Personal Descriptions of Life Before and After Bariatric Surgery From Overweight or Obese Men

Abstract

Bariatric surgery is now a common weight loss solution for morbidly obese men where meaningful weight reduction and improvements in quality of life have been identified postsurgery. As the majority of surgical candidates are female, there exists a paucity of literature relating to the experience of males undergoing bariatric surgery. In this study, a qualitative descriptive–exploratory design was used to explore body image descriptions, adaptation of a new lifestyle, new boundaries postsurgery, and any barriers seeking consultation for surgery. Six males who had undergone bariatric surgery were recruited in Australia. Data were collected and analyzed using NVivo between May and October 2014. The themes emerging from the data included living in an obese body, life before surgery, decision making for surgery, and life after surgery. The participants collectively reported that life before surgery was challenging. They described the changes the surgery had made in their lives including positive changes to their health, body image, social lives, and self-esteem. Some participants preferred not to tell others their intentions for surgery due to perceived stigma. The men in this study also described a lack of information available to them depicting male perspectives, a possible barrier for men seeking weight loss surgery options. Implications for practice highlighted in these results relate to a greater need for accessible information specific to men based on real-life experiences.

Introduction

Many traditional treatments for obesity including drug therapies, diet, and exercise programs have been offered; however, bariatric surgery is growing at a steady rate (Boeka, Prentice-Dunn, & Lokken, 2010). Surgery is now considered the treatment that offers the most effective and sustained weight loss for these people (Aguilera, 2014). Candidates for surgery include people who are classified as morbidly obese (or obesity class III with a body mass index [BMI] > 40 kg/m²) or when obesity (BMI > 35 kg/m²) is comorbid with other associated medical conditions (Obesity Surgery Society of Australia & New Zealand, 2015). Obesity affects 34% of all adults in the United States, and between 2003 and 2008, there were over 100,000 patients undergoing bariatric surgery (Wee, Davis, Huskey, Jones, & Hamel, 2013). In Australia, statistics identify that the number of hospital separations for bariatric surgery between 1998 and 1999 and 2007 and 2008 have increased from 535 to 17,000 (Australian Institute of Health and Welfare, 2010). The Australian Institute of Health and Welfare also reported four in five admissions for bariatric surgery were for women (Australian Bureau of Statistics, 2012). This figure is alarming as Australian National Survey figures from 2007 to 2008 indicated that men at all age groups have faster growing obesity rates than women (Australian Bureau of Statistics, 2012). The differences in numbers for surgery among men and women may be due to the diverse motivations for undergoing surgery. Research suggests that men are motivated to have surgery to improve both their current and future health status, where women are mostly concerned with improving their body image (Jensen et al., 2013).

Background

While an effective weight loss solution for many, the impacts of bariatric surgery on the individual’s lifestyle, interpersonal relationships, quality of life, and concept of body image can be complex (Grimaldi & Van Etten, 2010). Subsequently, mental health issues are also a concern for obese people; it is noteworthy that up to 40% of bariatric surgery patients meet the criteria for mental disorders (Van Hout, 2005) such as depression and anxiety. The majority of patients experience significant improvements in quality of life and body image (Sarwer et al., 2010) including sexual function (Assimakopoulos et al., 2011) postsurgery. Some studies report that patients can experience issues in adapting to new lifestyle patterns, learning new boundaries, and perception of control and body image (Jensen et al., 2013; Sarwer et al., 2010).

Aguilera (2014) recently reviewed literature related to support type and weight loss outcomes postsurgery. Support groups, supportive family members, and a multidisciplinary approach to care (i.e., surgeon, dieticians, nurses, and psychologists) were among the most successful approaches for supporting this patient group. The author revealed that most of the findings were reported from a majority of female cohorts. Where female patients undergoing surgery make up 80% of this population group (Gregory, Temple Newhook, & Twells, 2013), it stands for reason that most of the participants in these studies were female. The role of gender and its impact on shaping meaning to obesity and seeking bariatric surgery is almost nonexistent in the literature. A study by Temple Newhook, Gregory, and Twells (2015) recently examined the way gender shapes the meaning of obesity surgery, finding notable gender differences with implications for health care professionals. Walfish (2004) and Walfish and Brown (2009) investigated the emotional factors that contributed to weight gain in a cohort of people applying for bariatric surgery. They reported that obese men and women experience emotions differently, in particular, with emotional eating and have different weight loss expectations.

