Morbid obesity and physical activityfrom frustration to satisfaction of basic psychological needs

Resumen

The aims of this PhD work are three, as the number of the studies contained in it: 1- analyzing the different factors associated with the development of morbid obesity situations, 2- gaining an understanding of the personal experiences of individuals dealing with morbid obesity based on self-determination theory (SDT), and 3- providing an in-depth description and analysis of the perceived physical and, mainly, psychosocial benefits of participation in a six-month exercise program grounded on SDT, of post-bariatric surgery patients. These studies were conducted with 10 patients (nine women and a man) aged between 31 and 59 years (M = 45.90, SD = 8.78) who suffered morbid obesity and received bariatric surgery for weight loss. One month after bariatric surgery, patients joined the six-months physical activity (PA) program, and qualitative data was collected through observations and interviews. The field notes and interviews were transcribed and analyzed with the support of the software NVivo, which was used to organize and classify data efficiently. The content analysis of this qualitative information showed that there were multiple factors which conditioned the participants’ sedentary lifestyle and bad eating habits, and led them to morbid obesity. In this sense, some elements that contributed to their sedentary lifestyles were embarrassment of showing their body in public, pain and poor physical condition, and their bad experiences in non-inclusive PA contexts. Other factors such as bad family food education, loss of a loved person, family problems, arguments or disputes, and past traumatic events like childhood sexual abuse influenced their development and maintenance of unhealthy eating behaviors. Moreover, findings illustrate the continuous struggle that participants lived with obesity along their lives, with failed attempts of losing weight by multiple diets and PA, and the corresponding sense of failure. Likewise, participants suffered from health and mobility troubles in their daily life and experienced stigmatization and discrimination in most areas of their social functioning. Participants described how these experiences resulted in the thwarting of their basic psychological needs for autonomy, competence, and relatedness. In turn, psychological need frustration contributed to negative consequences such as body image concerns, low self-esteem, anxiety, and depression; controlled regulation of their eating behavior; rigid behaviors like avoiding social situations; and self-defeating behaviors like giving up diet and PA regimens and binge eating. These findings highlight how living with morbid obesity can impair optimal functioning and well-being via experiences of psychological need frustration. On regard the PA program participants followed after the bariatric surgery, they reported many circumstances which facilitated their basic psychological needs such as the instructors’ caring about their opinion, perceived social support and affection, fitness improvement, pain reduction, and acquisition of knowledge for being autonomous exercisers. These circumstances promoted autonomous motivation towards PA participation, enjoyment and intention to be physically active, and improved their happiness, self-confidence, and attitude for a better social life. The results suggest the need of rethinking strategies for prevention and treatment of morbid obesity, taking into account the specific profile and traits of these patients. Moreover, these studies highlight the convenience of incorporating psychological aspects based on SDT in dieting or PA programs, a part from developing coping strategies and social interventions to diminish the stigmatizing effects of the social obesity discourse.