As obesity becomes a growing concern in the United States, bariatric surgery is also growing in popularity, leading patients to regain control of their health and resolve many chronic conditions associated with morbid obesity, such as Type II diabetes mellitus (DM II), heart disease, and hypertension (HTN)[1–7]. On average, bariatric surgery patients lose 50% excess weight within the first two years following a Roux-en-Y gastric bypass, sleeve gastrectomy, or laparoscopic gastric banding[4–6,8–11], leading to problematic excess skin, most commonly located at the abdomen, but also found on the arms, thighs, buttocks, groin, and other areas of the body[12]. While survey-based studies have found approximately 90% of bariatric surgery patients develop excess skin[13], other studies have shown only 11-12% of patients undergo excess skin removal following bariatric surgery[14,15]. This study conducted a retrospective review of patients undergoing massive weight loss (MWL) (defined as at least 50% excess weight loss or 100 lb weight loss) at one year follow up after bariatric surgery at one large academic medical center in Massachusetts. The goal was to identify which step in the pursuit of excess skin removal created the largest barrier to entry and whether patient demographics (age, sex, type of bariatric surgery, payor, weight loss at one year, and highest level of education) played a role in creating a healthcare disparity in the patients undergoing excess skin removal. Patients were identified through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Through chart review, patients were followed from bariatric surgery to first complaint of excess skin to plastic surgery consultation for excess skin removal to undergoing excess skin removal. Of 370 patients who experienced a MWL within the first year after bariatric surgery, 36.2% (134) of patients complained of excess skin at bariatric surgery follow up and were referred to a plastic surgeon at the same academic institution for a plastic surgery consultation. Of patients who complained of excess skin, 37.3% (50) attended a plastic surgery consultation. Finally, 48% (24) of patients who attended a plastic surgery consultation underwent excess skin removal at the same academic institution. Of patients who complained of excess skin, 17.9% of patients underwent excess skin removal. Demographics of patients were tracked to determine whether certain demographics had a higher barrier to entry in pursuing excess skin removal. No healthcare disparity based on: patient age at time of bariatric surgery, race, highest level of education, type of bariatric surgery, or payor was found. It is important to note that this study was performed at a single Massachusetts academic institution, and the final number of patients undergoing excess skin removal was relatively small (n=24). A higher-powered study with a larger group of patients from multiple bariatric surgery programs could be more telling in identifying whether a healthcare disparity exists. Regardless of patient demographic, 82.1% of patients who complained of excess skin did not undergo excess skin removal, so there may be a societal or insurance-driven gap in understanding the importance and need for these procedures in bariatric surgery patients that should be studied further.

Bakgrund: Fetma är ett växande problem över hela världen och allt fler kirurgiska ingrepp utförs varje år för att minska fetma bland befolkningen. Komplikationer till följd av fetma kan bland annat påverka kvinnors fertilitet negativt vilket ger dem en större anledning till att genomgå viktminskningskirurgi. När fördelarna av kirurgi överväger hälsoriskerna så kan viktminskningskirurgi därmed vara ett alternativ. I rollen som ansvarig för omvårdnaden har sjuksköterskan en viktig funktion i den process av förändring som följer efter viktminskningskirurgi. Därför är det viktigt att ta del av de levda erfarenheter som dessa patienter har för att öka kunskap och förståelse. Syfte: Beskriva kvinnors levda erfarenheter efter viktminskningskirurgi. Metod: Analys av sju narrativer i form av bloggar för att studera kvinnors levda erfarenheter. Resultat / Diskussion: Resultatet presenteras i två huvudteman och tre underteman. Huvudteman presenteras i en kropp i förändring samt omställning i vardagligt liv. Underteman presenteras i andra förutsättningar i en lätt och frisk kropp, svårigheter efteråt samt att anpassas till en ny vardag. Slutsats: Det är viktigt att patienter som genomgår viktminskningskirurgi får rätt information och stöd för att nå ett bestående resultat och ökad livskvalitet. Vidare forskning om hur sjuksköterskan kan utveckla vården för dessa patienter är nödvändig då allt fler genomgår viktminskningskirurgi. / Background: Obesity is a growing problem worldwide, more and more surgical procedures are conducted every year to reduce obesity among the population. Complications resulting from obesity can adversely affect women's fertility, giving them a greater reason to undergo bariatric surgery. When the benefits of a surgical procedure outweigh health risks, an alternative solution to the problem may be bariatric surgery. Being responsible for nursing care the nurse has an important function in the process following bariatric surgery. Therefore, it is important to consider the experiences that these patients have in order to increase knowledge and understanding. Aim: Describe women's lived experiences after bariatric surgery. Method: Analysis of seven narratives in the form of blogs to study women's lived experiences. Result / Discussion: The result is presented in two main themes and three subthemes. The main themes are presented in a body of change and a change in everyday life. Subthemes are presented in other prerequisites in a lighter and healthier body, difficulties afterwards and adapting to a new everyday life. Conclusion: It is important that patients undergoing bariatric surgery to receive the right information and support to achieve lasting results and increased quality of life. Further research on how the nurse can develop the care of these patients is necessary as more and more people undergo bariatric surgery.