Bariatric Times - January 2009 - (Page 14)

14 Psychological Perspective Bariatric Times • January 2009 Continued from Page 1 Clinically severe or morbid obesity is associated with an increased risk of morbidity and mortality from many physical and emotional conditions. From a clinical perspective, most healthcare providers are well versed in the knowledge that conditions such as coronary artery disease, diabetes mellitus, dyslipidemia, and certain types of cancers are more prevalent in this population. However, the profound influence that severe obesity has on the individual and their identity as a member of society is less well understood. The purpose of this research was to explore, using qualitative research methods, the experience of 14 women who underwent WLS and their decision-making processes. This article explores one major theme that was identified; that being “secrecy” or purposeful nondisclosure. LITERATURE REVIEW Secrecy or nondisclosure has been reported in the healthcare literature among persons who are members of socially stigmatized groups. Robinson and McGrail report that the most common reason persons fail to fully disclose health information is due to a concern about receiving a negative response from others.3 This behavior is typically learned at an early age and may serve as a coping mechanism in overweight and obese children. It is well established that the majority of adults who choose to undergo a WLS report being overweight or obese as children and adolescents. Therefore, each diet failure or weight regain may negatively reinforce both the individual and societal stereotype and contribute to a personal desire to conceal past failures. This form of learned secrecy has been shown to have a more profound impact on adolescents, particularly adolescent females. Keijsers and colleagues reported that secrecy and nondisclosure are most damaging in early adolescence and found that younger adolescents who hid information from others tended to internalize problems and to have less self-concept clarity which leads to poor individualization.4 With the majority of WLS procedures being performed on adult females, this observation may serve as a link between behaviors learned early in life and those observed later in adulthood. In a 2008 iVillage online poll, 2,825 respondents were asked if they had ever dieted in secret, and the results revealed that 65 percent, or 1,846 people, indicated they had.5 These persons stated that they did so to avoid being sabotaged or judged. Stigmatizing obesity has been considered the last safe prejudice in our society. The belief that weight is controllable results in strong confidence that obese individuals simply lack motivation or responsibility for a condition that is under their control. Each time that an overweight or obese person attempts to lose weight and fails may reinforce to that person and to others the perception of a lack of self control. Obesity is associated with significant social consequences. Emerging evidence suggests that even as worldwide obesity rates increase, so too does the stigma related to body weight.6 Few studies have addressed the psychosocial attributes of the participant’s decision to undergo SWLI. Qualitative research provides a unique opportunity to learn about the participants’ experience and to illuminate the meaning of their experience expressed in their own words. RESEARCH QUESTION This paper describes the phenomenon of “secrecy,” also referred to as “failure to disclose,” that emerged from data collected from the experiences of women who underwent bariatric surgery. These findings are part of a larger study of women’s experiences after undergoing WLS. STUDY DESIGN AND METHODS A qualitative approach was used to explore women’s choice to undergo WLS. The goal of the research was to determine meaning in the individual experiences and choices of the participants. In this respect, the research approach was consistent with a phenomenological method of investigation. The study proposal was approved by the university’s institutional review board (IRB). Following completion of the informed consent procedures, a research assistant contacted the participants to schedule the interviews. The interviews were conducted by phone and audiotaped with the participants’ knowledge and assent. The same research assistant conducted all interviews to increase the consistency in the interview format and process. Using purposeful sampling, individuals who had undergone WLS were invited to participate in an interview about their experience. A semi-structured interview was conducted. The interview consisted of open-ended questions to allow participants to fully explain the thoughts and decisions leading to their surgeries. This article describes the findings related to secrecy, meaning the lack of I’ve Got a Secret: Nondisclosure in Persons Who Undergo Bariatric Surgery by Douglas Sutton, EdD, ARNP, ANP-C; Natalie Murphy, BSN, RN; and Deborah A. Raines, PhD, RN, ANEF Douglas Sutton, EdD, ARNP, ANP-C is Assistant Professor; Natalie Murphy, BSN, RN, is a PhD Student and Research Assistant; and Deborah A. Raines, PhD, RN, ANEF is Professor, all from Florida Atlantic University, Boca Raton, Florida.

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Bariatric Times - January 2009

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