All women had undergone gastric bypass surgery – one of the most common bariatric surgery procedures. It involves rerouting a part of the small intestine past the stomach in order to reduce food intake, promote satiety and suppress hunger.
The majority of the women were interviewed twice. The first time was 1 year after surgery, while the second interview took place 2.5-4 years following surgery.
Groven says although most previous research suggests that weight loss surgery leads to an increase in quality of life for the majority of patients, her findings suggest that not everyone lives happily ever after following bariatric procedures.
Positive outcomes after surgery 'can feel like grief'
There is no doubt that weight loss surgery puts the body through a series of radical changes.
Groven says that although the procedure leads to a slimmer body – which others perceive as a "sign of success" – the surgery can cause many smaller problems that other people are unable to see.
"Becoming slimmer and lighter is mostly perceived of as positive. At the same time it is ambivalent, since people start to behave differently towards the women after they've had surgery.
People are friendlier than before, and this may feel extremely provoking. And people often ask very invasive questions concerning the woman's radical weight loss."
The interviews revealed that some of the women experienced a boost in self-esteem after surgery, were more outspoken, and found other people were more likely to listen to what they were saying – particularly in the workplace.
Groven notes that although these factors are clearly positive outcomes, this could also be seen as a "grief" because the women realize they had to undergo weight loss surgery before seeing these outcomes.
Many of the women also felt embarrassment after the surgery, particularly when it came to speaking about their weight loss. Some women told others they had been on a diet to lose the weight because they were ashamed to say they had undergone bariatric surgery.
Excess skin promotes a negative self-image
Groven found that many of the women had mixed feelings about their naked body after surgery, and many of these feelings come from the occurrence of loose skin – a common consequence of rapid weight loss.
"It is given little focus before the operation. Patients are often told that this is something that can be fixed afterwards. But it is not so easily fixed, and the women are not prepared for the challenge of having to live with the loose skin," explains Groven.
Although women can undergo surgery to remove excess skin, Groven notes that many women are not prepared to take the risks associated with this procedure, which include hematoma or seroma formation, infection and risks associated with future pregnancies.
Groven found that some of the women interviewed even spoke about their excess skin in third person, which she believes is a way of distancing themselves from it.
Health problems and bad food relationships after weight loss surgery
According to Groven, five of the women interviewed reported a lower quality of life after they underwent weight loss surgery, compared with their quality of life before.
She notes that this was down to the development of chronic stomach and intestine problems, and one woman became so ill that she had to endure another operation because of problems with her scar tissue after the gastric bypass procedure.
The five women also said they felt as if they had complete lack of energy following weight loss surgery.
Furthermore, Groven found that many of the women reported having a negative relationship with food after the procedure.
Some women were worried about eating too much or too little, or eating the wrong food at the wrong time. Because of these concerns, some women experienced tiredness, nausea, dizziness and even intense shaking.
Some of the women who had problems with overeating before weight loss surgery continued to overeat after surgery, even though this made them ill. Groven says some women commented that "the eating disorder is not gone."
Groven says that while previous research suggests that patients can avoid testing their eating limits after surgery by following dietary advice, the reality is much more complicated.
"It is reasonable to ask, I think, whether the eating disorders that some of the women develop after surgery are diseases, or if they may be understood as normal changes as a result of the operation."
Although many women reported negative thoughts and health issues after weight loss surgery, none of them said they regret undergoing the procedure.
"They say they would have done the same today and that they had no choice considering their life before surgery. Some said that the pains were a small price to pay," says Groven.
She adds that this suggests women are influenced by society's perception of the ideal female body, and that being obese is not within this scope.
"They are living with a body which is not accepted by society, and they are constantly judged from their size," she says.
"The message from the media and medical science is that they are likely to get cancer or diabetes unless they lose weight and the surrounding world regards their obesity as self-inflicted. Some have children and are afraid to die and leave them alone."
Groven concludes that although it is true that obesity can lead to health complications, such as diabetes and heart attack, little is known about the long-term effects of weight loss surgery and what complications may arise from this procedure.
With this in mind, Groven plans to conduct further research that will look at the effects of bariatric surgery 3-10 years after patients have undergone the procedure.