Bariatric surgery stigma from the perspective of bariatric surgery patients: a scoping review

Background: Bariatric surgery is recognized as a generally safe and effective method for the treatment of obesity, however, the surgery as well as patients who choose for surgery are stigmatized. Although research into bariatric surgery stigma is receiving growing attention in the literature, patients’ experience with this stigma and the implications thereof remain unclear.

Objective: Therefore, the purpose of this scoping review was to review the currently available literature on patients’ experiences with bariatric surgery stigma and identify key findings and gaps in the literature.

Methods: A total of 2,835 records were screened, and 27 studies were included. Only (1) original research published in a peer-reviewed journal (2) written in English or Dutch (3) which discussed the perception, experiences and/or consequences of bariatric surgery stigma from the perspective of pre- or post-bariatric surgery patients were included. No date restriction was applied. Data from the articles were charted and findings related to stigma were grouped thematically using the health stigma discrimination framework developed by Stangl et al. [1].

Results: Many of the studies show that patients experience several types of stigmas, including public, perceived, anticipated, and internalized stigma related to undergoing bariatric surgery. Patients were confronted with negative comments and judgment from others, such as friends and family members, when they disclosed their decision to have surgery or when they revealed that they had undergone surgery. These experiences, including the perception, anticipation, and internalization of stigma, led to conflicts in the decision-making process, such as delaying the choice for surgery, seeking surgery abroad, or opting out. Patients who internalized the stigma often reported feelings of shame and embarrassment for choosing surgery and felt the need for secrecy or selective disclosure. Feelings of anger and frustration were also reported among patients who disagreed with the stigma surrounding surgery. Experiences of stigma were influenced by socio-cultural norms and neoliberal ideas about health and personal responsibility.

Conclusion: This scoping review enhances our understanding regarding the experiences with and implications of bariatric surgery stigma in patient’s everyday life. However, most of the included studies focused on patients’ experiences with weight stigma rather than bariatric surgery stigma. Those studies that did address bariatric surgery stigma from patients’ perspective tended to do this superficially or implicitly as no clear conceptualization of bariatric surgery stigma was provided. Further research which attempts to conceptualize bariatric surgery stigma and explores the experiences from bariatric surgery patients’ perspective are needed to increase our understanding and help inform stigma reduction strategies.

Reference
1. Stangl, A.L., Earnshaw, V.A., Logie, C.H. et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 17, 31 (2019).