The transtheoretical model (TTM) to gain insight into young women’s long-term physical activity after bariatric surgery: a qualitative study

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Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC).


Seventeen women with a mean age of 32.5 ± 3.3 years and a percentage of total weight loss of 29.6 ± 12.4 were interviewed at a mean of 9.4 ± 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.


The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints.


This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle.

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bariatric surgery


physical activity


stage of change


transtheoretical model


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The authors would like to thank the participants for their contribution to this research.

Funding Information

M.H. was supported by a PhD grant from the Région Sud Provence-Alpes Côte d’Azur, France, and co-supported by the association “Azur Sport Santé.” This work was supported by the French government, managed by the “Agence Nationale de la Recherche” as part of the UCAJEDI Future Investments project, reference number ANR-15-IDEX-01.

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Correspondence to Meggy Hayotte.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hayotte, M., Nègre, V., Gray, L. et al. The transtheoretical model (TTM) to gain insight into young women’s long-term physical activity after bariatric surgery: a qualitative study. OBES SURG 30, 595–602 (2020).

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  • Physical activity
  • Bariatric surgery
  • Stage of change
  • Transtheoretical model
  • Qualitative analysis
  • Interviews