{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:21:57Z","timestamp":1792783317618,"version":"4.5.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Haifa","id":[{"id":"https:\/\/ror.org\/02f009v59","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sustained healthy behaviors are critical for long-term success after metabolic bariatric surgery (MBS); however, patients from culturally distinct communities may face unique sociocultural and structural barriers to postoperative behavior change. We explored behavioral determinants of lifestyle modifications among women from the Arab society in Israel post-MBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi-structured, in-depth interviews were conducted with 20 women who underwent MBS at a public university-affiliated medical center. Interviews explored participants\u2019 experiences of postoperative lifestyle adjustments, including dietary and physical activity patterns. Data were analyzed using inductive thematic analysis followed by deductive mapping to the COM-B model and the Theoretical Domains Framework (TDF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen themes were identified across all COM-B components and 12 TDF domains. Key facilitators included knowledge of dietary recommendations; improved physical functioning and stamina; and social support as an enabler of behavior change. Motivation was reinforced by health-related consequences and concerns of relapse; and visible progress and external feedback. Major barriers included limited postoperative follow-up and healthcare access; time, resource, and infrastructure constraints to physical activity. Additional challenges included variability in physical activity guidance; social norms, pressure, and expectations; and postoperative emotional distress and adjustment. Participants also described self-directed learning and information seeking, including the use of AI and digital tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative lifestyle adherence following MBS is shaped by interacting individual, social, and environmental factors. Findings highlight the need for culturally tailored, theory-informed interventions integrating structured guidance, continuous follow-up, social support, and potentially digitally supported strategies to address real-world and culturally embedded barriers and support long-term outcomes following MBS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11695-026-08941-6","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:19:20Z","timestamp":1789449560000},"page":"5294-5306","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioral Determinants of Lifestyle Modifications Following Metabolic Bariatric Surgery in a Culturally Specific Population: A Qualitative Study"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5925-6794","authenticated-orcid":false,"given":"Haya","family":"Subhi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-2851","authenticated-orcid":false,"given":"Rana","family":"Hijazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5963-7047","authenticated-orcid":false,"given":"Mahmoud","family":"Abu Gazala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husam","family":"Mahajna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9297-7107","authenticated-orcid":false,"given":"Ram","family":"Elazary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5860-4972","authenticated-orcid":false,"given":"Tair","family":"Ben-Porat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"8941_CR1","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1111\/obr.12551","volume":"18","author":"GA Bray","year":"2017","unstructured":"Bray GA, Kim KK, Wilding JPH, World Obesity F. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18:715\u201323. https:\/\/doi.org\/10.1111\/obr.12551.","journal-title":"Obes Rev"},{"key":"8941_CR2","unstructured":"National Program for Quality Indicators in Community Healthcare in Israel. 2023 Report. (2023). Ministry of Health and the National Institute for Health Policy Research. https:\/\/israelhealthindicators.org\/"},{"key":"8941_CR3","unstructured":"Abdel-Rahman N, Laron M. Obesity and Diabetes among the Arab Population in Israel: Prevalence, Lifestyle and Usage of Healthcare Services. Myers-JDC-Brookdale Institute; 2023."},{"key":"8941_CR4","doi-asserted-by":"publisher","first-page":"2531","DOI":"10.1016\/S0140-6736(17)30574-3","volume":"389","author":"K Muhsen","year":"2017","unstructured":"Muhsen K, Green MS, Soskolne V, Neumark Y. Inequalities in non-communicable diseases between the major population groups in Israel: achievements and challenges. Lancet. 