Current Challenges
 

Bariatric Patient Pre-Operative Challenges

Person

• Participant A reported low functional endurance which inhibited their ability to complete leisure activities and socialize with others. They were in a great amount of pain each day which caused increased irritability and conflict with others. Participant A then chose to self-isolate during their days before deciding to undergo bariatric surgery because of their significant low self-esteem. 

• Participant B reported the number of health issues and medications they had to take prior to surgery was extremely alarming and scary for them. They reported feelings of guilt and hopelessness because of their failures that led them to get to this point in their life. They reported having a constant fear of missing out on future life events with family and not living out their purpose on earth by dying early. 

• Participant C reported decreased confidence and decreased energy prior to surgery.

Task

• Participant A reported missing the outdoors; even going on a walk was difficult for them and they were less able to enjoy activities that brought them great joy. They also reported difficulties in completing daily self-cares independently because of their size; they could not wash or wipe their backside thoroughly. 

• Participant B stated that the most difficult pre-operative tasks were basic ones they had to complete every day. The amount of pain they experienced with getting out of bed each morning and walking throughout their home was enough to make them feel upset and frustrated. Participant B enjoys cleaning and could not clean their home without taking many rest breaks and being exhausted for the rest of the day once they finished. 

• Participant C reported embarrassment and discomfort when traveling on a plane if offered an extension seatbelt. They also spoke of generally low physical endurance and their physical work being particularly challenging. 

Context​

• Participants A and B reported social and public physical environments as uncomfortable due to the fear of judgment from others, their low self-esteem, the additional time they required to rest between ambulation or using electric scooters to get around, and not feeling comfortable or fitting properly with the furniture found in public areas. 

• The most frequently reported contextual barriers for this population included narrow chairs and seats, fear of looks or comments from others, and social anxiety (Nossum, Johansen, & Kjeken, 2018). Other contextual factors reported included doorway width, public toilet accessibility, public transport, and stairs (Ellison, Keesing, & Harris, 2020; Forhan, Law, Taylor, & Vrkljan, 2012).

Performance

• Habits and routines of an individual’s leisure and instrumental activities of daily living (IADL) engagement prior to surgery were reported as primarily sedentary (Mata, Mikkola, Loveland & Hallowell, 2015).

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Bariatric Patient Post-Operative Challenges

Person​

• Participants who received bariatric surgery described the procedure as an external control that could provide structure over their eating; however, those feelings did not remain after one-year post-operation (Coulman, Mackichan, Blazeby & Owen-Smith, 2017).

• Individuals often face social ridicule for taking the easy way out by undergoing surgery rather than losing weight the natural way (Coulman et al., 2017).

• Participant A reported excess skin as a challenge in their recovery process and something they wish they were informed about more prior to surgery. They found the excess skin unappealing, making it more challenging to like the way they looked. Participant A also experienced constant problems with constipation and diarrhea post-operatively. 

Task

• Participants objectively lost weight, but their identified personal roles were still tied to their weight and lifestyle before bariatric surgery (Faccio, Nardin, & Cipolletta, 2016).

• All three participants reported the strict diet guidelines they had to adhere to (specific to the type of bariatric surgery they had) as a challenge due to the large time spent planning their meals and making sure they were eating the types of foods in the right portion size and in the correct time frame.

Context

• Participant B's insurance dictated what kind of care they received after bariatric surgery. This caused unwanted challenges in their ability to maintain a positive mindset during their very intense physical and mental recovery as they could not pay out of pocket for the follow-up appointments they desired. 

Performance

• Postoperative participants continued to limit their participation and engagement in occupations because they anticipated a dramatic, supernatural change after surgery that did not often occur (Faccio et al., 2016).

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Photo used with permission.

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Occupational Therapy Practitioner Challenges

​Person​

• OT practitioners rate themselves as willing to treat clients seeking bariatric surgery, yet believe they are not trained well enough (Lang et al., 2013).

• Nearly half of the practitioners surveyed stated they were motivated to treat clients who were at an unhealthy weight (Lang et al., 2013); however, Forhan and Law (2009) found that less than 50% of OT practitioners believed that OTs know the needs of clients who are at an unhealthy weight.

• Many OT practitioners viewed bariatric needs as a circumstance that occurs under the control or lack thereof of individuals and their eating habits. It is something that individuals allow to happen to them (Forhan & Law, 2009).

Task​

• OT’s role lacks proper identification and clarification of their fit within an interprofessional team (Lang et al., 2013; Lee, van der Zalm, Van Stralen, Voigt, Wou, & DePaul, 2015; Leemhuis & Cozzolino, 2010).

Context

• In 90% of OT workplaces, OTs reported no guidelines to work within or provide to their clients with bariatric needs for management of weight (Lang et al., 2013).

• There are additional challenges for occupational therapists to make their mark in interprofessional bariatric healthcare teams due to limited funding allotments for OT services (Forhan & Gill, 2013).

Performance

• There are currently no strategies in place for occupational therapists to declare their interest related to bariatric care in either national associations or regulatory registrations because weight and bariatric needs are not considered an area of practice or interest (Forhan & Gill, 2013).

• There is current evidence supporting the contribution of occupational therapists to an interprofessional approach to prevention, treatment, and management for people seeking bariatric surgery, but no literature to support specific occupation-based interventions (Forhan & Gill, 2013).

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Occupational Therapy Student Challenges

Person

• The majority of OT students surveyed by Vroman and Cote (2011) held stereotypical and strong prejudicial beliefs towards these individuals.

Task​​

• The field of OT lacks education pertaining to nutrition and physical activity for weight loss, as well as intervention strategy training for this population (Lang et al., 2013; Lee et al., 2015; Leemhuis & Cozzolino, 2010).

Context

• Only eight percent of participants stated their entry-level OT education included weight management education (Lang et al., 2013). ​

Performance

• The stigma and prejudice held within OT students and future practitioners’ beliefs about this population are likely to negatively impact the therapeutic relationship, therapeutic process, and therapeutic outcomes they have with their clients (AOTA, 2015; Vroman & Cote, 2011).