Table 2.

Socioeconomic barriers to weight loss after bariatric surgery

Barrier theme	Description of barrier theme
1. Challenging employment situations	Patients who had physically demanding jobs or multiple jobs struggled to follow dietary, physical activity, and follow-up care recommendations.
2. Limited income	Lower income patients: a) had a difficult time affording supplements and vitamins; b) skipped meals or relied on cheaper convenience food options/unhealthy options at food pantry; c) did not have access to affordable fitness centers; d) did not have reliable internet access for virtual follow-up meetings; e) struggled with gas money and co-pays, which prevented their attendance to follow-up meetings.
3. Unreliable transportation	Patients who did not have reliable transportation were restricted by bus routes to obtain healthier foods. Public transportation or insurance-provided transportation (e.g., scheduled service driver) was often unreliable.
4. Unsafe/inconvenient neighborhoods.	Grocery stores in disadvantaged neighborhoods carried fewer healthy options. Patients in these neighborhoods struggled to have groceries delivered to their homes because of fear of theft. These neighborhoods were often unsafe for exercising or did not have sidewalks.
5. Limited health literacy	Patients with less formal education needed more training/teaching regarding recommendations for diet, physical activity, and post-op care.