A Critical Appraisal Of A Study Examining Perception Regarding Bariatric Surgery For Obesity Management

Background and Rationale

Evidence-based practice has become one of the greatest needs for the practice of health care professionals. In order to be able to competently utilize the benefits of evidence-based practice, it is crucial for the healthcare professionals to be able to understand the literature value of an article and critically analyse it (Zeng et al. 2015). This study will attempt to take the aid of the CASP or Critical appraisal skills program tool in order to critically appraise the study by the da Silva and da Costa Maia. The selection of the CASP tools is based on the applicative benefits associated with it. CASP tool allows the researchers with a standardized template format encompassing a systematic, strategic and methodological steps to analyse a research evidence before utilizing it in the practice. Along with that a CASP tool has differentiated checklist for different research designs or methods which allows to critically analyze with minimal bias. Additionally, impartial set of factors and elements allows the biased opinion of the researchers to be eliminated as well (Buccheri and Sharifi 2017).

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One of the greatest health concerns all over the globe is the prevalence of obesity and the ever-increasing incidence rate of the obesity among the target groups (Ejima, Aihara  and Nishiura 2013). It has to be mentioned in this context that for most of the first world countries, obesity is an alarming public health priorities and it has become very difficult to control the ever-rising prevalence of this disease. The prevalence of obesity has enhanced at a frightening rate since the last couple of years all over the world. The alarming statistical data suggests the fact that within the time period of 1998 to 2008, the mean body mass index of men has enhanced by 0.8 kg/m2 and the same has increased by a 1 kg/m2 on a worldwide basis (da Silva and da Costa Maia 2012). According to Wolfe, Kvach and Eckel (2016), obesity is by far the health adversity which is considered to be the second leading cause of death as it is associated with a variety of different co-morbid health disorders such as diabetes, cardiovascular diseases, cerebrovascular diseases, and renal disorders. Hence, obesity can be broadly considered as the precedent of a number of serious health concerns and hence, better management of obesity before it can facilitate a severe comorbid disorder is crucial.

Among various other options for obesity management, the bariatric surgery is one of the most effective therapeutic measures for the patients who have clinically significant morbid obesity (Chang et al. 2014). The study under focus for this critical appraisal paper identifies the dilemma in the available literature regarding the use of bariatric surgery as the therapeutic measure for the better management of obesity and its effect on the outcome. As described by the Jakobsen et al. (2018), the available literature on obesity management with bariatric surgery only focuses on quantitative data, which does not take into consideration the perceptions, expectancies, and beliefs of the patients regarding the bariatric surgery and obesity management outcomes. Hence, the aim and objectives of this study focus on the perceptions of the people regarding obesity, its management with bariatric surgery, and the outlook of the patient population regarding the outcomes achieved by the bariatric surgeries.


Hence, it can be considered that the aims and objectives of the research study have been very clearly identified by the authors and is also relevant to the present public health priority issues. It has to be understood in this context that a clear and relevant justification provided by the researchers is critically important for the authenticity and validity of the study is to be established. In this case, as well, the justification for the conduction of this study is provided by the literature cited by the authors in the article. Exploring the details further, the recent literature data cited by the authors in the study states that along with the physical impact of the obesity in the form of comorbid disorders, the obese target people are also subjected to extreme psychological stress induced by bullying, negative body image and lack of self-worth due to the obesity (Ejima, Aiharz and Nishiura 2013). Furthermore, though bariatric surgery is extremely beneficial for weight loss which shows drastic improvements instantaneously, there is very little focus on how the obese people perceive the concept of the bariatric surgeries and its effect on the weight-loss. As this study focuses on the perception of the obese people regarding their obesity and bariatric surgery, the justification provided by the authors is apt (Cohen,  Manion and Morrison 2013).

The research methodology of a study succeeds to achieve the set outcome or goals in case the methodology selected is critically aligned with each of the exact factors associated with the study and the goals set by the researchers to be achieved (Gloy et al. 2013). The research design that has been selected for this assignment is a qualitative research design, now it has to be mentioned that the qualitative research design allows the researcher to observe and document non-numerical data (Inge et al. 2014). Along with that, the qualitative research methodologies are mainly concerned with exploring and comprehending the perception, attitude, beliefs, and outlook of different individuals with the lack of any statistical data interpretation. As the primary aim and objective of this research study had been associated with interpreting the perception, expectations, and outlook of the obese people regarding the bariatric surgeries for weight-loss, the use of qualitative research design can be easily considered apt. In justification of the research design chosen, the authors have stated that this research design chosen is to deliver richness of details on the concept of the obese regarding the surgical intervention and obesity management outcome, which had been missing in the previous literature published (Nakamura et al. 2014).  

