Title: The health-seeking itinerary of individuals with morbid obesity for bariatric surgery in the public healthcare system

Abstract

Objective: To understand the health-seeking experience of individuals with morbid obesity in search of bariatric surgery in the public healthcare system. Methods: This was a qualitative study based on social phenomenology with 17 individuals with morbid obesity, hospitalized, and scheduled for bariatric surgery in a public hospital in the city of São Paulo, Brazil. Interviews were carried out based on the following guiding questions: How was your search for bariatric surgery? What are your expectations after the surgery? Results: Individuals with morbid obesity in search of bariatric surgery have (i) experienced a health-seeking itinerary in public healthcare services; (ii) dealt with long waiting times for surgery, which contributed to weight gain and triggered biopsychosocial issues and limitations in their daily lives; (iii) felt careless due to the gap between the care received and that recommended by health policies, programs, and guidelines; (iv) considered the assistance of health professionals essential for them to navigate the health itinerary and obtain approval for bariatric surgery; and (v) expected structural improvements in the healthcare network and care practices carried out by a trained multidisciplinary team; and (vi) expected a reduction in the gap between the care delivered by the public healthcare service and the therapeutic itinerary experienced by them. Conclusion: When following a health-seeking itinerary for bariatric surgery, individuals with morbid obesity experienced difficulties and obstacles that led them to seek and use resources that were not always available in the healthcare system. The aspects involved in such an itinerary highlighted a need of strengthening the care flow in the healthcare system and investing in professional training to reduce inequalities in access to bariatric surgery, which can substantially increase the quality of care delivery through interventions that encourage autonomy and self-management of the body weight.

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