The degree of success of weight-loss surgery (WLS) for improvement in metabolic derangements such as type 2 diabetes is impressive. Bariatric surgery has even been associated with improved mortality in morbidly obese individuals. Not everyone, however, enjoys the same degree of weight loss, and even though the endpoint of WLS in the minds of clinicians may be improvements in metabolic status and cardiovascular risk, in the minds of patients, the primary endpoint may be more cosmetically oriented. That is, just how much weight am I going to lose?
To better understand the expectations of WLS patients, Li and Heber interviewed patients seeking WLS and asked them (preoperatively) questions to better understand how much weight they expected to lose, the minimum weight loss with which they would not be disappointed, and how much risk they were willing to bear as part of WLS.
On average, patients expected to lose 38% of their weight; the Swedish Obesity Study found that 75% of gastric banding patients lost < 20% of their weight. Even though almost all (84.8%) of the WLS patients understood and accepted that there was a risk of dying from surgery, about one-third of these would no longer be willing to shoulder that risk if the weight loss was only 20%.
WLS has confirmed sustained metabolic and even mortality benefits. However, clinicians must confirm that patients concretely understand these parameters before embarking on such procedures, since some patients may no longer be willing to undertake risk if personally disappointing weight loss results were to occur.
Source: Li Z, Heber D. Managing weight loss expectations: The challenge and the opportunity. JAMA 2014;311:1348-1349.