2017;389:2531\u201341. https:\/\/doi.org\/10.1016\/S0140-6736(17)30574-3.","journal-title":"Lancet"},{"key":"8941_CR5","doi-asserted-by":"publisher","first-page":"2000","DOI":"10.1001\/jama.2023.19897","volume":"330","author":"A Elmaleh-Sachs","year":"2023","unstructured":"Elmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity Management in Adults: A Review. JAMA. 2023;330:2000\u201315. https:\/\/doi.org\/10.1001\/jama.2023.19897.","journal-title":"JAMA"},{"key":"8941_CR6","doi-asserted-by":"publisher","first-page":"4836","DOI":"10.1007\/s11695-021-05650-0","volume":"31","author":"T Ben-Porat","year":"2021","unstructured":"Ben-Porat T, Mashin L, Kaluti D, Goldenshluger A, Shufanieh J, Khalaileh A, Abu Gazala M, Mintz Y, Brodie R, Sakran N, et al. Weight Loss Outcomes and Lifestyle Patterns Following Sleeve Gastrectomy: an 8-Year Retrospective Study of 212 Patients. Obes Surg. 2021;31:4836\u201345. https:\/\/doi.org\/10.1007\/s11695-021-05650-0.","journal-title":"Obes Surg"},{"key":"8941_CR7","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.amjsurg.2024.04.020","volume":"234","author":"D Moriconi","year":"2024","unstructured":"Moriconi D, Manca L, Rebelos E, Guidotti E, Bonvicini L, Troilo A, Anselmino M, Nannipieri M. Long-Term effects of physical activity on weight loss, metabolic parameters and blood pressure in subjects undergoing bariatric surgery: A 5-year follow-up study. Am J Surg. 2024;234:143\u20139. https:\/\/doi.org\/10.1016\/j.amjsurg.2024.04.020.","journal-title":"Am J Surg"},{"key":"8941_CR8","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1097\/SLA.0000000000003281","volume":"272","author":"WC King","year":"2020","unstructured":"King WC, Belle SH, Hinerman AS, Mitchell JE, Steffen KJ, Courcoulas AP. Patient Behaviors and Characteristics Related to Weight Regain After Roux-en-Y Gastric Bypass: A Multicenter Prospective Cohort Study. Ann Surg. 2020;272:1044\u201352. https:\/\/doi.org\/10.1097\/SLA.0000000000003281.","journal-title":"Ann Surg"},{"key":"8941_CR9","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/1747-0080.12728","volume":"79","author":"C Wright","year":"2022","unstructured":"Wright C, Barnett A, Campbell KL, Kelly JT, Hamilton K. Behaviour change theories and techniques used to inform nutrition interventions for adults undergoing bariatric surgery: A systematic review. Nutr Diet. 2022;79:110\u201328. https:\/\/doi.org\/10.1111\/1747-0080.12728.","journal-title":"Nutr Diet"},{"key":"8941_CR10","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1007\/s11695-015-1873-6","volume":"26","author":"F Stewart","year":"2016","unstructured":"Stewart F, Avenell A. Behavioural Interventions for Severe Obesity Before and\/or After Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg. 2016;26:1203\u201314. https:\/\/doi.org\/10.1007\/s11695-015-1873-6.","journal-title":"Obes Surg"},{"key":"8941_CR11","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1016\/j.soard.2021.06.015","volume":"17","author":"EP Inocian","year":"2021","unstructured":"Inocian EP, Nolfi DA, Felicilda-Reynaldo RFD, Bodrick MM, Aldohayan A, Kalarchian MA. Bariatric surgery in the Middle East and North Africa: narrative review with focus on culture-specific considerations. Surg Obes Relat Dis. 2021;17:1933\u201341. https:\/\/doi.org\/10.1016\/j.soard.2021.06.015.","journal-title":"Surg Obes Relat Dis"},{"key":"8941_CR12","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1037\/hea0001277","volume":"42","author":"A Fortin","year":"2023","unstructured":"Fortin A, Lavoie KL, Ben-Porat T, Yousefi R, Pelaez S, Studer AS, Bacon SL. Coconstruction of adjunct behavioral interventions to bariatric surgery: The INTER-Change program. Health Psychol. 2023;42:343\u201352. https:\/\/doi.org\/10.1037\/hea0001277.","journal-title":"Health Psychol"},{"key":"8941_CR13","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1093\/heapro\/day054","volume":"34","author":"T Bayram","year":"2019","unstructured":"Bayram T, Donchin M. Determinants of health behavior inequalities: a cross-sectional study from Israel. Health Promot Int. 2019;34:941\u201352. https:\/\/doi.org\/10.1093\/heapro\/day054.","journal-title":"Health Promot Int"},{"key":"8941_CR14","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1111\/j.1365-2524.2009.00896.x","volume":"18","author":"HI Ali","year":"2010","unstructured":"Ali HI, Baynouna LM, Bernsen RM. Barriers and facilitators of weight management: perspectives of Arab women at risk for type 2 diabetes. Health Soc Care Community. 