Martha Lystad

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)




The purpose of this qualitative study was to investigate the decision making process of morbidly or severely obese individuals who engage in weight loss surgery and the role of nurses in this process using a grounded theory research design. Morbid or severe obesity is a chronic illness that is increasing in prevalence throughout the United States. The Center for Disease Control (2007) reported the obesity population of adults doubled from 15.1% in 1976-80 to 30.9% in 1999-2000. The current most effective long-term treatment for morbid or severe obesity is weight loss surgery, most commonly gastric bypass or gastric banding. Furthermore, weight loss surgery may be clinically indicated for the treatment of morbid obesity to reduce co-morbid disease processes and promote health. However, it remains an elective surgery and ultimately a personal decision. Thus, the research questions for this study were: How did the participant come to the decision to pursue weight loss surgery? How were nurses involved in the weight loss surgery decision making process? The grounded theory methodology of semi-structured interviews and constant comparative analysis (including open, axial and theoretical coding) was used for data collection and analysis. Eighteen participants (3 males, 15 females) were interviewed (40 to 90 minutes). The preliminary results of this study provided the foundations for the development of a dynamic model of the participants' decision making process related to choosing weight loss surgery for their obesity. The core variable identified is 'critical point of change'. The antecedents identified include a cycle of obesity and motivating or re-energizing factors within the context of the obesity experience. Information gathering and seeking social support were identified as key actions in the decision process. The common intervening factors discussed were support systems, insurance/financial issues, as well as access and availability of bariatric services. Outcomes of weight loss surgery health changes, using the 'tool', sense of hope/help and altered relationship with food and eating. This model may be a tool for clinicians to assess readiness for weight loss surgery, and provide information and support to this population throughout their decision making process. Nurses were not readily identified by most participants as key informants in their decision making process. Further discussion of nurse's roles within this process may need to be examined.

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