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Sunderland Repository records the research produced by the University of Sunderland including practice-based research and theses.

The forgotten patient: a psychological perspective on the implementation of bariatric surgery guidelines

Johnston, Lynne, Jackson, Kacey, Hilton, Charlotte and Graham, Yitka (2023) The forgotten patient: a psychological perspective on the implementation of bariatric surgery guidelines. Obesity Science and Practice. ISSN 2055-2238

Item Type: Article


There is strong evidence demonstrating the impact of bariatric surgery on weight-loss and comorbidity improvement. In the UK, there is specific guidance to facilitate the assessment of a person’s suitability for bariatric surgery. This paper highlights the clinical reality of routinely implementing this guidance, supported by literature and the perspectives of practicing psychologist. The consequences of the implementation of clinical guidelines within the context of the typical biopsychosocial profile of those referred for bariatric surgery are discussed. The ramifications of a screening approach rather than a clinical formulation-based approach to assessment, impact of a possible unconscious bias in commissioning and an overemphasis on a biomedical model approach to treatment are also presented. These contextual factors are argued to contribute to a population of ‘forgotten patients’ i.e., patients who have been assessed as not suitable for bariatric surgery, and thus ‘stuck’ in their journey towards better health. For these individuals the only option left are energy balance only approaches, which are the very same approaches to weight-loss and comorbidity improvement that have been attempted, often for many years. Not only have these approaches not resulted in weight-loss and health improvement, they also fail to address the underlying psychological causes of obesity. Consequently, this lack of support means that patients continue to suffer from poor quality of life, with no clear pathway to improved health and wellbeing. This paper illuminates the clear gaps in weight management service provision, the implementation of guidelines in practice, and offers practical suggestions to reduce the unintended consequences of clinical guidelines for bariatric surgery.

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Uncontrolled Keywords: psychology, guidelines, patients, bariatric surgery
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Depositing User: Yitka Graham


Item ID: 15836
Identification Number:
ISSN: 2055-2238
Official URL:

Users with ORCIDS

ORCID for Yitka Graham: ORCID iD

Catalogue record

Date Deposited: 20 Mar 2023 17:27
Last Modified: 26 Jun 2023 12:58


Author: Yitka Graham ORCID iD
Author: Lynne Johnston
Author: Kacey Jackson
Author: Charlotte Hilton

University Divisions

Faculty of Health Sciences and Wellbeing


Sciences > Nursing

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