Filling The Critical Void: Virtual Postoperative Bariatric Support Groups

| September 1, 2022

by Aaron J. Goodman, JD

Mr. Goodman is an attorney and support group leader in Tulsa, Oklahoma.

Funding: No funding was provided for this article.

Disclosures: The author reports no conflicts of interest relevant to the content of this article.

Bariatric Times. 2022;19(9):8–9.


Abstract

After the “honeymoon” period has lapsed, many postoperative bariatric surgery patients face struggles that put them outside of the familiar boundaries laid out in the preliminary roadmap given to them by their surgeons. To ensure long-term success for bariatric surgery patients, mechanisms must exist to enable ongoing communication, information sharing, and socialization with similarly situated individuals. One such mechanism, the bariatric support group, has been repeatedly proven to increase the odds of a successful post-bariatric surgery journey. Given the efficacy and necessity of telehealth services during the last few years, virtual support groups have become a powerful tool to maintain connections with postoperative patients, as well as to increase the ease-of-access for participation.

Keywords: Bariatric surgery, weight loss surgery, support group, virtual, online, postoperative, postoperative patient struggles, telehealth


In today’s modern age of technology, virtual support groups provide a fantastic opportunity to bridge the gap between patient needs and accessibility. As a successful vertical sleeve gastrectomy (VSG) patient, I developed a virtual support group in October 2020 (which still meets regularly) to help other post-bariatric surgery patients survive during the absence of in-person groups. Appreciating why the online support groups effectively fill a critical void to connect postoperative patients requires a brief understanding of the bariatric journey and highlighting some common realities of bariatric patients. 

Asking your patients for a description of the post-bariatric surgery patient life will likely produce a wide spectrum of responses that vary by person and by the phase of life each person is in when they respond. For many, the journey is a winding path filled with the usual ups and downs of life. For others, the journey is a daily battle to fight temptations and to avoid minefields. In 2001, HBO released its critically acclaimed television miniseries, Band of Brothers, depicting the real-life experiences of the heroes of E (“Easy”) Company in the 506th Parachute Infantry Regiment of the 101st Airborne Division in World War II. The title of the companion documentary, We Stand Alone Together: The Men of Easy Company, perfectly encapsulates one common reality of the postoperative bariatric experience: we stand alone together.1 

It is important to distinguish between the concepts of standing alone as an individual patient responsible for one’s own choices and being alone without a support network. Boot camp transforms inexperienced recruits into survival-ready soldiers through military training. Bariatric healthcare teams transform preoperative patients into survival-ready postoperative patients through research-based guidance. All post-bariatric surgery patients, like combat soldiers, share the common experience of walking through incredible struggles toward the goal of victory. Post-bariatric surgery success or failure is often contingent on individual patient choices and lifestyle changes. Thus, all post-bariatric surgery patients stand separately within the sphere of control they have over their own actions, but stand together as part of a community with shared challenges. Support groups serve as a proven component of the postoperative patient’s support network. 

I once heard a wise bariatric surgeon quip that his patients receive weight loss surgery, not lobotomies. The surgeon learned from his relationship with thousands of patients that the most perfect surgical techniques, equipment, and results cannot replace the need for his patients to overcome their disordered thinking about food. 

Another common reality of the postoperative bariatric experience is perfectly encapsulated in Joyce Meyer’s book title, Battlefield of the Mind.2 We know conclusively that the failure to adopt appropriate behavioral changes will result in weight regain and rebounding of chronic diseases that had been in remission, as well as a less successful overall bariatric surgery experience. There is not only a plethora of published research proving the absolute necessity of behavioral modification for long term success, but also the anecdotal stories swapped among both patients and nonpatients about people they know who have “gained back all of their weight” after bariatric surgery. 

In a recent journal article, the authors make a compelling case that addressing postoperative weight regain should include the professional expertise of multiple specialties within the bariatric treatment team. As these authors state, “Weight regain is a common phenomenon following bariatric surgery…The causes of weight regain are multifactorial with the main contributing factors being the lack of lifestyle changes, patient adherence to the support groups, and preoperative body mass index (BMI).”3

The postoperative journey requires an appropriate combination of strategy, tactics, and logistics to win the long-term battle. Similar to a military commander, the surgeon is a leader who has the first opportunity to frame a strategy to begin changing the patient’s diet mentality (short-term) for a lifestyle mindset (long-term). One necessary element of the bariatric treatment team’s ongoing strategy after surgery is the postoperative support group. Adherence to the support group increases when attendance can be accomplished online because interfering barriers are either eliminated or reduced.

Twelve years before the world would adopt the widespread use of virtual meeting technology in response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the concept of online bariatric support groups was mentioned in a prophetic Bariatric Times article. In their 2008 article, “Who Participates in Online Support Groups for Bariatric Patients?,”4 authors Douglas Sutton, EdD, ARNP, NP-C, and Deborah A. Raines, PhD, RN, discussed, in part, the benefits of online messaging boards for supporting postoperative patients. At the time their article was written, videoconferencing software was not in widespread use by the general public, and that technology was cost-prohibitive enough to be limited to business or governmental applications. Nonetheless, these authors would prove to have incredible prescience about how bariatric support groups adapted and thrived in response to the SARS-CoV-2 pandemic. 