Research investigating the effectiveness of bariatric surgery is ubiquitous; however, much of the research has been conducted using quantitative measures where a deep understanding of the impact of surgery to the life of a patient from the patient’s point of view is lacking (Bocchieri, Meana, & Fisher, 2002). Overall, there is limited evidence regarding details about the psychological impacts of undergoing surgery (Kubik, Gill, Laffin, & Karmali, 2013) and of individual perceptions and expectations on surgery outcomes including body image (Lyons, Meisner, Sockalingam, & Cassin, 2014; Pataky, Carrard, & Golay, 2011). Both males and females are seeking consultation for bariatric surgery as a weight loss option; however, more females are involved in empirical research leaving a dearth of understanding of this experience by the view of male patients. The aim of this study was to explore descriptions from male bariatric patients before and after surgery and, specifically, their adaptation to a new lifestyle, new boundaries postsurgery, and illuminate any potential barriers to seeking consultation for bariatric surgery.

Method

Design

A descriptive–exploratory qualitative study design was employed using semistructured interviews. The use of this design and data collection method permitted an examination of a number of broad areas related to this experience where participants were able to lead their own disclosures. The aim of the in-depth interview was to provide researchers with a narrative of which to draw themes from the data in order to describe this experience from the participant’s viewpoint.

Ethical Considerations

Ethical approval was received from the University’s Human Research Ethics Committee prior to recruitment (Protocol Number 2014 164V).

Participants and Recruitment

Males who had undergone bariatric surgery were recruited through an advertisement flyer located in a Victorian-based weight loss surgery clinics. Participants who could not understand English were not included in this study due to funding restrictions for interpreters. The data were collected and analyzed between May and October 2014. At the time of data collection, a possible eight males in total who had recently undergone surgery were approached with the advertisement flyer, of which six consented to participate in the study. The males included in this study were either morbidly obese or obese patients with a related comorbidity at the time of their surgery. Participants were aged between 27 and 69 years (M = 50.3 years) and represented men from urban and rural living. One participant was retired, one participant was seeking employment, and the other four participants were employed. All but one participant was either married or in a relationship. The one single participant was living with relatives.

Data Collection

After participant consent was obtained, one of the researchers experienced in qualitative interviewing contacted each participant and conducted a telephone interview. Interviews were conducted by telephone as this was the preferred method for participants to discuss their experiences in regard to both their availability and time as most of them had to work or lived a distance from the clinic. Interviews ranged between 30 and 60 minutes in duration. The interviews were digitally recorded and transcribed verbatim. An interview guide with open-ended questions was used for men to describe their experiences of undergoing bariatric surgery. The guide was used solely as a prompt for the researcher, as the men spoke freely and harmoniously about their experiences of having undergone surgery and, dependent on the responses from the participants, most questions were recursive in nature. Examples of the questions on the guide included the following:

• How did you feel about your body before surgery?

• How did you find out about surgery as a weight loss option?

• What were your motivations to have the surgery?

• Can you describe how your lifestyle has been affected since surgery?

• How do you feel about your body after surgery?

Data Analysis and Rigor

Thematic analysis was used as the strategy to categorize the data. As this method does not require a predetermined theoretical paradigm and is theoretically flexible (which is appropriate given the exploratory nature of the current study), this method concurred with the research question investigating males’ experiences of bariatric surgery (Braun & Clarke, 2006). Thematic analysis was conducted using NVivo (QSR International, Victoria, Australia). Two of the researchers with experience in interviews and qualitative research methods undertook data analysis. The researchers read and re-read the transcripts for familiarity and the development of theme ideas. The data were then coded across each transcript systematically and codes were identified into themes. To ensure rigor was maintained, both researchers coded the transcripts independently and then discussions were undertaken to confirm agreement with the emerging themes.

