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

Abstract 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/m2. The association network analysis revealed two 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=0.02) and expressed more ‘hope' (OR=142, P Conclusion Patients with obesity in our study tend to think about weight loss along two 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.