Original article|Articles in Press

Patient experiences with micronutrient and overall nutrition management after bariatric surgery: identifying facilitators and barriers to implementing care

Published:February 14, 2023DOI:



      Adherence to perioperative guideline recommendations for prophylactic supplementation and regular biochemical monitoring is suboptimal. However, little is known about the patient perspective on this postoperative challenge.


      To qualitatively explore patient experiences of postoperative micronutrient management and identify patient-reported barriers and facilitators to the provision of nutrition care.


      Two tertiary public hospitals in Queensland, Australia.


      Semi-structured interviews were conducted with 31 participants 12 months after bariatric surgery. Inductive analysis of interview transcripts was performed using applied thematic analysis, and deductive analysis was performed by aligning interview themes against the Theoretical Domains Framework and the Capability, Motivation, and Opportunity Behavior Change Wheel Framework.


      Participants’ perceptions of engagement with the bariatric surgery multidisciplinary team greatly influenced their experience with overall nutrition care, including but not exclusive to micronutrient care. At times, this engagement negatively impacted patients’ experiences with their nutrition care and related to varied acceptance of healthcare advice from the team or, at times, an unmet desire for person-centered communication styles. Engaging person-centered care techniques had a positive influence on patient experience with micronutrient and overall nutrition care. Micronutrient management (taking supplements and having regular blood tests) was broadly accepted and enabled by the presence of established medication and blood test routines preoperatively. However, challenges did exist and were practical in nature. Incorporating education on habit-forming techniques was identified as a facilitator to assist with micronutrient management.