The authors observed that “another potential benefit of an online support group is the ability to overcome geographic obstacles that may interfere with monthly face-to-face participation.” Furthermore, they point out that “The widespread use of computers in the home or work setting has decreased the barriers of technology used as a therapeutic tool for support group participants… Healthcare providers clearly recognize the need to facilitate and nurture healthy behaviors following bariatric surgery. Realizing the complexities and designing forums that mitigate obstacles for individual support group participation can only serve to enhance the therapeutic relationship between the healthcare professional and the individual as well as improve patient outcomes.”4

Fast forward to October 2020, when the world was about seven months into the SARS-CoV-2 pandemic. At that time, in-person bariatric postoperative support groups had been scuttled, and there were no alternatives on the horizon. In a vulnerable population whose very success has been proven to include support groups, this was a huge problem. At the time, many of us assumed that life would return to normal fairly quickly (with in-person support groups resuming), but that obviously did not happen. Seeing no alternatives and taking an uncomfortable first step, I started an independent, online bariatric support group geared to postoperative patients using a popular virtual conferencing platform. When my group began, I was only 16 months out from my gastric sleeve procedure. Nonetheless, I secured the generous assistance of two successful, long-term bariatric surgery patients beginning with the very first session to provide the online group with necessary experience. 

As of writing this article, I have successfully hosted and led 41 separate virtual postoperative support group meetings since October 2020. The many helpful tips, tricks, techniques, and tools shared within the online support group have immeasurably benefitted the participants. In the dichotomy of clinician-led and patient-led groups, mine are patient-led support groups. In the dichotomy of closed (set attendees without new members joining) and open groups (anyone with a meeting link can join a group regardless of past attendance), mine are open support groups. As the host, I facilitate the meetings, advertise them, and coordinate the speakers. I also obtain articles of interest, videos, and research papers to provide to the attendees to serve as the foundation for the various discussions. Invitations for my groups are sent by me to a closed email distribution list, through direct messaging, and within a closed bariatric Facebook page.5 

Many sessions have also included raw discussions about struggles group members were having while in different phases of their journeys. The participants give and receive authentic support from fellow group members. The camaraderie among participants exists because of the honesty and empathy exhibited by the attendees. New friendships have emerged between many of the attendees with people who did not know each other prior to attending the online support group.

In session, we have covered all of the major topics in postoperative care (e.g., mindful eating, accountability steps, nutrition, weight regain, hydration, mental health issues, head hunger, nonscale victories, weight plateaus, food logging), as well as many less obvious topics (e.g., processed foods, addiction transference, holiday and celebration survival techniques, gut microbiota). Many of the virtual meetings include credentialed bariatric healthcare professionals volunteering their time to speak to the group. These professionals will often incorporate PowerPoint presentations, exhibit slides, and handouts as part of their presentations. The relaxed environment presented within the virtual support group fosters an effective platform for the participants to engage in discussions with the credentialed speakers. As expected, the virtual support group has the advantage of allowing out-of-town presenters to appear without the cost-prohibitive impediments of travel. Moreover, the group dynamic allows different perspectives to be shared in session, which generates additional discussion topics not originally anticipated. 

While attendance waxes and wanes depending upon the covered topics, I have seen as few as eight and as many as 30 participants, with an average of 12 attendees for a normal meeting. As expected, larger groups enable a greater number of people to receive information (such as with a guest speaker), whereas the smaller groups allow for more intimate discussions and more airtime for attendees. In my groups, everyone who wants to share will have that opportunity, and no one is relegated to hiding in the shadows, unless they only want to observe. 

To promote a consistent level of decorum, most participants (including the host) will mute their microphones to eliminate background noise and unmute when they want to speak. Additionally, the host will serve as traffic control to admit people from the virtual waiting room, mute people who are unmuted with background noise, and ensure an equitable speaking order is maintained. 

Virtual support groups offer a terrific mechanism for promoting connection when time, distance, and other considerations prevent in-person attendance. The ability of participants to multitask during the sessions, such as preparing and eating dinner, listening while driving, attending while shopping, and removing childcare concerns, further increases the inclusive effects of participating in online support group sessions. Other positive aspects of virtual groups are that participants can hear discussions better than sitting in a large room and distracting side conversations are eliminated. 

Healthcare providers specializing in the treatment of bariatric populations face patient compliance challenges that differ from other specialties. With the common goals of maximizing long-term success and increasing desired health outcomes, well-planned postoperative bariatric support groups are effective tools to increase connectivity with patients. Telehealth and its associated benefits are here to stay, such that a dedicated virtual support group should be considered as a compliment to traditional, in-person bariatric support groups. 

References

  1. Cowen M, Richter W. We Stand Alone Together: The Men of Easy Company. Home Box Office, Inc; 2001. 
  2.  Meyer J. Battlefield of the Mind. Faithwords; 2002.
  3. Cambi MPC, Baretta GAP, Magro DDO, et al. Multidisciplinary approach for weight regain—how to manage this challenging condition: an expert review. Obes Surg. 2021;31(3):1290–1303.
  4. Sutton D, Raines DA. Who participates in online support groups for bariatric patients? Bariatric Times. 2008;5(10).
  5. Goodman A. My Bariatric Journey and Lessons Learned for Success. Weight Matters. 2021;17(Fall):6–9. 

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