2010;18:219\u201328. https:\/\/doi.org\/10.1111\/j.1365-2524.2009.00896.x.","journal-title":"Health Soc Care Community"},{"key":"8941_CR15","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/j.jand.2019.10.017","volume":"120","author":"T Ben-Porat","year":"2020","unstructured":"Ben-Porat T, Weiss R, Sherf-Dagan S, Nabulsi N, Maayani A, Khalaileh A, Abed S, Brodie R, Harari R, Mintz Y, et al. Nutritional Deficiencies in Patients with Severe Obesity before Bariatric Surgery: What Should Be the Focus During the Preoperative Assessment? J Acad Nutr Diet. 2020;120:874\u201384. https:\/\/doi.org\/10.1016\/j.jand.2019.10.017.","journal-title":"J Acad Nutr Diet"},{"key":"8941_CR16","doi-asserted-by":"publisher","unstructured":"Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E et al. (2021). A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ 374, n2061. https:\/\/doi.org\/10.1136\/bmj.n2061.","DOI":"10.1136\/bmj.n"},{"key":"8941_CR17","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1037\/hea0000161","volume":"34","author":"SM Czajkowski","year":"2015","unstructured":"Czajkowski SM, Powell LH, Adler N, Naar-King S, Reynolds KD, Hunter CM, Laraia B, Olster DH, Perna FM, Peterson JC, et al. From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol. 2015;34:971\u201382. https:\/\/doi.org\/10.1037\/hea0000161.","journal-title":"Health Psychol"},{"key":"8941_CR18","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","volume":"6","author":"S Michie","year":"2011","unstructured":"Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. https:\/\/doi.org\/10.1186\/1748-5908-6-42.","journal-title":"Implement Sci"},{"key":"8941_CR19","unstructured":"Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. Silverback Publishing); 2014."},{"key":"8941_CR20","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","volume":"12","author":"L Atkins","year":"2017","unstructured":"Atkins L, Francis J, Islam R, O\u2019Connor D, Patey A, Ivers N, Foy R, Duncan EM, Colquhoun H, Grimshaw JM, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12:77. https:\/\/doi.org\/10.1186\/s13012-017-0605-9.","journal-title":"Implement Sci"},{"key":"8941_CR21","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349\u201357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042.","journal-title":"Int J Qual Health Care"},{"key":"8941_CR22","doi-asserted-by":"crossref","unstructured":"Braun V, Clarke V. Thematic analysis: a practical guide. SAGE; 2022.","DOI":"10.4135\/9781036232078.n9"},{"key":"8941_CR23","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.soard.2024.11.005","volume":"21","author":"M Fernandez-Alonso","year":"2025","unstructured":"Fernandez-Alonso M, Bejarano G, Creel DB, Kohl HW, Messiah SE, Altieri MS, Papasavas P, Horn C, Marroquin E. Expert-based physical activity guidelines for metabolic and bariatric surgery patients: a systematic review of randomized controlled trials. Surg Obes Relat Dis. 2025;21:606\u201314. https:\/\/doi.org\/10.1016\/j.soard.2024.11.005.","journal-title":"Surg Obes Relat Dis"},{"key":"8941_CR24","doi-asserted-by":"publisher","first-page":"e13168","DOI":"10.1111\/obr.13168","volume":"22","author":"CA Julien","year":"2021","unstructured":"Julien CA, Lavoie KL, Ribeiro PAB, Dragomir AI, Mercier LA, Garneau PY, Pescarus R, Bacon SL. Behavioral weight management interventions in metabolic and bariatric surgery: A systematic review and meta-analysis investigating optimal delivery timing. Obes Rev. 2021;22:e13168. https:\/\/doi.org\/10.1111\/obr.13168.","journal-title":"Obes Rev"},{"key":"8941_CR25","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1016\/j.soard.2021.07.020","volume":"17","author":"C Wright","year":"2021","unstructured":"Wright C, Mutsekwa RN, Hamilton K, Campbell KL, Kelly J. Are eHealth interventions for adults who are scheduled for or have undergone bariatric surgery as effective as usual care? A systematic review. Surg Obes Relat Dis. 2021;17:2065\u201380. https:\/\/doi.org\/10.1016\/j.soard.2021.07.020.","journal-title":"Surg Obes Relat Dis"},{"key":"8941_CR26","doi-asserted-by":"publisher","first-page":"3212","DOI":"10.1007\/s11695-023-06795-w","volume":"33","author":"E Yildiz","year":"2023","unstructured":"Yildiz E, Karagozoglu S. The Effects of a Web-Based Interactive Nurse Support Program Based on the Health Promotion Model on Healthy Living Behaviors and Self-Efficacy in Patients Who Regained Weight after Bariatric Surgery: A Randomized Controlled Trial. Obes Surg. 2023;33:3212\u201322. https:\/\/doi.org\/10.1007\/s11695-023-06795-w.","journal-title":"Obes Surg"},{"key":"8941_CR27","doi-asserted-by":"publisher","first-page":"e13893","DOI":"10.1111\/obr.13893","volume":"26","author":"R Yousefi","year":"2025","unstructured":"Yousefi R, Bacon SL, Boucher VG, Acosta PFC, O\u2019Neill J, Gonzalez-Gonzalez M, Raymond FC, Lorencatto F. Barriers to and enablers of modifying diet after metabolic bariatric surgery: A systematic review of published literature. Obes Rev. 2025;26:e13893. https:\/\/doi.org\/10.1111\/obr.13893.","journal-title":"Obes Rev"},{"key":"8941_CR28","doi-asserted-by":"publisher","first-page":"101677","DOI":"10.1016\/j.eatbeh.2022.101677","volume":"47","author":"G Billing-Bullen","year":"2022","unstructured":"Billing-Bullen G, Nielsen D, Wham C, Kruger R. Enablers and barriers to prevent weight-regain post bariatric surgery - A qualitative enquiry. Eat Behav. 