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Regarding the sampling technique that has been considered in the research study, 30 participants have been selected for the study involving 10 men and 20 women from a multidisciplinary treatment centre for obesity located in northern Portugal. Thus, the participants were selected within the mean age group of 31.17 years that had a mean BMI of 42.5 (da Silva and da Costa Maia 2012). Now, it has to be mentioned that sampling of the research study is a very important aspect as it has a direct impact on the research validity and hence the sampling technique of any research study is supposed to be executed very critically. According to the CASP tool, the sampling procedure of the research study is considered as complete in case the researcher has explained how and why the participants were selected, and whether the researcher has included any additional discussions regarding recruitment provided. In this case, the researcher has incorporated how the participants were selected (Buccheri and Sharifi 2017); the only information regarding why the participants were selected includes the participants that are about to undergo a bariatric surgery; which can be considered insufficient and to be a drawback of the study. Lastly, the authors have not incorporated any additional details regarding the sampling and exclusion of certain participants either in order to further analyze the sampling, the sample size for the study had been very small which can aid in maintaining the homogeneity of the data collection and its subsequent analysis (da Silva and da Costa Maia 2012).

According to the CASP tool, a data collection process of a research study is supposed to be complete if the researchers have justified the setting of the data collection, how the data was collected, methods chose for data collection, clear description of the form of the data, and saturation of data (Zeng et al. 2015). This research study had been a qualitative research study which focused on interviewing the study participants before their bariatric surgery. The data collection method selected for the research study is also qualitative, however, as mentioned by the authors, the data collection and analysis for this study had been deliberately interweaved to the process of theoretical sampling which allows the researcher to revise and reflect on the subsequent questions and check the emergent categories (Lewis 2015). Regarding the data saturation, the authors have mentioned that theoretical saturation method has been used in order composes the sampling data. The method of data collection and its documentation had been through audio taping the interviews, turning into transcripts and then coding it through grounded analysis, which eases the process of understanding and interpreting the qualitative data. It has to be mentioned in this context that the interview process and the collection of the data had been discussed very critically in the research study, which is undoubtedly commendable (Silverman 2016).

The data collection method that has been implemented in this assignment is semi-structured interviews which are associated with asking the study participants open-ended questions. The primary aim of the research study had been to explore or understand the perception and outlook of the obese regarding obesity and use of bariatric surgery. The open-ended questions allow the data to be very versatile and inclusive or the exact opinion and perception of the research participants which further helped the researcher achieve the aims and objectives of the research study (Creswell and Creswell 2017). Furthermore, the parameters that were included in the semi-structured interviews include age, weight, BMI, eating habits of the person. Moreover, questions were also asked questions pertaining to their eating habits, which further enrich the collected data. Exploring the data analysis further the process of grounded analysis had been taken which is a highly systematic method of deducing final themes. The software used for the coding and further analysis of the data had been NVivo 8.0 with the use of the constant comparative method which eased the process of open coding. Furthermore, in order to ensure the validity of the data coding based analysis method, a second researcher has also been employed as the auditor to challenge he present ideas and assist in the constructing the coding categories. Hence, it can be stated that the data analysis process had been much consolidated, robust and with as minimal bias as possible (Green and Thorogood 2018).

Considering the reflexivity of the research, the relationship between the researcher and participants, very limited information has been provided. However, the data collection, sample recruitment and choice of the location have been discussed in details as well, although no information is available in the article regarding the response of the researchers regarding the events during the study or any changes in the study design. Regarding the ethical considerations being employed in the research, the authors have mentioned that informed consent has been taken from the participants for audiotaping the interviews that have been approved by the Clinical Research Ethics Committee of the Hospital of Braga. However, no other ethical considerations have been incorporated or declared in the study design, especially ensuring that no participants are forced to participate in the interview. This can be considered a significant drawback of the study (Taylor, Bogdan and DeVault 2015).

In order for a research study to be valid and authentic, the data findings need to be explained critically in relation with the research questions asked and goals with respect to a balanced discussion of the topic from the perspectives of all participant groups. The key findings of the research study had been the fact that the bariatric patients entertain many false beliefs regarding the outcomes of the surgical intervention. One of the primary requirements of the research study had been to establish a link between the obese patients and their outlook before and after the commencement of the surgery, and the data findings discussed in the paper had been successful in establishing the link between the perceptions. Considering the data findings, they can be considered adequately explicit meeting the quality benchmarks of the study (Sjöström et al. 2014). Exploring further, three core processes have been represented in the research study, obesity eating behavior and the surgical treatment. The findings indicate that the bariatric surgery as per the outlook of the patients is associated with bariatric surgery is of a miraculous result without any amendments to eating behavior. As per the data findings of the research the perception of the research participants is associated with the idealizing the surgery expecting bariatric surgery to be the only miracle that has the potential to magically solve all the problems without changing the eating behaviors from the patient’s ends which on the other hand is considered to be a huge sacrifice in the perception of the students.