Results

The data analysis process revealed three major themes: living in an obese body—life before surgery, issues related to the decision-making process, and life after surgery.

Living in an Obese Body—Life Before Surgery

Participants described mostly negative images of themselves presurgery. They described a range of health concerns and life restrictions due to being obese. Being obese had impacted ontheir careers, family, and social lives and they also experienced stigma. They all described trying different ways to lose weight but nothing was sustainable. The men spoke about their physical and psychological well-being before surgery, relationship with food, life restrictions, and body image issues.

Physical and Psychological Well-Being Before Surgery

Participants experienced a range of health problems presurgery including diabetes, high blood pressure, high cholesterol, difficulty in breathing, and pain. Most of the participants described feeling unfit, sluggish, and feeling older beyond their years. “I felt older than I am, I am only 27 but I felt like a 40 year old” (P1) and “I stopped training because my joints were killing me. . . . So I put on a little weight and then . . . they told me I had diabetes . . . when I was put on insulin the weight just piled on” (P6). Participants described feelings of having low self-esteem and confidence because of their size, often feeling upset about not being able to fit into clothes. A sense that the psychosocial issues they experienced were not something they would like to talk to with others was perceived. One of the men, who was single, admitted to seeing a counsellor, but others felt that they did not need to talk to a professional about their weight concerns other than discussing their psychological concerns with immediate family members (usually their spouse) where it seemed they felt adequately supported.

Some of the men were also worried about their health and becoming a burden to their families if they did not take drastic measures to lose weight. They also described feelings of being discontented with their weight and had attempted a number of diets and exercise programs that did not give them desired and sustained results, “[you get sent] off to programs and lose half a stone . . . 12 months down the track after the program ends you whack it and a bit more [weight] on” (P4). Where the men reported difficulty at finding a sustained weight loss solution, they also all discussed their relationship with food, which was often unhealthy.

Relationship With Food

All of the men spoke about their food habits before surgery. They all described unhealthy eating habits, often craving fatty and sweet foods or overeating: “I just used to overeat . . . [I would] have a pyramid of food in front of me” (P3). One of the men spoke about eating take away foods out of convenience, others spoke about constantly craving unhealthy food and eating as a source of comfort: “When I was depressed I would eat, eat, eat and I used to be happy after” (P1).

Life Restrictions

Being obese placed a number of life restrictions on these men. They described basic tasks as being difficult, such as tying their shoelaces, getting up out of bed, struggling to get into and out of their car, and walking around. They often avoided social events, feeling embarrassed and often it was related to not fitting into their clothes or having anything to wear: “Very embarrassed—I wouldn’t openly get involved in social events” (P5). Not being able to fit into appropriate clothing placed restrictions on one participant’s career prospects:

When I was overweight I used to work in offices, and never felt comfortable wearing suits and would always have to wear a big jacket to hide my love handles and my man boobs and stomach . . . to try and be normal and to just fit in when you walk in the city. I can apply for more jobs . . . it is just more comfortable for me. (P1)

The limitations placed on their lives due to being obese were also described by the men in context of their self-concept and body image.

Body Image Issues

The male participants, while describing their bodies in a negative manner, for the most part, did not always identify as having body image issues. However, their body image appeared to be centered on others’ negative perceptions: “I always used to think that people were looking at me and think that I was one of those lazy people that just gained weight and couldn’t be bothered” (P4). Some men also described the challenge of always being obese: “so body image for me, I have always struggled with the fact that I was always large” (P5).

