Living the dream – but not without hardship: stories about self-directed weight transformation from severe obesity

The objective of this narrative study was to explore experiences and assigned meanings in stories about self-directed weight loss (WL) maintenance after severe obesity (SO). Design In-depth interviews were conducted with eight women and two men, aged 27 to 59 years, who had carried out self-directed WL from SO for 5 years or more. Two themes ran across the stories: Fear of weight-regain, and food and emotion. We performed a case-based narrative analysis of especially rich interviews that illustrate these. Results pointed to persistently cultivating new competencies, establishing new eating habits, re-establishing old physical-training habits, and forming new relational bonds. Participants reinvented themselves and their lives. However, the stories are not all about transformation, but also about new and old health problems. Conclusion The study directs attention to ‘different obesities’, not only to initial weight from which WL takes place, but also linked to the experiential horizons that the persons embody from childhood on. Furthermore, there was no way back in the present stories, always haunted in the wake of the lost weight. A double burden imposed on the person with obesity related to meta-stories in society deepens the understanding of this imperative: being vulnerable health-wise and exposed to stigmatization.publishedVersio

Practising physical activity following weight-loss surgery: The significance of joy, satisfaction, and well-being

While health care professionals advise those who have undergone weight loss  surgery (WLS) to increase their levels of physical activity, research suggests that  often this is not achieved. This paper explores the experiences of ten Norwegian women as they engaged in physical activity several years after weight loss surgery (WLS). In contrast to the existing literature, which explores physical activity post-WLS largely in terms of quantitative data and measurable outcomes, the present study sought to explore women’s lived experiences of physical activity, including the meanings they ascribed to different forms of activity and how such meanings changed over time. The research participants, all of whom had undergone WLS more than five years earlier, described (during individual interviews) the meanings they attached to becoming physically active, as well as the different  activities and movement practices they engaged in, from interval training to  mountain hiking and yoga. For all the women, maintaining and increasing their level of physical activity was challenging. On the one hand, engaging in exercise after weight loss improved their sense of joy and well-being and expanded their  opportunities to move and act. On the other hand, during physical activity they needed to be constantly alert to symptoms of post-surgical side-effects, including variable energy levels, digestive problems and acute illness episodes. As the women explored their new capacities, it seemed to be important for them to explore various forms of physical activity in order to find the form of exercise which best suited them or which they most enjoyed. In some cases, they constructed new meanings around activities which, prior to surgery, had seemed onerous and bereft of pleasure. We argue that such insights will benefit health professionals who provide advice on physical activity at different post-surgical stages, sometimes to persons seriously concerned about regaining weight

How people diagnosed with borderline personality disorder experience relationships to oneself and to others. A qualitative in-depth study

Background The first-person experiences of people diagnosed with borderline personality disorder (BPD) is an important area of research. It can support clinical and ethical practice, and nuance and expand on insights offered by diagnostic and treatment-oriented research approaches. In this study, we aimed to develop knowledge about how persons who were recently diagnosed with BPD experience being in relationships with themselves and others. Methods We conducted in-depth life-world interviews with 12 women recently diagnosed with BPD. The interviews focused on their lived experiences of relationships to self and others. All participants gave their informed consents to participate. We analysed the data with a structured approach to reflexive thematic analysis, conducted as a team-based approach. Results We extracted an overarching theme, “Reaching for firm holdings”, that is the most abstract interpretation of participants’ experiences. The five subordinate themes (“Captive of emotions”, “Keeping undeservedness at bay”, “Distrusting oneself”, “Dependence as stability” and “The uncertainty of reaching out”) are specific constituents of the overarching theme, and provide detail and variations across individual accounts. Conclusions The results suggest that the experience of relationship to self and others of people recently diagnosed with BPD entails feeling insecure, unsafe and frightened. We report five themes that describe ways participants seek to cope with this situation. The results indicate that their experiences encompass turning to others, or to objects, for feelings of safety. As such, the experience of relationship to self and others in the context of receiving a BPD diagnosis seemed to entail finding and evolving strategies to protect a vulnerable self. Self-harm, suicide attempts and addiction all seemed to be ways of handling and tolerating chaotic and frightful emotions. One major limitation of our study is that only people who identified as female were recruited to participate in the study.publishedVersio

Carrying on life at home or moving to a nursing home: frail older people’s experiences of at-homeness