      Although participants mostly accept embedding micronutrient management into their life, developing interventions that focus on habit-forming skills and that enable multidisciplinary teams to provide person-centered care is recommended to enhance care after surgery.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Colquitt J.L.
        • Pickett K.
        • Loveman E.
        • Frampton G.K.
        Surgery for weight loss in adults.
        Cochrane Database Syst Rev. 2014; 2014: CD003641
        • Mechanick J.I.
        • Apovian C.
        • Brethauer S.
        • et al.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures—2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery.
        Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring). 2020; 28: O1-O58
        • O’Kane M.
        • Parretti H.M.
        • Pinkney J.
        • et al.
        British Obesity and Metabolic Surgery Society guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update.
        Obes Rev. 2020; 21e13087
        • Lewis C.-A.
        • de Jersey S.
        • Hopkins G.
        • Hickman I.
        • Osland E.
        Does bariatric surgery cause vitamin A, B1, C or E deficiency? A systematic review.
        Obes Surg. 2018; 28: 3640-3657
        • Lewis C.-A.
        • de Jersey S.
        • Seymour M.
        • Hopkins G.
        • Hickman I.
        • Osland E.
        Iron, vitamin B12, folate and copper deficiency after bariatric surgery and the impact on anaemia: a systematic review.
        Obes Surg. 2020; 30: 4542-4591
        • Fox W.
        • Borgert A.
        • Rasmussen C.
        • Kallies K.
        • Klas P.
        • Kothari S.
        Long-term micronutrient surveillance after gastric bypass surgery in an integrated healthcare system.
        Surg Obes Relat Dis. 2019; 15: 389-395
        • Mahawar K.K.
        • Clare K.
        • O’Kane M.
        • Graham Y.
        • Callejas-Diaz L.
        • Carr W.R.J.
        Patient perspectives on adherence with micronutrient supplementation after bariatric surgery.
        Obes Surg. 2019; 29: 1551-1556
        • Sunil S.
        • Santiago V.A.
        • Gougeon L.
        • et al.
        Predictors of vitamin adherence after bariatric surgery.
        Obes Surg. 2017; 27: 416-423
        • Graham I.D.
        • Logan J.
        • Harrison M.B.
        • et al.
        Lost in knowledge translation: time for a map?.
        J Contin Educ Health Prof. 2006; 26: 13-24
        • Smith J.
        • Bekker H.
        • Cheater F.
        Theoretical versus pragmatic design in qualitative research.
        Nurse Res. 2011; 18: 39-51
        • Kaushik V.
        • Walsh C.A.
        Pragmatism as a research paradigm and its implications for social work research.
        Soc Sci (Basel). 2019; 8: 255
        • Lohse S.
        Pragmatism, ontology, and philosophy of the social sciences in practice.
        Philos Soc Sci. 2017; 47: 3-27
        • Atkins L.
        • Francis J.
        • Islam R.
        • et al.
        A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems.
        Implement Sci. 2017; 12: 77
        • Galletta A.
        • Cross W.E.
        Mastering the semi-structured interview and beyond.
        New York University Press, New York2013
        • Guest G.
        • MacQueen K.M.
        • Namey E.E.
        Applied thematic analysis.
        Sage Publications, Thousand Oaks (CA)2012
        • Michie S.
        • van Stralen M.M.
        • West R.
        The behaviour change wheel: a new method for characterising and designing behaviour change interventions.
        Implement Sci. 2011; 6: 42
        • West R.
        • Michie S.
        • Atkins L.
        • Chadwick P.
        • Lorencatto F.
        Achieving behaviour change: a guide for local government and partners.
        Public Health England, London2019
        • Tong A.
        • Sainsbury P.
        • Craig J.
        Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.
        Int J Qual Health Care. 2007; 19: 349-357
        • Australian Commission on Safety and Quality in Health Care (ACSQHC)
        Safety and quality improvement guide standard 2: partnering with consumers.
        ACSQHC, Sydney2012
        • Australian Commission on Safety and Quality in Health Care (ACSQHC)
        Review of the key attributes of high-performing person-centred healthcare organisations.
        ACSQHC, Sydney2018
        • Australian Commission on Safety and Quality in Health Care (ACSQHC)
        Implementing the comprehensive care standard: identifying goals of care.
        ACSQHC, Sydney2019
        • Wright C.
        • Kelly J.T.
        • Healy R.
        • Musial J.
        • Campbell K.L.
        • Hamilton K.
        Lived experiences and unique psychosocial impacts following bariatric surgery in a publicly funded Australian tertiary hospital: a qualitative study.
        Aust J Psychol. 2022; 74
        • Aarts M.A.
        • Sivapalan N.
        • Nikzad S.E.
        • Serodio K.
        • Sockalingam S.
        • Conn L.G.
        Optimizing bariatric surgery multidisciplinary follow-up: a focus on patient-centered care.
        Obes Surg. 2017; 27: 730-736
        • Youssef A.
        • Wiljer D.
        • Mylopoulos M.
        • Maunder R.
        • Sockalingam S.
        “Caring about me”: a pilot framework to understand patient-centered care experience in integrated care—a qualitative study.
        BMJ Open. 2020; 10e034970
        • NatCen
        Wellcome monitor report 2018: wave 4.
        Wellcome, London2019
        • Cardenas D.
        • Fuchs-Tarlovsky V.
        Is multi-level marketing of nutrition supplements a legal and an ethical practice?.
        Clin Nutr ESPEN. 2018; 25: 133-138
        • Carpenter D.M.
        • Geryk L.L.
        • Chen A.T.
        • Nagler R.H.
        • Dieckmann N.F.
        • Han P.K.J.
        Conflicting health information: a critical research need.
        Health Expect. 2016; 19: 1173-1182
        • Teisberg E.
        • Wallace S.
        • O’Hara S.
        Defining and implementing value-based health care: a strategic framework.
        Acad Med. 2020; 95: 682-685
        • Porter M.E.
        What is value in health care?.
        N Engl J Med. 2010; 363: 2477-2481
        • Houts P.S.
        • Doak C.C.
        • Doak L.G.
        • Loscalzo M.J.
        The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence.
        Patient Educ Couns. 2006; 61: 173-190
        • Thakkar J.
        • Kurup R.
        • Laba T.-L.
        • et al.
        Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis.
        JAMA Intern Med. 2016; 176: 340-349
        • Cleo G.
        • Glasziou P.
        • Beller E.
        • Isenring E.
        • Thomas R.
        Habit-based interventions for weight loss maintenance in adults with overweight and obesity: a randomized controlled trial.
        Int J Obes (Lond). 2019; 43: 374-383
        • Lavrakas P.J.
        Encyclopedia of survey research methods.
        Sage Publications, London2008: 825-826
        • Kochkodan J.
        • Telem D.A.
        • Ghaferi A.A.
        Physiologic and psychological gender differences in bariatric surgery.
        Surg Endosc. 2017; 32: 1382-1388