December 20, 2018
3 min read

Cost, expected weight loss primary factors in opting for bariatric surgery

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The amount of weight loss expected, the likelihood of alleviating medical conditions and the potential out-of-pocket costs are the most important factors for adults considering bariatric surgery, according to findings published in JAMA Surgery.

Michael D. Rozier

“Nearly every decision we make in health care involves trade-offs,” Michael D. Rozier, PhD, assistant professor of health management and policy at Saint Louis University College for Public Health and Social Justice in St. Louis, told Endocrine Today. “We are not very good at understanding how and why other people make the trade-offs that they do, and this study gives us a methodology to dig into that part of health care a bit more deeply.”

Rozier and colleagues created an online survey to assess which factors were most important to adults considering bariatric surgery. The survey consisted of eight questions in which 815 participants (79.9% women; mean age, 44.5 years) were asked to select between two procedure options. Information on how a treatment works, its extensiveness, how long it had been available, how much weight loss could be expected, its effectiveness in resolving weight-related conditions, risk for complications, adverse effects, dietary changes and estimated out-of-pocket costs were provided for each procedure. The survey was completed by participants between May 1, 2015, and Jan. 30, 2016.

Conjoint analysis was performed on the results of the survey, providing coefficient values for each factor. A coefficient value of more than zero indicated participants were more likely to undergo a procedure based on a factor, whereas a value below zero meant they were less likely to choose that procedure. Researchers found that how well a procedure resolved medical conditions (0.229; 95% CI, 0.177-0.28), the total weight loss expected (0.46; 95% CI, 0.373-0.546) and estimated out-of-pocket costs (0.309; 95% CI, 0.211-0.406) were the most important factors when comparing bariatric surgery procedure options.

The researchers further noted that participants were more likely to favor a procedure with each 20% increase in estimated weight loss, whereas the opposite was true for each increase in out-of-pocket costs. However, greater weight loss and resolving weight-related conditions was worth higher costs in the overall population, with respondents willing to pay $5,470 for each 20% increment of weight loss and up to $12,843 to relieve all weight-related conditions.

“Perhaps it shouldn’t be surprising, but other studies haven’t noted the importance of out-of-pocket costs,” Rozier said. “We clearly identify that as a major factor in patient priorities, which should motivate us to figure out better ways to have a conversation about costs with patients. That is often a taboo subject in the patient-provider relationship, but it can’t be ignored.”

Factors such as how a treatment works, how long it has been available and required dietary changes were least likely to influence a participant’s choice, although if a procedure had been available for 20 years or more, it was more likely to be favored (0.165; 95% CI, 0.097-0.234).

In comparisons based on age, the researchers found that adults aged 18 to 44 years were more likely to favor procedures with increased weight loss (0.543; 95% CI, 0.435-0.651) compared with adults aged 45 years or older (0.397; 95% CI, 0.315-0.482). A similar difference was found for younger adults when weighing out-of-pocket costs (0.346; 95% CI, 0.221-0.470) vs. adults aged at least 45 years (0.262; 95% CI, 0.174-0.35).

In total, the researchers identified three groups of respondents, with 38.3% of respondents mostly concerned with quantity of weight loss (n = 312), 31.4% concerned with costs primarily (n = 256) and 30.3% considered balanced (n = 247).

“We often know why patients select one procedure over another, but the hypothetical trade-offs in this study give us the relative importance of these attributes,” the researchers wrote. “Recognizing that patients will understand these trade-offs differently can improve the discussion between patient and physician on the risks and benefits of various weight-loss options.” – by Phil Neuffer

For more information:

Michael D. Rozier, PhD , can be reached at Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave., St. Louis, MO 63104; email:

Disclosures: The authors report no relevant financial disclosures.