Aims and objectives The aim was to explore frail older people’s lived experiences of managing life at home on the verge of moving to a nursing home. Background As people age, their reserve capacity decreases, increasingthe risk of morbidity and frailty.. The experience of frailty extends beyond declining health and physical well-being and encompasses various dimensions, including familiarity with both the place and the people around. Design A phenomenological study. Methods We interviewed ten frail people aged 72–90 years in-depth in their homes. We used phenomenological hermeneutical analysis inspired by van Manen and followed the COREQ checklist. Results We identified three main themes: (1) being home with cherished people and possessions, (2) giving the nursing home a go and (3) attuning to the natural rhythms. Conclusions Our study gives insight into the lived experiences with frailty related to at-homeness. The experience of being lost in transition represents a uniquely significant experience for frail older people, foregrounding existential issues and carrying the potential of at-homeness.publishedVersio

Being recognised as a whole person: A qualitative study of inpatient experience in mental health

Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient–professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one‘s self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance.publishedVersio

“Finding oneself after critical illness”: voices from the remission society

Under embargo until: 2021-10-07The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants’ lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants’ narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger’s concept of homelikeness and Arthur Frank’s typologies of illness narratives. In conclusion listening to and acknowledging the patients’ lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients’ lived experience of critical illness and its aftermaths.acceptedVersio

Carrying the weight of uncertainty: Patients' long-term experiences after bariatric surgery

The prevalence of obesity and severe obesity has increased rapidly in Norway since the 1980’s. Severe obesity is a medically introduced term for large body weight that is connected to health risk and impaired quality of life. The health care services can offer people with severe obesity an interdisciplinary assessment and possibly a weight loss intervention, although not necessarily bariatric surgery. Bariatric surgery is an option in severe obesity, and seems to be the most efficient intervention in terms of providing sustainable weight loss and reduction in comorbidities for the majority of patients. However, surgery involves risk and long-term outcomes, and complications beyond 1- 2 years are currently scarcely reported in research. The aim of this study is to explore patients’ long-term experiences with bariatric surgery. The study has a qualitative design and is grounded in phenomenology. Data was produced by in-depth interviews more than five years after surgery. Seven women and 13 men with different backgrounds participated. The participants were aged 28-60 at the time of the interview. All of them had undergone a combined surgical procedure, called Duodenal Switch, which provides most substantial weight loss and carries a somewhat higher risk of complications when compared to other surgical procedures. The data consists of the patients’ experiences after bariatric surgery processes, as recalled and described in the interviews. The analysis was inspired by Giorgi’s phenomenological method. The process of reflexivity has been emphasised throughout the whole research process. The findings are presented in three separate articles. The first article presents findings based on the first eight interviews. The article concentrates on the intertwining of change and altered social encounters and negotiation of embodied identity after surgery. In the second article, findings based on the first 14 interviews describe eating as an existential and situated practice which remained a sensitive issue after surgery. The third article reports the 13 male participants’ experiences after bariatric surgery, and describes agency as pivotal for the men’s self-understanding. Thus, bariatric surgery was experienced as a radical intervention, yet deeply meaningful because it gave access to actively engage with the world and others. “Carrying the weight of uncertainty” constitutes a common and essential theme of the long-term experiences, across the presented findings. Despite sufficient weight loss and comorbidities in remission, the patients lived with health problems, illness, complications and worries about the future connected to body weight and health

The hamster wheel: a case study on embodied narrative identity and overcoming severe obesity

Based in narrative phenomenology, this article describes an example of how lived time, self and bodily engagement with the social world intertwine, and how our sense of self develops. We explore this through the life story of a woman who lost weight through surgery in the 1970 s and has fought against her own body, food and eating ever since. Our narrative analysis of interviews, reflective notes and email correspondence disentangled two storylines illuminating paradoxes within this long-term weight loss process. Thea’s Medical Weight Narrative: From Severely Obese Child to Healthy Adult is her story in context of medicine and obesity treatment and expresses success and control. Thea’s Story: The Narrative of Fighting Weight is the experiential story, including concrete examples and quotes, highlighting bodily struggles and the inescapable ambiguity of being and having one’s body. The two storylines coexist and illuminate paradoxes within the weight loss surgery narrative, connected to meaningful life events and experiences, eating practices and relationships with important others. Surgery was experienced as lifesaving, yet the surgical transformation did not suffice, because it did not influence appetite or, desire for food in the long run. In the medical narrative of transforming the body by repair, a problematic relationship with food did not fit into the plot