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

Voting when the Stakes are High

Rational choice theories of electoral participation stress that an individual's decision to vote depends on her expected net benefit from doing so. If this instrumental motive is relevant, then turnout should be higher in elections where more is at stake. We test this prediction, by studying how turnout is affected by exogenous variation in governments’ financial flexibility to provide pork for their voters. By utilizing simultaneous elections for different offices, we identify a positive effect of election stakes on turnout.voter motivation, elections, turnout

Do re-election probabilities influence public investment?

We identify exogenous variation in incumbent policymakers’ re-election probabilities and explore empirically how this variation affects their investments in physical capital. Our results indicate that a higher re-election probability leads to higher investments, particularly in the purposes preferred more strongly by the incumbents. This aligns with a theoretical framework where political parties disagree about which públic goods to produce using labor and predetermined public capital

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

Patients’ experiences from basic body awareness therapy in the treatment of binge eating disorder -movement toward health: a phenomenological study

Background Binge Eating Disorder (BED) is the most common eating disorder. Patients with BED are often not diagnosed, nor offered adequate specific treatment. A great number of those who receive recommended treatment do not recover over time. More knowledge about central aspects of BED, and treatments that specifically target such aspects is needed. Previous research has linked body experience to the development and maintenance of eating disorders, as well as influencing treatment results and the risk of relapse. The aim of this study was to explore how patients with BED experience Basic Body Awareness Therapy (BBAT), which is a psychomotor physiotherapy treatment addressing body experience. Method In this phenomenological study, we interviewed two patients with BED in depth during and after treatment. Video observations of treatment sessions and logs written by the patients were used as supporting data. The analysis was guided by Van Manen’s hermeneutic phenomenology. Results A meaning structure was identified: “On the way from the body as a problem to the body as a possibility.” The two participants that besides BED also had a history of childhood trauma, perceived BBAT as a process of getting to know their own bodies in new ways, and described that the way they related to their own body changed as did aspects of their way of being. These changes were prominent when the participants described emotions, movement, pain, calmness, and self-experience, and interwoven with relational aspects as well as practices in everyday life. Conclusion The present results indicate that BBAT stimulated body experience in a way that opened new possibilities for two participants with BED, and hence that BBAT can improve the health status of BED patients also suffering from childhood trauma.publishedVersio

Do Re-election Probabilities Influence Public Investment?

We identify exogenous variation in incumbent policymakers' re-election probabilities and explore empirically how this variation affects the incumbents' investment in physical capital. Our results indicate that a higher re-election probability leads to higher investments, particularly in the purposes preferred more strongly by the incumbents. This aligns with a theoretical framework where political parties disagree about which public goods to produce using labor and predetermined public capital. Key for the consistency between data and theory is to account for complementarity between physical capital and flow variables in government production.political economics, strategic capital accumulation, identifying popularity shocks

Flyttesjau i innvandrings- og integreringsfeltet Endringar i politikk og forvalting frå 2013

I desember 2015 omorganiserte Solberg-regjeringa innvandrings- og integreringsfeltet. Integreringsavdelinga vart flytta til Justis- og beredskapsdepartementet og det mest innvandringskritiske partiet på Stortinget, Framstegspartiet, fekk statsrådsposten for innvandring og integrering. Venstre har stilt seg særleg kritisk til Framstegspartiet si rolle i dette feltet. Med Venstre sin inngang i regjeringa i januar 2018, vart integreringsavdelinga fjerna frå Framstegspartiet sin kontroll og flytta inn i Kunnskapsdepartementet. Denne masteroppgåva undersøkjer korleis større regimeendringar kan opna opp for særskilde endringar i forvaltinga. Studien undersøkjer om Framstegspartiet sin auka kontroll på dette feltet endra forholdet mellom den politiske styringa og fagorgana. Dette blir studert med utgangspunkt i statsråden si tredimensjonale rolle som skal balansera rettsideala, fagleg korrekte løysingar og eigne politiske standpunkt. Datagrunnlaget er rapportar om forvaltinga, stortingsdokument, regjeringsdokument, partiprogram, medieoppslag og statistikk frå forvaltingsdatabasen til NSD. Analysen syner at endringane i forvaltinga kan bli forstått som eit resultat av tautrekkingar i regjeringsforhandlingane. Flyttinga av integreringsavdelinga til JD i 2015 syner klare likskapstrekk med Framstegspartiet sin politikk. Venstre sin påverknad for å fjerna integreringsavdelinga frå Framstegspartiet i 2018 er også tydeleg. Studien syner at for å forstå endringar i forvalting og politikk er det avgjerande å undersøkja politiske intensjonar på feltet.Masteroppgåve i administrasjon og organisasjonsvitskapAORG350MASV-AOR