 Understanding Obese Patients’ Engagement by Their Empowderment Level: the Case of Bariatric SurgeryAngélique Rodhain () and
Andréa Gourmelen ()
Post-Print from HAL Abstract: Called ‘one of the greatest public health challenges of the 21st century' (World Health Organisation – Europe), obesity has nearly tripled since 19751. This fact is particularly alarming since, in addition to the direct deaths it implies, obesity is also a major risk factor for many other diseases such as diabetes. Since obesity is difficult to overcome, bariatric surgery is then presented as a solution for patients. It aims at reducing drastically the patient's ingestion capacity by reducing the stomach size (sleeve) or by short-circuiting a part of the stomach and of the small intestine (by-pass). Nevertheless, even if bariatric surgery is almost systematically efficient in the short-run, its success in the long-run is far from being satisfactory, and it relies heavily on the patient's engagement which is mainly based on regular physical activities, a suited diet and regular medical monitoring. Thanks to life narratives of 14 patients (more than 36 hours of recording, 420 single- spaced pages) who are about to get a bariatric surgery, this study aims at offering a patient- centered perspective on their own engagement and empowerment. A bulk of research on public health deals with patient empowerment. Schneider-Kamp and Askegaard (2019) have emphasized four dimensions of patient empowerment: participation, control, education and autonomy. Even if a consensus on the definition of this concept is still needed, since it is defined as a process, a state or some behaviors (Fumagalli et al., 2015) and according to the sense of the process (top-down or bottom-up) (Fayn et al., 2019), we understand patient empowerment here as "a process which help patients reject their passivity in their health behavior and assume their responsibility in their own care process" (Ben Ayed and El Aoud, 2016, p.9). The case of bariatric surgery is theoretically interesting in the consumer behavior field since it can be either imposed by the surgeon for medical reasons or chosen by the patient for personal reasons but, whatever the case, the patient has to prove his/her engagement in a suited physical activity and diet for the surgery to be accepted by the medical team. Therefore, the link between patient's empowerment and engagement remains to be deepened (Cases, 2017), and particularly in this case of bariatric surgery. By crossing engagement and empowerment levels, 4 profiles arise: (1) the group of "watchers" is composed by 7 people who are rather passive in the medical protocol and low in engagement. For example, Stéphane underwent the mandatory protocol to have surgery without seeking any information: he started and continues the process following a succession of advices from his general practitioner. He doesn't realize how his diet will have to change in the future. He claims that he has already changed, but still describing fairly limited modifications, or procrastinates. For the "watchers", the doctors bring the solution to their problem in a somewhat miraculous way. Most of them having never been sportspeople, they don't seem ready to start any physical activity afterwards. They know they are supposed to be involved, but their discourse show that they hope bariatric surgery should change their lives without their participation. (2) The "contributors" (4 women – high engagement – high empowerment) are strongly engaged in the medical protocol, have implemented changes in their current behavior, and think about other changes in their daily life after surgery. For example, Tania, who chose to consult a psychologist, an endocrinologist and a nutritionist for many years, has internalized the reasons for her weight gain. She understood that it was time to take care of herself by adapting her diet and starting physical activity. The "contributors" engage in a win-win relationship: the medical staff give them a boost, but it's up to them to be active for a long- term weight loss; (3) the (small) group of "repentants" (2 people – high engagement / low empowerment) doesn't seek to emancipate themselves from the medical profession. They follow the protocol and opt for the surgeon and the doctors they have been advised. They differ from "the watchers" in the sense that their respect for the medical staff lead them to internalize their discourse. They started the bariatric surgery process because they operated a reflexivity leading to an understanding of their weight gain responsibility. For example, even if Pierre initiated the first discussion with his general practitioner about the operation, he then followed all his recommendations. Particularly attentive to the specialists he met, he has integrated the mistakes he made, wishing to readjust himself. He really becomes aware of the need to change his whole way of life; (4) finally, the (very small) group of "cheaters" (1 woman – high empowerment / low engagement) uses information learned on social networks to set up strategies to get around the rules. Only one patient out of the 14 we met confesses to be in this case. Thus, Karine explains that she followed up to 150 virtual accounts in social media in order to learn the "tricks" to get the "green light" for surgery: "There is…What we should tell the psychologist?". In terms of engagement, she says: "I know that I eat too much, I know it, too much junk food" without talking about any actual or planned changes. In addition, she understood the paradoxical injunctions given to patients: to pretend that one is in the process of losing weight, but to have a high BMI at the appointment. Thus, the strategy is to gain weight just before the first appointment, to show 2-3 months later that one has been able to lose few pounds (by pretending to change one's behavior, but without doing so): it is therefore a matter of integrating the rules to turn them to one's personal advantage. To sum up, the majority of interviewees showing strong empowerment also shows high engagement. This taxonomy could serve as a first basis for the health care staff during appointments throughout the process, to personalize the doctor-patient relationship as much as possible, and for public policies to better inform about the consequences of such a surgery in terms of engagement. Keywords: life narrative; empowerment; obesity; implication; health marketing (search for similar items in EconPapers) Published in Advances in Consumer Research, Oct 2020, Paris, France. pp.625 - 645 There are no downloads for this item, see the EconPapers FAQ for hints about obtaining it. 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