There appeared to be some disconcerted discord in some of the men’s descriptions regarding the limitations being obese placed on their lives in terms of socializing and career choices, negative descriptions of their body, and the concern regarding body image in terms of others’ judgments about them. Men described their obese bodies as, “ugly” (P6), “[I looked like] Mr Michelin Man . . . I wasn’t very good to look at” (P3), and “bulging out of my large t-shirts” (P2); yet they appeared to minimize their own body image concerns: “Like a lot of males I don’t worry about body image that much . . .even though I stand in front of the mirror every morning I don’t tend to look at that” (P2) and “I’d try to cut it out off my mind being overweight and just get on with my life” (P5). Some of the men reported that their larger size had protective quality especially in their work or social situations.

Making the Decision for Surgery

The men all spoke about how they came to the realization that they would need to have the surgery. They spoke about the motivators, support, and information sources.

Motivators

The main motivator for these men was to improve their health and experience longevity. The men described trying diets and programs where nothing would work in the long term; they often reported that having surgery was their last resort at restoring their health. Many men were facing serious health issues such as cardiovascular disease, stroke, and diabetes. The thought of being a burden on their loved ones or dying prematurely was a strong motivator for surgery: “I say I was a prime candidate for heart attack and stroke” (P5). Another motivator was feeling like they were taking control of their situation, as a couple of participants described,

I realise I had come to a crossroads in my life and had to do something dramatic . . . otherwise I was heading into heart attack and stroke territory . . . I would rather take control of the situation. (P4)

and “I just got to the stage where I was just piling on the weight . . . and enough was enough so we had to do something about it” (P6).

Often, spouses were a source of inspiration and encouragement with one participant having the surgery the same day as his wife: “we both said to each other before the operation that maybe we would be able [to lose weight] without the struggle” (P2). The participants described a number of different support strategies they used which guided their decision to have the surgery, including other family members, medical professionals, and acquaintances who had also had the surgery.

Support

The main source of support described by participants was the support from their family: “my wife being a nurse and daughters has wanted me to do something for a long time . . . they’re very supportive” (P5). Others used medical professionals as a source of support where some men regularly attended appointments with a dietician and surgeon if they could afford to. Again, well-being before surgery was maintained by only one of the participants through the support of psychological specialists and dieticians. The only participant who reported seeking professional psychological support was the unmarried participant. He found that his psychological health was significantly boosted by undergoing surgery.

[I received support through] dieticians and I went to a psychologist about my weight as well. I don’t need them anymore, I feel much better now. What I really needed was for this surgery to be done. (P1)

Generally, male participants did not widely share their decision to have the surgery with others, opting to keep the information in a small, close circle of people:

They [friends] have found out that I have done it, I haven’t told people, but I have told a few and they have probably told a few, it’s all spread out. (P1)

Participants sometimes avoided sharing their intentions of undergoing surgery in case the outcome did not match participants’ expectations:

We told our two children and one of their partners knew, because we are living in the same house and someone had to take us to hospital and all those sort of things. But no, we thought we would tell everyone after the surgery, and we just haven’t done it . . . we didn’t want to tell anyone we just wanted to try it and see if it worked. (P5)

On the other hand, Participant 6 reported being agreeable to tell fellow patients at his specialist’s clinic. He reported being willing to speak to other men about his surgery to help educate them about it:

[my doctor] is actually trying to convince some others to have it and I said “well, if you want me to give a reference about it, I’ll do it for you” . . . but he’s got some stubborn people that he’s trying to convince—and they’re all blokes. No women. . . . Blokes are stupid . . . we just don’t want to go to the doctor.

This comment highlights masculinity related to help seeking and the importance of males supporting other males for health care matters.

Other sources of support reported by one of the participants were the use of Internet support groups. The Internet was used as a source of support and for obtaining information, where the participants could remain anonymous. The majority of the men reported using the Internet as a tool to embark on their research about the surgery.

Information Sources

All of the men had done some research before seeking consultation for surgery. The majority of the men had known someone, usually a family member or friend, who had the same surgery or similar and used them as an information source. The loved ones of some participants warned against surgical intervention due to risks, food restrictions, and at times, fear of the unknown impacts:

I was just asking my friend things about the surgery, about how he feels and how much he can drink and eat, [whether he] can he drink alcohol, and smoke. I was just getting his feedback and that is how I educated myself.