2022;47:101677. https:\/\/doi.org\/10.1016\/j.eatbeh.2022.101677.","journal-title":"Eat Behav"},{"key":"8941_CR29","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.amjsurg.2022.09.049","volume":"225","author":"LM Funk","year":"2023","unstructured":"Funk LM, Alagoz E, Murtha JA, Breuer CR, Pati B, Eierman L, Jawara D, Farrar-Edwards D, Voils CI. Socioeconomic disparities and bariatric surgery outcomes: A qualitative analysis. Am J Surg. 2023;225:609\u201314. https:\/\/doi.org\/10.1016\/j.amjsurg.2022.09.049.","journal-title":"Am J Surg"},{"key":"8941_CR30","doi-asserted-by":"publisher","first-page":"119276","DOI":"10.1016\/j.socscimed.2026.119276","volume":"400","author":"D Lev-Arey","year":"2026","unstructured":"Lev-Arey D, Nasser A, Levental O. Available but unusable: Theorizing layered exclusions as a barrier to women\u2019s physical activity. Soc Sci Med. 2026;400:119276. https:\/\/doi.org\/10.1016\/j.socscimed.2026.119276.","journal-title":"Soc Sci Med"},{"key":"8941_CR31","doi-asserted-by":"publisher","first-page":"e13608","DOI":"10.1111\/obr.13608","volume":"24","author":"W MacAskill","year":"2023","unstructured":"MacAskill W, Gillanders T, Wylie N, Pinidiyapathirage J. Finding what works-Patients\u2019 long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies. Obes Rev. 2023;24:e13608. https:\/\/doi.org\/10.1111\/obr.13608.","journal-title":"Obes Rev"},{"key":"8941_CR32","doi-asserted-by":"publisher","first-page":"4352","DOI":"10.1007\/s11695-025-08230-8","volume":"35","author":"HD Guney","year":"2025","unstructured":"Guney HD, Gobel P. A Qualitative Study of Eating Behaviours and Weight Change After Metabolic Bariatric Surgery in Women. Obes Surg. 2025;35:4352\u201361. https:\/\/doi.org\/10.1007\/s11695-025-08230-8.","journal-title":"Obes Surg"},{"key":"8941_CR33","doi-asserted-by":"publisher","first-page":"1280071","DOI":"10.3389\/fpsyg.2024.1280071","volume":"15","author":"V Timkova","year":"2024","unstructured":"Timkova V, Minarikova D, Fabryova L, Buckova J, Minarik P, Katreniakova Z, Nagyova I. Facilitators and barriers to behavior change in overweight and obesity management using the COM-B model. Front Psychol. 2024;15:1280071. https:\/\/doi.org\/10.3389\/fpsyg.2024.1280071.","journal-title":"Front Psychol"},{"key":"8941_CR34","doi-asserted-by":"publisher","first-page":"e13927","DOI":"10.1111\/obr.13927","volume":"26","author":"AJ Budin","year":"2025","unstructured":"Budin AJ, Brown WA, MacCormick AD, Caterson I, Sumithran P. Depressive symptoms at short-, medium-, and long-term follow-up after bariatric surgical procedures: A systematic review and meta-analysis. Obes Rev. 2025;26:e13927. https:\/\/doi.org\/10.1111\/obr.13927.","journal-title":"Obes Rev"},{"key":"8941_CR35","doi-asserted-by":"publisher","first-page":"e12998","DOI":"10.1111\/obr.12998","volume":"21","author":"D Spirou","year":"2020","unstructured":"Spirou D, Raman J, Smith E. Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review. Obes Rev. 2020;21:e12998. https:\/\/doi.org\/10.1111\/obr.12998.","journal-title":"Obes Rev"},{"key":"8941_CR36","doi-asserted-by":"publisher","first-page":"e12926","DOI":"10.1111\/obr.12926","volume":"21","author":"LA David","year":"2020","unstructured":"David LA, Sijercic I, Cassin SE. Preoperative and post-operative psychosocial interventions for bariatric surgery patients: A systematic review. Obes Rev. 2020;21:e12926. https:\/\/doi.org\/10.1111\/obr.12926.","journal-title":"Obes Rev"}],"container-title":["Obesity Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-026-08941-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11695-026-08941-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-026-08941-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:19:09Z","timestamp":1791382749000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11695-026-08941-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":36,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["8941"],"URL":"https:\/\/doi.org\/10.1007\/s11695-026-08941-6","relation":{},"ISSN":["0960-8923","1708-0428"],"issn-type":[{"value":"0960-8923","type":"print"},{"value":"1708-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"assertion":[{"value":"27 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}