Table 2 Representative Quotations from Major Themes and Sub-Themes

Theme 1: Change in Self-Perception

 “When I Look in the Mirror”

  “I don’t feel like a different person. I don’t see it most of the time. I can put on one of my shirts that I could hardly button before I had surgery…it’s the only time I can see [the weight loss]...now it’s like a dress.”

  “I went in to try to find a pair of jeans because people were complaining that my butt was so saggy. And I said I wear a size 17 and they’re like, no you don’t. I came out in a 9–10, and I still can’t believe that.”

 “I Have More Confidence”

  “I would say that my friendships have gotten better. [My friends,] they loved me no matter what, and I just think my confidence has grown so much so that I have opened up to them and have a better connection with them now.”

  “I would’ve considered myself a wallflower before because I was embarrassed with how I looked. And I would imagine what people would think looking at me, you know. No more, no more. About a year and a half ago, I went to a wedding, and I’m dancing. I’m dancing fast. I’m dancing, I’m smiling the whole time. I danced the whole night, I made it the whole night dancing.”

 “I Used Food to Cope”

  “I’m losing the weight…I’m going back to the old me because I understand what happened throughout my life to make me emotionally eat and drink to gain weight. I’m embracing the change, mentally being healthier and more stable, knowing why I became overweight.”

  “[Before surgery] I could just eat a pack of cookies, get sick, whatever, and pass out like an alcoholic. [Now] the surgery limits how much food I can intake. So it made me go to counseling and start dealing with the underlying issues that were causing me to overeat.”

Theme 2. Change in Perception by Others

 “You Took The Easy Way Out”

  “I work in the ER and I told everyone at work I was having the surgery and I was really surprised with some of the backlash that I got. They’re like, ‘You’re not trying hard enough. You need to run. You need to do this. You need to diet.’”

  “I had one friend [that would tell people that I had bariatric surgery.] It was like a flipping dirty word. Finally I said, ‘Why do you have to tell people that? It’s not their business. That’s my business.’ [And she said,] ‘Well, they should know.’”

 “Are You New Here?”

  “I have people at work that would see me and say, are you new? And I’m like, no, I’ve been here for like 12 years.”

  “I went home to my dad’s funeral two years ago and the number of people who didn’t know me really upset me...people who have known me all my life walked right by me. Even as I walked right up to them said ‘Hi, I’m Nicole...I’m Nicole. You’ve known me since I was a babe in arms.’”

 “I’m no longer invisible”

  “I’m being perceived in a more professional way. I can dress differently now and I’m finding that I’m trying to take on new projects. I feel that professionally, I might have more opportunities for advancement just because I look different. Sad, but true. It’s the way of the world.”

  “People would let a door slam in your face before. I would sit on bleachers at my kids’ events and people didn’t look at me, didn’t talk to me, nothing. Now they’re like, ‘Hey, let’s go for dinner after this.’”

Theme 3: Change in Relationships

 “It made my relationship stronger”

  “My marriage is great. He is going to love me no matter what but I feel better in my marriage because I feel healthier.”

  “My husband and I have been together since we were 16 years old so he basically watched me go down and come back up…When we’re intimate now I’m not afraid to take my shirt off. We went years with the lights off and the clothes were on as much as possible and that kind of thing.”

 “They Didn’t Like the Change”

  “My engagement ended, because he didn’t like the weight loss. At first it was, ‘Have the surgery’ and then he didn’t like how I looked after the weight loss.”

  “I wish somebody would’ve told me how it was going to change my marriage, how it was going to change all my relationships that existed, and the ones that didn’t even exist. It changed my marriage. I almost got a divorce because I was changing so quickly.”

 “They’re Jealous of Me”

  “They don’t verbally say they’re jealous but you can kind of tell that they are getting jealous because you’re getting more attention now than they normally do. People treat you a lot differently. They open doors for you. They say hi to you.”

  “[My friend is] seeing a guy and she was like, ‘I don’t want him to meet you because he’s going to fall in love with you’ .... We’ve been friends for a really long time, but that was my first inkling of a little bit of a change in the relationships, which was kind of weird for me.”