Abstract

The purpose of this thesis is to provide insights into the treatment and management of youth living with severe obesity within Quebec through the perspective of key stakeholders with a focus on the decision-making process for adolescent bariatric surgery. Semi-structured interviews were conducted with pediatricians (n=8), bariatric surgeons (n=5), healthcare administrators (n=4), and adolescents contemplating bariatric surgery (n=7). Adolescents also produced body map collages following the interview. This art-based method involves youth outlining their perceived body shape on a piece of paper (16”x20”) and using drawings and/or magazine images to represent their embodied experience with weight management. Interview results were transcribed and analysed inductively to identify emerging themes. Body maps were analysed using collage in conceptualization which resulted in the creation of an analytical collage by grouping related images from the body maps.
Results are presented as five papers: (1) findings from a pilot study examining the feasibility of using body-map storytelling with adolescents; (2) the perceptions of pediatricians on obesity as a disease and the practice implications; (3) the perceptions of pediatricians on adolescent bariatric surgery; (4) the factors adolescents consider when deciding on bariatric surgery; and (5) a multi-stakeholder perspective on bariatric surgery for adolescents living with severe obesity.
There was a generally positive perception regarding bariatric surgery for adolescents with medically urgent needs across all four stakeholder groups. There were also points of divergence regarding pre-requisites for the surgery, and which factors are considered in the decision to refer, finance, or undergo the procedure. Comparison of the stakeholders demonstrated that the acceptability of bariatric surgery was inherent to a healthcare context that offered no other alternative to primary care management for adolescents struggling with weight. Thus the pathway to bariatric surgery was perceived as skipping some key steps in the care pathway. Interestingly, a group of pediatricians and adolescents did not view obesity as a disease. Implications from this study include the need for improved availability of behavioural interventions with a team of weight management experts to address the gap between primary care counseling and tertiary care surgical intervention.