Disclosures: The authors report no relevant financial disclosures.
May 25, 2021
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Health concerns, invasiveness among influences in decision to undergo bariatric surgery

Disclosures: The authors report no relevant financial disclosures.
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Health concerns, interference with lifestyle and frustration with weight-loss attempts are among the primary reasons a group of adults with obesity decided to have bariatric surgery, according to study findings.

“This study explored the motivations and influences on patients’ decisions regarding bariatric surgery,” Amanda Lynch, PhD, RDN, an associate professor in the department of interdisciplinary health sciences at Oakland University in Rochester, Michigan, and colleagues wrote in a study published in Bariatric Surgical Practice and Patient Care. “Health emerged as the most common motivation, followed by obesity-related activity limitations and a history of unsuccessful weight-loss attempts. When deciding between surgery types, participants balanced the desire for weight loss and health improvements with their perceptions of the surgery, specifically, invasiveness of the procedure and potential negative side effects.”

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Researchers conducted interviews with 30 adults aged at least 18 years who had scheduled Roux-en-Y gastric bypass surgery (n = 11) or sleeve gastrectomy (n = 19) and had no prior history of bariatric surgery. Participants were recruited from an American Society for Metabolic and Bariatric Surgery accredited surgery center in southeast Michigan in 2013 and 2014 during their final class before surgery. All participants met with the primary investigator before surgery and at 6 and 12 months after surgery. A semi-structured interview was conducted at each meeting with questions on dietary behaviors, weight management, and weight loss and surgery expectations. Dietary, health and lifestyle questionnaires were completed at each meeting, and weight was obtained from medical charts.

When discussing motivations for choosing bariatric surgery, participants discussed five main factors. More than two-thirds of participants expressed concerns about obesity-related health conditions and expressed a willingness to avoid future health problems and increase their longevity. Nearly all participants discussed the limitations obesity imposed on daily activities and the ability to participate in vacations or dining with family and friends. Participants also expressed a desire to be more physically active and to exercise. Frustration with weight was another major factor, with participants saying surgery was their only option remaining for weight loss and expressing frustration at past failed weight-loss attempts.

Some participants elected bariatric surgery due to suggestions from a physician, family member or close friend, and some said the support of family encouraged them to have surgery. Three mothers participating in the study said they wanted to be a role model for their children. Finally, a minority of participants said body image was a factor in having surgery.

Participants gave a variety of reasons for the choice between gastric bypass or sleeve gastrectomy. Those who chose gastric bypass cited the potential for better weight loss, confidence in the procedure and medical conditions. Those who had sleeve gastrectomy cited confidence in the procedure, not wanting to have a lap band, a perception that gastric bypass was “too extreme,” having gastric bypass as a backup option and medical conditions as factors behind their decision.

The researchers wrote that the findings reveal how providers must take many factors into account when considering bariatric surgery for patients.

“Selection of bariatric surgery procedure should be based on a patient’s health, weight-loss needs, individual preferences, risk factors and surgeon expertise,” the researchers wrote. “Ultimately, it is the patient’s decision which surgery to undergo, and they may have decided on their preferred procedure before surgical consultation. It remains important for clinicians to inquire about the factors patients considered in their decisions, as this will reveal patient expectations for weight loss and health along with their understanding of the surgery.”