Understanding metabolic bariatric surgery stigma through the lived experiences of Dutch women

Abstract

Metabolic bariatric surgery (MBS) is an effective treatment for severe obesity, yet patients often face stigma related to both obesity and MBS, complicating their treatment experience. Despite its significance, MBS stigma remains under-theorized in research. This study applies a socio-ecological stigma framework to explore how MBS stigma is experienced by patients in the Netherlands.

Using qualitative methods, we conducted semi-structured interviews with 16 Dutch women undergoing MBS and employed reflexive thematic analysis to examine how stigma shapes their decision-making, disclosure practices, social relationships, and post-operative adjustment. Four core themes emerged: (1) The Decision-Making Journey, highlighting internal conflicts driven primarily by weight stigma and feelings of personal failure; (2) Disclosure and Reactions, which revealed that sharing MBS decisions often brought social support but also exposed participants to stigma from those outside their immediate circles; (3) Life After Surgery, capturing improvements in health and social engagement alongside ongoing struggles with body image and eating behaviors; and (4) Healthcare Support and Missed Opportunities, reflecting mixed experiences with healthcare professionals and a notable lack of psychological follow-up care.

Stigma emerged at multiple levels - internalized, interpersonal, and structural - affecting patients’ well-being and access to care. MBS stigma is a pervasive, embedded part of obesity treatment. Our findings emphasize the urgent need for stigma-informed, empathetic healthcare and sustained psychological support throughout patients’ treatment journey. Effectively addressing both weight- and MBS stigma requires change at the institutional level and addressing the moral judgments often tied to obesity treatment to improve patient care and outcomes.