Barriers to and enablers of modifying diet after metabolic bariatric surgery: A systematic review of published literature

This is a qualitative systematic review in which we investigated barriers and enablers influencing dietary behavior change after metabolic bariatric surgery (MBS). Database searches retrieved publications reporting perceived factors influencing dietary behavior change post-MBS. Data (quotes, survey results, interpretative summaries) were extracted and analyzed using combined deductive and inductive thematic analyses. The generated barrier/enabler themes mapped to the Theoretical Domains Framework and then behavior change techniques to identify potential strategies to improve post-operative dietary behavior. Thirty-four publications were included. Key barriers fell within the domains of 'Environmental Context and Resources' (e.g., insufficient and unreliable healthcare services), 'Behavioral Regulation' (e.g., lack of self-discipline), 'Emotions' (e.g., eating as a strategy to overcome negative emotions), 'Beliefs about Consequences' (e.g., the extent of realistic expectations from MBS), and 'Social Influences' (e.g., challenge of eating at social events). Key enablers were also identified within 'Environmental Context and Resources' (e.g. self-access internet-based resources), 'Behavioral Regulation' (e.g. learning how to develop new dietary strategies), 'Beliefs about Consequences' (e.g., positive impacts of surgery-induced food intolerances), and 'Social Influences' (e.g., support from social/group sessions). Potential strategies to change postoperative dietary behavior include social support, problem-solving, goal setting, and self-monitoring of behavior. This provides insight into the targets for future post-operative nutrition-focused interventions.