I spoke to some of my relatives about it and they told me that if I did it I would never be able to do things, like I would never be able to do a lot of work, that it was dangerous and there were a lot of side effects. (P1)

The Internet was a major source of information as well, others used it for testimonials: “I was always online researching for how people felt and stuff, and results and stuff. Most of the things people were saying on YouTube was good” (P1), where others only used it to locate a suitable surgeon. The men who used the online information found it useful to a certain extent; where people sharing their experience was useful, they also were wary of unverified information and the limited amount of local information: “I was Googling a lot of it and looking at forums. There a lot of forums overseas, not a lot in Australia, but we were reading a lot from overseas, in America” (P2). Some participants described their general practitioners (GPs) as being somewhat supportive but unhelpful:

I went and spoke to the doctor and he almost—he had no qualms. I remember I said “I need a referral, I want to go and have this sleeve” and he said “good for you, that’s good” . . . he didn’t know much. (P4)

And others had GPs who were not supportive at all: “my GP wasn’t keen at all. . . . He just reckons it’s a money-making exercise” (P6).

In general, participants agreed that having access to the personal experiences of someone who had been through the procedure would have been helpful, as indicated in the following participant comments:

I wouldn’t have minded listening to a video, like a testimonial . . . I would love to have had a tape where someone actually spoke about it, that was a complete stranger that I didn’t know and how they felt about it. (P1)

While there was a lot of information for the participants to access online, some participants were disappointed at the lack of male-specific resources available:

Everything you see on YouTube is for ladies, there is hardly anything about this surgery for males, and there were only a few 3 or 4 that I found. You only see the ladies doing it and talking about it but what about the men? (P1)

Being obese was an issue for men in terms of a desire to wear smaller clothing, looking good, and feeling better. Men described not being able to find suitable clothing and also identified a range of gendered issues which affected their decision making for surgery:

At first I thought I was a little bit feminine [wanting the surgery] . . . that I wasn’t man enough [to lose weight myself] and all that stuff but I got over it.

It is more about the ladies; I think it has always been about ladies. I think it is only recent that men want to look good too. (P1)

I don’t know if it’s just an image, just a bravado [being a tough man] . . . it looks like a weak way out if you have to have surgery. You haven’t got the strength of character to do the dieting thing. (P3)

Life After Surgery

Following surgery, men described changes to their body image, their physical fitness, and expectations and the barriers experienced to weight loss aftercare.

Body Image

Postsurgery participants noted important positive changes to health concerns and their physical condition. Some participants noted hair loss, attributing this to a decreased consumption of food and therefore nutrients. Hair loss was described as a concern for one participant (the youngest of the participants in the study). He commented about the hair loss in the main due to altering his appearance and potentially affecting his sense of self-esteem and body image. These participants largely considered the benefits of surgery to outweigh seemingly negative consequences like hair loss:

I have experienced some hair loss mainly because I don’t eat as much as I used to. You can’t eat all those different types of foods to get the nutrients that you need for your hair and overall health.

Hair loss was only going to be for a few months, until you adjust to it. They said your body is like in starvation mode because it is changing. It is not used to the amount of food coming in constantly. Now it is used to a quarter of the amount and it has to adjust. (P1)

Participants’ perceptions of excess skin as “unattractive” made body image postsurgery similarly problematic:

What happens now is my body keeps shrinking, it is not as tight as it used to be. (P5)

My breast [chest] area is kind of like falling down they are not like they used to be, they used to be stiff and up there. Now it is like loose. That’s not pretty. (P1)

However, participants were generally happy with their smaller size and how that affected their body image:

I feel more comfortable trying on clothes and stuff. “Oh yeah I’ll take that,” when I was overweight I wasn’t ever comfortable doing that. (P1)

Just the whole way you look and stuff, you feel different, basically you feel skinnier. You feel more accepted, society is so judging. (P3)

