Importance Weight loss surgery (WLS) has been shown to produce long-term
weight loss but is not risk free or universally effective. The weight
loss expectations and willingness to undergo perioperative risk among
patients seeking WLS remain unknown.
Objectives To examine the expectations and motivations of WLS patients
and the mortality risks they are willing to undertake and to explore
the demographic characteristics, clinical factors, and patient perceptions
associated with high weight loss expectations and willingness to assume
high surgical risk.
Design We interviewed patients seeking WLS and conducted multivariable
analyses to examine the characteristics associated with high weight
loss expectations and the acceptance of mortality risks of 10% or
Setting Two WLS centers in Boston.
Participants Six hundred fifty-four patients.
Main Outcome Measures Disappointment with a sustained weight loss of 20% and willingness
to accept a mortality risk of 10% or higher with WLS.
Results On average, patients expected to lose as much as 38% of their
weight after WLS and expressed disappointment if they did not lose
at least 26%. Most patients (84.8%) accepted some risk of dying to
undergo WLS, but only 57.5% were willing to undergo a hypothetical
treatment that produced a 20% weight loss. The mean acceptable mortality
risk to undergo WLS was 6.7%, but the median risk was only 0.1%; 19.5%
of all patients were willing to accept a risk of at least 10%. Women
were more likely than men to be disappointed with a 20% weight loss
but were less likely to accept high mortality risk. After initial
adjustment, white patients appeared more likely than African American
patients to have high weight loss expectations and to be willing to
accept high risk. Patients with lower quality-of-life scores and those
who perceived needing to lose more than 10% and 20% of weight to achieve
“any” health benefits were more likely to have unrealistic
weight loss expectations. Low quality-of-life scores were also associated
with willingness to accept high risk.
Conclusions and Relevance Most patients seeking WLS have high weight loss expectations
and believe they need to lose substantial weight to derive any health
benefits. Educational efforts may be necessary to align expectations
with clinical reality.