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O'Sullivan, Nicola (2025) An exploration into the decision-making process of female patients going abroad for bariatric surgery: an interpretative phenomenological analysis. Doctoral thesis, London Metropolitan University.
Bariatric surgery is for many a life-saving intervention for people with severe obesity and serious health complications such as type 2 diabetes (Courcoulas et al., 2024; Ebadinejad et al., 2022). Decision making forms an important part of the pre-surgery process to have bariatric surgery, including deciding whether to have surgery abroad, which the rise in medical tourism has shown (Border, 2020). However, concerns have been raised that bariatric tourism poses significant health risks, with post-operative complications frequently managed by healthcare services once patients return home (Carey et al., 2025). To date, the lived experience of deciding to have bariatric surgery abroad has not been explored in depth. This study therefore aims to address this gap by examining how patients make sense of that decision, with the goal of informing Counselling Psychologists in supporting patients through the decision-making process and in their psychologically preparation for their life after surgery abroad.
Design and method:
Participants were six women who had travelled abroad for bariatric surgery over 24 months ago. Semi-structured interviews were conducted, and the data was analysed using Interpretative Phenomenological Analysis.
Findings:
From the analysis, three Group Experiential Themes (GET) emerged: 1 - Jumping through a "trillion hoops", referring to feeling dismissed and overlooked by the NHS versus feeling reassured and cared for abroad both pre and post surgery; GET 2 - Reaching a breaking point, referring to personal agency in weight management, taking control and who holds control; GET 3 "No regrets" and "worth it in the end", referring to reconciling physical suffering with a strong sense that surgery abroad was worth it in the end.
Conclusion:
The findings of this study highlight that the decision to choose to go abroad for bariatric surgery is driven by women's experiences of feeling dismissed and overlooked by the NHS, culminating in a psychological breaking point in which control and agency became central. Despite some negative health consequences, all women reported being satisfied with their decision, though they also described a difficult post-surgery adjustment. These findings emphasise the importance of accessible psychological support before surgery, to help individuals navigate the decision to go abroad, and afterwards to process their decision-making and adjust to lifestyle changes, regardless of whether the procedure takes place abroad or in the UK.
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