The research study had been capable of incorporating for supportive and argumentative takes from literature evidence while discussing the research findings of the research study, although the argumentative take to the research is limited lacking more explicit details from relevant and authentic literature. The data findings of this research study have been discussed with accurate details and have been correlated with the original research questions of the study as well. Along with the above mentioned strengths of the research study, there are certain limitations of the study as well. Exploring more, it has to be mentioned that sample size of the research study had been extremely small and the data had been collected from only collected from one hospital, which limits the variability of the data collected and enhances the possibility of uncoverage bias and voluntary response bias. Hence, this limitation of the data findings need to be interpreted with caution (Nakamura et al. 2014).

A very important element in the CASP tool for the research study requires the authors to contribute new areas to the research which is considered to enhance the value and authenticity of the research. For this research study, the authors have mentioned the fact that this research study had been the first step of a longitudinal mixed method study that fundamentally aims to develop a theory that typifies the psychosocial phenomenon linked with surgical management of obesity with bariatric surgery. This study had been the first attempt at incorporating a qualitative intake to researching the impact of bariatric surgery in obesity management. Considering the contribution of this research study to the existing literature, it has to be mentioned that there has been an acute lack of research studies focusing on the perception and outlook of the patients regarding the outcome bariatric surgeries an achieve. On a more elaborative note, research suggests that obesity management cannot be achieved only through surgical intervention.

Even though bariatric surgeries help the patients attain an immediate drastic weight-loss, the bariatric surgery is by no means a miracle and without consistent lifestyle modifications with extra emphasis on improving the eating behaviour to maintain the weight for the prolonged time (Inge et al. 2014). It also needs to be mentioned that the previous literature has focused on only quantitative data, lacking extensive details regarding the outlook of the patients regarding this surgery. This qualitative design based longitudinal study had been successful in providing key details regarding the perception of the patent regarding the surgery and revealed the idealizing attitudes that the patients entertain regarding the surgery expecting miraculous consistent results from the surgery without changing the eating behaviour or any other related lifestyle modifications. Hence, this study had been able to shed light on key issues associated with the psyche of the patient before and after a bariatric surgery and its impact on their obesity management progress after the surgery. The data findings indicate at the need for extensive patient education for the patient before and after the surgery to help them understand the need for additional behavioural and lifestyle modifications especially eating behaviour to ensure better outcome achievement. Hence, this research study can be considered the first step to a better understanding of health promotional educations the patient population needs to overcome the false beliefs and idealization of a surgery.

Considering the generalizability and transferability of the study, it has to be mentioned that the sample size for this research study had been very small focusing on only one hospital setting which reducing the variability of the data incredibly and enhances the possibility of several biases. Hence, this limitation of this study reduces the transferability and generalizability of the study to a larger sample size and the data collected is completely subjected to the personal perception of each of the participant and have not been standardized (Fellows and Liu 2015). Furthermore, the Inge et al. (2014) have also mentioned in this discussion that in order to validate the study there is a need for a larger sample population with the addition of quantitative data employing a mixed methodology. Although, it has to be mentioned that the contribution of the study to the area of study cannot be ignored, even after the drastic results achieved by a bariatric surgery, a large percentage of obese patient population revert back to being obese due to no modification in their eating behaviour or lifestyle.

Hence, this longitudinal study has been the first to reveal the idealizing attitude of the patient regarding the surgery while eating behaviour change is seen as a huge sacrifice. This data is of tremendous use in clinical practice, and with further research to validate the authenticity of the findings, patient education and promotional programs can be designed to change the idealizing attitude of the patients and improve the long-term success rate of the surgical intervention and changing the lifestyle and health status of the bariatric patients (Clarke and Charmaz 2014).


On a concluding note, critical appraisal exercise of a research study allows the development of skills needed to explore the authenticity and reliability of an article before utilizing it in the evidence-based practice. This had been an excellent opportunity for me to understand the process evaluating the authenticity of literature evidence as per the standardized format provided by the CASP checklist. This report has discussed in detail the different methodological sections of the research study chosen, the data analysing and interpretation, results and discussion and value of the research encompassing all key areas of a research study to be authentic; and it can be hoped that this exercise will be of extreme help to me in my clinical practice.


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