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Obesity and Effects of Bariatric Surgery - with a Certain Focus on Women's Health
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.ORCID iD: 0000-0001-5355-8276
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss.    

This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss.  

Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery.  

Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data.  

Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration of levels after surgery. Ten women were included, and analysis of the horizons created the fusions of “Recognition of Unhealthy Body Weight”, “Dealing with Other People’s Opinions and Society’s Norms”, “Life has Changed in a Positive Way” and “Accepting Inner Self and Bodily Changes”.  

Finally, to elaborate on previous studies' findings and better understand the current knowledge base, a systematic review and interpretative meta-synthesis of published literature involving qualitative methods concerning women’s experiences of womanliness related to changes after undergoing bariatric surgery was conducted in study IV. Ten relevant studies were included, and a meta-synthesis, according to Gadamer’s hermeneutics, created the fusions of “Womanliness,” “A Healthy and Functioning Body,” and “Mind and Body Connection.”  

This thesis provides a clearer understanding of the experiences of living with obesity that motivate premenopausal women to seek bariatric surgery. The importance of postoperative benefits such as restored function, health and womanliness are illustrated as well as clarifying difficulties involving adaptations to life after surgery. These findings may inform potential bariatric surgery candidates and healthcare professionals of the experiences of women living with obesity, as well as expectations,  postoperative experiences and challenges. These findings promote patient-centred guidance prior to surgery and during postoperative follow-up. 

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2023. , p. 93
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1832
Keywords [en]
Sex hormones, Fertility, Women’s health, Obesity, Bariatric surgery, Experiences
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-198590DOI: 10.3384/9789179295608ISBN: 9789179295592 (print)ISBN: 9789179295608 (electronic)OAI: oai:DiVA.org:liu-198590DiVA, id: diva2:1805943
Public defence
2023-12-01, Fornborgen, Campus Norrköping, Norrköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2023-10-19 Created: 2023-10-19 Last updated: 2023-10-31Bibliographically approved
List of papers
1. Health-Related Quality of Life, Sexuality and Hormone Status after Laparoscopic Roux-En-Y Gastric Bypass in Women
Open this publication in new window or tab >>Health-Related Quality of Life, Sexuality and Hormone Status after Laparoscopic Roux-En-Y Gastric Bypass in Women
2020 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, p. 493-500Article in journal (Refereed) Published
Abstract [en]

Objective

Few studies have been carried out concerning the influence of bariatric surgery on female sexuality and hormones, particularly utilizing hormone-based questionnaires. The effect of bariatric surgery on sex hormone levels, sexual function and health-related quality of life (HRQL) in women was analyzed in this study. Participants were included in a single-center study at a regional hospital in Sweden, with a duration of one-year follow-up.

Methods

One hundred non-smoking women, undergoing laparoscopic Roux-en-Y gastric bypass, were included in the study. Blood assay for sex-hormone binding globulin (SHBG), testosterone, estrogen, progesterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was analyzed. Participants completed the Female Sexual Function Index (FSFI), Women’s Health Questionnaire (WHQ) and Psychological General Well-being Inventory (PGWB) parallel to lab testing.

Results

At one-year follow-up, several significant results were found concerning hormones and questionnaires. Testosterone decreased and SHBG increased, N = 68/100. Desire, arousal, orgasm, satisfaction and total score domains for the FSFI increased after one year, N = 53/100. WHQ domains concerning depressed mood, somatic symptoms, memory, anxiety, sexual behavior and attractiveness improved after one year, N = 47/100. All domains in the PGWB (N = 52), including anxiety, depressed mood, positive well-being, self-control, general health, vitality and total score improved at follow-up. Spearman’s Rho coefficient analysis found correlation between testosterone/WHQ-sexual problems (0.3), SHBG/WHQ-general health (0.3) and SHBG/FSFI-arousal (−0.3).

Conclusions

Bariatric surgery normalizes levels of sex-hormones in women, and results in improved sexual function, health-related quality of life and psychological well-being.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2020
Keywords
Obesity; Hormones; Bariatric surgery; Women; Sexual function
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-162345 (URN)10.1007/s11695-019-04197-5 (DOI)000494169700003 ()31641981 (PubMedID)2-s2.0-85074025932 (Scopus ID)
Note

Funding Agencies|Linkoping Medical Faculty Grant Board [LIO-309361]; Region Ostergotland [LIO-421541, LIO-601561, LIO-507021, LIO-342321]

Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2023-10-19Bibliographically approved
2. Motherhood and motivations for bariatric surgery - a qualitative study
Open this publication in new window or tab >>Motherhood and motivations for bariatric surgery - a qualitative study
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2023 (English)In: Human Fertility, ISSN 1464-7273, E-ISSN 1742-8149, Vol. 26, no 2, p. 257-265Article in journal (Refereed) Published
Abstract [en]

Obesity and its concomitant comorbidities have a myriad of detrimental effects on health, fertility, and quality of life. Bariatric surgery is an effective treatment for inducing weight loss and reduction of obesity-related comorbidities including subfertility. The aim of this study was to explore the expectations and experiences of women with a desire to have children as a motivation for undergoing bariatric surgery. An inductive qualitative design was used. Fourteen women were interviewed, and transcriptions were analysed with thematic analysis. Two themes emerged: (i) Motherhood and Femininity and (ii) A Normal Life. Participants found no other solution than to seek bariatric surgery to be able to become pregnant and carry a child to term. Coping physically with pregnancy and being an active mother were important factors. Overall, postoperative expectations were met, and the women experienced the effects of normalised sex hormone levels, were more physically mobile, and were released from the previous social hindrances that obesity caused them. This study has clinical implications for providing support and information to women with subfertility considering bariatric surgery and to better understand their experiences of life after bariatric surgery.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2023
Keywords
Bariatric surgery; experience; infertility; obesity; qualitative study; womens health
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-183587 (URN)10.1080/14647273.2022.2045520 (DOI)000764926200001 ()35243963 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland, Sweden [06000984]

Available from: 2022-03-15 Created: 2022-03-15 Last updated: 2023-11-21Bibliographically approved
3. Womens lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study
Open this publication in new window or tab >>Womens lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study
Show others...
2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 6, article id e072085Article in journal (Refereed) Published
Abstract [en]

ObjectivesThe study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels. DesignA qualitative interview study with transcribed text analysis based on Gadamers hermeneutics. SettingRegional hospital and outpatient bariatric clinic in central Sweden. ParticipantsTen women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed. ResultsThe transcribed interviews were analysed according to Gadamers hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions Recognition of unhealthy body weight, Dealing with other peoples opinions and societys norms, Life has changed in a positive way and Accepting inner self and bodily changes. ConclusionWomen highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2023
Keywords
bariatric surgery; life change events; obesity; hermeneutics; sex steroids & HRT
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-196872 (URN)10.1136/bmjopen-2023-072085 (DOI)001021531400049 ()37355262 (PubMedID)
Available from: 2023-08-25 Created: 2023-08-25 Last updated: 2024-01-15

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