Mental and emotional representations of weight loss: free-word association networks in members of bariatric surgery-related social media communities

Background: Mindset and communication barriers may hinder the acceptance of bariatric surgery (BS) by the eligible patient population. Objectives: To improve the understanding of expectations, opinions, emotions, and attitudes toward weight loss among patients with obesity. Setting: Switzerland, Germany, Austria. Methods: Survey data collected from BS-related social media communities (n = 1482). Participants were asked to write 5 words that first came to their mind about weight loss, and to select 2 emotions, which best described their corresponding feelings. Demographic and obesity-related data were collected. Cognitive representations were constructed based on the co-occurrence network of associations, using validated data-driven methodology. Results: Respondents were Caucasian (98%), female (94%), aged 42.5 +/- 10.1 years, current/highest lifetime body mass index = 36.9 +/- 9/50.7 +/- 8.7 kg/m(2). The association network analysis revealed the following 2 cognitive modules: benefit-focused (health, attractiveness, happiness, agility) and procedure-focused (effort, diet, sport, surgery). Patients willing to undergo BS were more benefit-focused (odds ratio [OR] = 2.4, P = .02) and expressed more hope (OR = 142, P <.001). History of BS was associated with higher adherence to the procedure-focused module (OR = 2.3, P < .001), and with increased use of the emotions gratitude (OR = 107, P < .001), pride (OR = 15, P < .001), and decreased mention of hope (OR = .03, P < .001). Conclusion: Patients with obesity in our study tend to think about weight loss along 2 cognitive schemes, either emphasizing its expected benefits or focusing on the process of achieving it. Benefit-focused respondents were more likely to consider BS, and to express hope rather than gratitude or pride. Novel communication strategies may increase the acceptance of BS by incorporating weight loss-related cognitive and emotional content stemming from patients' free associations. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.