Behavioral Determinants of Lifestyle Modifications Following Metabolic Bariatric Surgery in a Culturally Specific Population: A Qualitative Study.

Abstract

Introduction: Sustained healthy behaviors are critical for long-term success after metabolic bariatric surgery (MBS); however, patients from culturally distinct communities may face unique sociocultural and structural barriers to postoperative behavior change. We explored behavioral determinants of lifestyle modifications among women from the Arab society in Israel post-MBS.

Methods: Semi-structured, in-depth interviews were conducted with 20 women who underwent MBS at a public university-affiliated medical center. Interviews explored participants' experiences of postoperative lifestyle adjustments, including dietary and physical activity patterns. Data were analyzed using inductive thematic analysis followed by deductive mapping to the COM-B model and the Theoretical Domains Framework (TDF).

Results: Seventeen themes were identified across all COM-B components and 12 TDF domains. Key facilitators included knowledge of dietary recommendations; improved physical functioning and stamina; and social support as an enabler of behavior change. Motivation was reinforced by health-related consequences and concerns of relapse; and visible progress and external feedback. Major barriers included limited postoperative follow-up and healthcare access; time, resource, and infrastructure constraints to physical activity. Additional challenges included variability in physical activity guidance; social norms, pressure, and expectations; and postoperative emotional distress and adjustment. Participants also described self-directed learning and information seeking, including the use of AI and digital tools.

Conclusion: Postoperative lifestyle adherence following MBS is shaped by interacting individual, social, and environmental factors. Findings highlight the need for culturally tailored, theory-informed interventions integrating structured guidance, continuous follow-up, social support, and potentially digitally supported strategies to address real-world and culturally embedded barriers and support long-term outcomes following MBS.