How Do Trauma- and Violence-Informed Care Approaches Underpin Bariatric Surgery Interventions for Type 2 Diabetes Mellitus Remission? A Scoping Review.

Abstract

For individuals living with obesity, bariatric surgery is an effective intervention for type 2 diabetes mellitus (T2DM) remission. Given the established relationships between trauma and obesity, and obesity and T2DM, there is a need to examine bariatric surgical practices from a trauma- and violence-informed care (TVIC) perspective. The purpose of this scoping review was to explore and describe the extent to which the four TVIC principles-(1) understand trauma, violence, and its impact; (2) create emotionally and physically safe environments; (3) foster opportunities for choice, collaboration, and connection; and (4) use a strengths-based and capacity-building approach-have been integrated into bariatric surgery processes for T2DM remission. Following the PRISMA-ScR framework, we searched MEDLINE and EMBASE from inception to January 2024. Eligible studies included adults ≥ 18 years with T2DM undergoing bariatric surgery and reporting remission outcomes. Data were summarized narratively and charted using the TIDieR checklist. Nineteen studies were included, described in 30 publications. Despite established associations between trauma, obesity, and chronic illness, none of the included studies collected demographic data on participants' history of trauma or violence. Among included studies, mental health exclusions were common, potentially limiting access for individuals with trauma-related mental health challenges. Our findings highlight the absence of reporting TVIC principles in bariatric surgery for T2DM remission, raising concerns about emotional safety, risks for retraumatization, and long-term outcomes. Integrating the principles of TVIC throughout bariatric surgical care is essential to promote emotionally safe and inclusive care to enhance postoperative success and sustained health outcomes.