clinical indicators of a person being underweight or having anorexia ner
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