Physical Fitness and Expectations

Participants also spoke about level of fitness before and after surgery. Some described no change in level of fitness. Participants generally agreed about an improved sense of enjoyment from exercising:

Fitness-wise no real change other than I’m probably enjoying it more because I’m losing the weight. (P3)

The relationship with food was a common topic discussed. Participants spoke about moving the focus of food from eating for comfort or enjoyment to seeing food as a source of energy and nourishment:

Once upon a time I used to—the old saying “you live to eat.” Now it’s the other way around. You just eat food to live. . . . It’s quite a change. (P4)

Talking with their doctor or dietician was effective in giving some patients realistic expectations about adjustments to life postsurgery. Some participants spoke about changes to their routines and how these adaptations affected them personally:

I would not go the footy club where they just have steak and chips and mixed grills and stuff like that because I just won’t be able to eat it. (P3)

I have just ordered a Caesar salad, and everyone is just like “but they have a mixed grill and this and this and this,” and I say “no, no, no I am on a diet and I want to lose weight” you know. I don’t think anyone has come close to thinking that we have had the lap band surgery. (P2)

Barriers to Weight Loss Aftercare

Some of the men reported concerns related to the additional costs of follow-up aftercare postsurgery. The aftercare needs included ongoing appointments with surgeons, dieticians, psychologists, and the potential need for corrective plastic surgical procedures to remove excess skin. Participants, however, reported an understanding of the initial costs for surgery, as this was often reported as originally prohibitive and was an expense that they had to plan and prioritize for: “Not everyone can afford it and a lot of people want to do it. So if they could reconsider that price. If I could I would have done it ages ago” (P4).

Some of the participants described a lack of awareness for the ongoing costs to seek professional advice and the possibility for the need for corrective surgery following their procedure and subsequent weight loss. Not having a full appreciation of the total costs that would be involved following their procedure was a concern for one participant: “The dieticians, the psychologists and they all charge by the hundred . . . it is just too high. Everywhere you go you have to pay a few hundred bucks, and not everyone has that lying around” (P1).

Discussion

This study, exploring descriptions of bariatric surgery from the perspective of men before and after surgery, highlights a number of issues related to obesity and weight loss surgery as an option for obese men. The men participating in this study had recently undergone bariatric surgery and collectively reported positive weight loss outcomes and improvements to their physical and psychological well-being. They did so despite the need to make dramatic changes to their lifestyles and reporting of unexpected changes to their bodies such as excessive and loose skin and health care costs related to treatment follow-up. The main findings of this study, from a sample of obese men in Australia, include the impacts of being obese and bariatric surgery on psychosocial health and body image, the prime motivators for men undergoing surgery, and gender-sensitive bariatric surgery care, support, and information targeted for men.

While the men in this study have all had early positive weight loss outcomes following the surgery, intuitively, psychological and physical factors play a role in weight loss following bariatric surgery and understanding how these factors interact to affect outcomes for men is important (Livhits et al., 2012; Wimmelmann, Dela, & Mortensen, 2013). Previous research identified a higher incidence of females than males with body dissatisfaction when seeking bariatric intervention (Grilo, Masheb, Brody, Burke-Martindale, & Rothschild, 2005) and suggests that bariatric surgery does not fully address the intersection of psychological and physical issues. This could potentially increase the chance of unsuccessful weight loss (Bonne, Bashi, & Berry, 1996; Masheb, Grilo, Burke-Martindale, & Rothschild, 2006; Ogden, Avenell, & Ellis, 2011). While the physical benefits of bariatric surgery for weight loss are well-known (Adams et al., 2012; Pagoto et al., 2012), the psychosocial aspects of postsurgery adjustment, especially for male patients, requires further investigation.

