The dissonance of "expectation-reality": a narrative study on preoperative identity expectations and postoperative identity reconstruction of patients after metabolic and bariatric surgery.

BACKGROUND

More than 1 billion people globally live with obesity. Individuals who have undergone metabolic and bariatric surgery (MBS) face identity reconstruction challenges linked to poor dietary adherence and psychological distress. Few studies analyze the mechanism of dissonance between preoperative identity expectations and postoperative reality, leaving a psychosocial support gap for long-term recovery.

OBJECTIVES

To explore the dynamic collision between preoperative identity expectations and postoperative reality and identify key turning points in identity reconstruction among patients who have undergone MBS, guided by Social Identity Theory and Narrative Identity Theory.

SETTING

Metabolic and Bariatric Surgery Department, University Hospital (June 2023-June 2024).

METHODS

Purposive sampling of 18 patients who have undergone MBS (1-2 years postsurgery). Interpretive narrative design with semi-structured interviews; data triangulation (diaries, social media, and clinical records). Analysis used Riessman's framework integrated with Social Identity and Narrative Identity Theories.

RESULTS

Preoperative expectations covered 4 dimensions (body image, social role, self-identity, and health function). Postoperative conflicts occurred across these dimensions, leading to a 3-stage identity reconstruction process: Conflict Adaptation (0-6 mo), Cognitive Adjustment (6-12 mo), and Identity Reconstruction (12-24 mo). Key turning points included successful social experiences, athletic breakthroughs, and family support.

CONCLUSIONS

This study provides a theoretically grounded model of MBS identity reconstruction, highlighting the role of social group dynamics and narrative storytelling in navigating expectation-reality dissonance. The findings provide preliminary insights that may inform future development of clinical psychological support and psychosocial adaptation interventions.