Dr Sophia Quirke-McFarlane

In the context of bariatric surgery, negative social support has recently been conceptualized in terms of sabotage, feeding behaviour and collusion undermining a person’s effort to lose or maintain weight. While sabotage and feeding behaviour are thought to be motivated consciously, collusion can be conceptualised as a bond, by which protagonists are bonded together sharing an unresolved and unconscious psychological issue such as dependency, domination and submission, and so on. Drawing upon a systemic and psychodynamic understanding, we analysed interviews with patients (n = 10) who had undergone bariatric surgery and their partners (n = 10) focusing on support. We selected interviews (n = 4 + 4), illustrative of sabotage, feeding, collusion and identified a further notion of co-evolution based on the comprehensiveness of information, their emblematic quality and suitability to delineate these phenomena. Our analysis confirms that negative social support can be considered as an attempt to reestablish a level of homeostasis within the couple. However, rather than being intentional, we consider that sabotage and feeding behaviour are better conceptualised as consequences of collusive relationships.

Objective: Social support is mostly seen as a positive resource for many health outcomes. However, some research indicates that weight loss may disrupt the equilibrium of relationships and highlights the potential for a more negative form of social support. This qualitative study aimed to explore bariatric surgery (BS) patients’ perceptions of the way in which their current or previous partner supported them throughout their BS journey.Design: BS patients (N=30) participated in remote qualitative semi-structured interviews. Methods: The data were analysed using an inductive approach to reflexive thematic analysis. At the time of this study, patients had undergone BS a mean of 5.1 years ago. Results: Four themes were derived from the data. While two themes reflected social support as a form of caring (Mutual Investment and Positive Reinforcements),the other two themes indicated aspects of sabotage (Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes). Transcending these themes was the notion of Bariatric Surgery as an Opportunity or Threat to the Relationship.Conclusions: Some patients perceived social support as a positive resource for achieving optimal clinical response post-BS. This was characterised by Mutual Investment from their partners and being offered Positive Reinforcements for changes in their weight status and wellbeing. Some, however, described more negative aspects of support which had undermined their BS goals, either unintentionally or intentionally, through acts of sabotage including Feeder Behaviours and Negative Reactions to Weight Loss Attempts and Successes. Future research should develop interventions to help prepare the partners of those undergoing BS for the changes to both their partner’s weight status and the dynamics of their relationship.

Online support forums (OSFs) are an increasingly utilised social support resource for bariatric surgery (BS) patients. OSFs could permit patients to discuss sensitive topics, such as being sabotaged post-BS. This study aimed to explore the phenomenon of BS saboteurs via BS-specific OSFs. Two internet search engines were used to identify BS-specific OSFs. The eligible OSF(s) was searched to identify relevant threads. Thread data were analysed using reflexive thematic analysis. One OSF was eligible. The final dataset included 18 threads (N replies = 569). Three themes were identified: Feeder Behaviours, Negative Reactions to Bariatric Surgery-Induced Weight Loss and Strategies to Avoid and/or Manage Bariatric Surgery Saboteurs. Transcending these was the notion of The Online Support Forum as a Source of Substituted Social Support and Place of Solace. In lieu of the limited social support received in real life, BS patients use OSFs as a form of social support when being sabotaged.

Purpose of review: Whilst research indicates the positive impact of social support across a number of health domains, including weight management, not all social support is beneficial. Findings: This paper reviews the evidence for both positive and negative social support in the context of behavioural interventions and surgery for obesity. It then presents a new model of negative social support focusing on sabotage (‘active and intentional undermining of another person’s weight goals’), feeding behaviour (‘explicit over feeding of someone when they are not hungry or wishing not to eat’) and collusion (‘passive and benign negative social support to avoid conflict’) which can be conceptualized within the context of relationships as systems and the mechanisms of homeostasis. Summary: There is increasing evidence for the negative impact of social support. This new model could form the basis of further research and the development of interventions for family, friends and partners to maximise weight loss outcomes.