The participants of this study collectively described a number of impediments to their psychosocial functioning due to being obese that were closely related to their descriptions of poor physical health and poor body image/concept of shape or size. A conflict between men’s description of their obese body and their body image concerns seemed to resonate from the data. It appeared that some of the males in this study attempted to whitewash their concerns related to body image, which could be related to gender factors where typically body image and body descriptions have been largely restricted to women. More recently, the male’s ideal body size and image have been made more visible in society and men are aspiring to a perfect body shape (Grogan, 2007). Women’s decisions to undergo bariatric surgery are typically motivated by concerns about their appearances and, in general, women seeking bariatric surgery have a lowered body satisfaction compared with men (Jensen et al., 2013). Similar to previous research findings, the men in this study identified body image concerns, which in some cases were minimized by them, where they identified that their primary motivation was to improve their health in the first instance. This is supported by recent research where men minimize the cosmetic benefits of surgical interventions for weight loss (Bocchieri et al., 2002; Brantley et al., 2014).

Another interesting finding was the men’s description of seeking information and consultation for their surgery. The main source of information for obese men, identified by the findings of this study, was predominately the Internet (i.e., YouTube and Google). Participants suggested videos of other men’s experiences with bariatric surgery would be valuable in helping them determine their options in an anonymous way. Unfortunately, YouTube testimonials of obese men who have had bariatric surgery were thought to be elusive, and available information on the web relating to surgical options was generally perceived as being geared toward females. In consideration of this point, there is a need for more accessible information specifically for men to assist them in making a decision for surgery than is currently available.

Given that men are an underrepresented group in the bariatric patient cohort, gender-sensitive practices are recommended. The men in this study identified that they needed the gastric surgery to assist them to take control of their weight loss, as all other methods such as dieting had failed. A couple of the participants interestingly reported that having surgery may appear to others as a sign of weakness or being undisciplined with dieting. The majority of participants were only comfortable to disclose their surgery to close family, if at all. In a review, Galdas, Cheater, and Marshall (2005) identified gender-specific differences related to help-seeking health behaviors, where “traditional masculine behavior” in White, middle-class men was considered an explanation for differences in male and female help seeking. Gender differences, including help seeking, is a complex construct in health care and can affect health behavior and influence health overall including health beliefs (Evans, Frank, Oliffe, & Gregory, 2011), thus identifying a need for gender-sensitive care in men’s health and, in particular, bariatric care (Celik, Lagro-Janssen, Widdershoven, & Abma, 2011).

While this study does highlight some of the important factors related to men regarding undergoing bariatric surgery, the sampling of a small number of available participants from a single practice in Australia may prohibit the transferability of the results to other settings. The participants of this study were homogenous in the context of White, privileged, and Australian-born males. The men in this study had also recently undergone surgery (>3 months and <12 months) prior to the interview. As research suggests, a substantial portion of individuals regain weight at 18 to 24 months postsurgery (Ogden, Clementi, & Aylwin, 2006); therefore, the findings can only be interpreted for the short-term implications of bariatric surgery. Follow-up research may include investigating the psychosocial impacts for men postbariatric surgery in the long term and sustaining weight loss outcomes. The homogenous and small sample size may also implicate findings; however, qualitative research is such that a large sample is not required and data saturation can be obtained with as few as six participants for a homogenous group (Kuzel, 1992). Additionally, the telephone interview process used for data collection, while it may contribute to the participant’s willingness and authenticity to describe their experiences fully, does exclude the opportunity to capture important data related to participant’s body language, facial expressions, and gestures. The telephone interview used for this study still allowed a positive relationship to develop between the researcher and participant.

Conclusions and Implications

The male experience of postbariatric surgery adaptation, body image, and changes explored in this study identified areas which may be targeted to potentially improve medium- and long-term outcomes for men who may require bariatric surgery. The implications for practice relate to a need for more information targeted for men who are deciding to undergo bariatric surgery. Information that is readily accessible, anonymous, and based on real-life experiences of other men who have undergone the procedure may be preferred by men. While input from experts in the field is valuable and necessary, having access to Internet-based health care information may offer a private “first stop” for males considering weight loss surgery. Given the dearth of available health information, specifically for obese men, on the Internet, this is an area for further contribution from health care providers.