Patient expectations of bariatric surgery are gender specific—a prospective, multicenter cohort study

doi:10.1016/j.soard.2014.02.040

Surgery for Obesity and Related Diseases

Volume 10, Issue 3, May–June 2014, Pages 516-523

https://doi.org/10.1016/j.soard.2014.02.040 Get rights and content

Abstract

Background

The effect of bariatric surgery on weight loss and improvement of co-morbidities is no longer doubted. However, little attention has been given to the treatment goals from the patient’s point of view (patient expectations). The objective of this study was to examine patients’ expectations of bariatric surgery and identify gender differences.

Methods

Bariatric patients were asked to complete a questionnaire. Statistical analysis was performed using chi-square, Pearson correlation coefficient, and Wilcoxon rank sum test.

Results

Overall, 248 patients participated in this study (69.4% females). The male patients (45.2 yr, SD±11.1) were significantly older than the female (41.8 yr, SD±12.0; P = .04) and suffered significantly more often from diabetes, hypertension, hypercholesterolemia, and sleep apnea. One hundred thirty patients (52.4%) expected to lose at least 45 kg and 39 patients (15.7%)>70 kg. The mean expected excess weight loss was 71.8%. Females expected significantly more often that surgery alone would induce weight loss (P = .03). “Improved co-morbidity” was by far the highest ranked parameter.

Conclusion

The male bariatric surgery patients were older and suffered from more co-morbidities. Most of the patients had unrealistic weight loss goals and overestimated the effect of the surgical intervention. However, for both female and male patients, “improved co-morbidity” was the most important issue.

Section snippets

Methods

Bariatric patients were invited to complete a questionnaire about their expectations. Patients were deemed eligible for bariatric surgery according to the most recent S3 German guidelines. To qualify, the patients must have exhausted conservative treatment for at least 6 months, undergone a psychosomatic and endocrinologic evaluation, have a BMI of>35 kg/m² with at least 1 co-morbidity such as diabetes mellitus, hypertension or sleep apnea, or a BMI of 40 kg/m² or more. Generally, insurance

Results

Overall, 248 patients participated in this study (Heidelberg, 166 patients; Hamburg, 72 patients; Karlsruhe, 10 patients) and 69.4% were females. The mean age was 42.8 years (SD±11.8 years). The mean BMI was 48.4 kg/m² (SD±8.0 kg/m²). There were no significant differences in BMI between the male and female patients (Table 1). However, the male patients (45.2 yr, SD±11.1) were significantly older than the females (41.8 yr, SD±12.0; P = .04, Table 1). There were no significant gender differences

Discussion

Studies dealing with bariatric procedures mainly focus on endpoints such as EWL or diabetes remission. Little attention has been given to the question of whether such endpoints really matter from the patient’s perspective. It may be possible to evaluate the relevance of a given endpoint from a patient’s point of view by using questionnaires to ask patients to rank possible outcomes [31], [38], [39]. However, in this field, which is evolving so rapidly, the required scientific analysis

Conclusion

In this descriptive survey, carried out on a convenience sample, male bariatric patients were older and suffered from more co-morbidities than female patients. Most patients had unrealistic weight loss goals and overestimated the effect of the surgical intervention on their weight loss. However, both female and male patients, and particularly patients with diabetes, ranked the parameter “improved co-morbidity” at the top position.

Disclosures

Lars Fischer, Johannes Sander, Alexander Ernst and Rune Sandbu were participants in the second European Obesity Academy, which was sponsored by Johnson&Johnson. Fifty of the here presented 115 female patients will be included in a study examine the expectations of female patients in 5 northern European countries.

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Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study
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Existing research has primarily focused on weight as the outcome of interest for bariatric surgery; however, patients frequently report other lifestyle and interpersonal surgery motivations and goals. Understanding the spectrum of bariatric surgery goals and motivations has important implications for enhancing patient-centered care and surgery outcomes.
The current study characterized the nature of bariatric patient motivations and goals for surgery, described the extent to which motivations matched goals, and examined whether men and women differed in the specific motivations/goals described.
Teaching hospital, United States
Data were obtained via retrospective chart review of bariatric patient responses to the clinic’s standard open-ended questions about motivations and goals for bariatric surgery. A mixed method approach was used, including content analysis, to identify themes and χ²/t test analyses to test gender differences.
Surgery motivations and outcome goals were reflected by 8 overarching and overlapping themes. The most common motivations were related to general health and quality of life. The most common goals were to improve health/longevity and mobility. Over a quarter of patients showed no overlap between motivations and goals. Few gender differences were observed.
Findings underscore the importance of goals beyond weight loss, as well as the utility of helping patients shape their goals in accordance with goal-setting theories.
Outcome expectation and risk tolerance in patients seeking bariatric surgery
2021, Surgery for Obesity and Related Diseases
Citation Excerpt :
Multivariable regression analysis showed that lower physical functioning was associated with the tolerance of surgical risks, while a trend was seen for a higher number of co-morbidities and lower current health state. This is in concordance with studies by Karmali et al. and Fischer et al. in which health and health benefit has been shown to be a motivator to undergo bariatric or metabolic surgery [15,27]. The present study gives insight in how candidates for bariatric and metabolic surgery weigh risk and outcome.
Average long-term outcome after laparoscopic Roux-en-Y gastric bypass is 25% total weight loss. The risk of short-term complications (leakage and bleeding), acute internal herniation, and mortality are 4.0%, 2.5%, and .2%, respectively. There is a paucity of evidence on what patients expect in terms of weight loss and to what extent surgical risks are tolerated.
To examine the patient’s weight loss expectations and acceptance of the morbidity and mortality risk after primary laparoscopic Roux-en-Y gastric bypass.
Teaching hospital, Amsterdam, the Netherlands.
Two-hundred patients participated in a standardized survey after completion of an extensive multidisciplinary screening, before surgery. Weight loss expectations, naive assessment, and acceptation of risks of morbidity and mortality were addressed with standard gamble methods.
The 200 participants (156 female, 78%) had a mean age of 45.1 years and a mean body mass index of 42.3 kg/m². Weight loss was overestimated by 151 patients (75.5%), and 79 participants (39.5%) were disappointed with the predicted weight loss. Median accepted risks on short-term complications, acute internal herniation, and mortality were 35.8% (interquartile range, 21.0%–58.0%), 25.1% (interquartile range, 15.9%–50.8%), and 4.5% (interquartile range, 1.0%–10.0%), respectively.
Patients seeking bariatric surgery seem to have unrealistic weight loss objectives and are willing to accept substantial risks to achieve these goals.
Patient perspectives about bariatric surgery unveil experiences, education, satisfaction, and recommendations for improvement
2018, Surgery for Obesity and Related Diseases
Following bariatric surgery, up to 35% of patients struggle with strict regimens and experience weight recidivism within 2 years [1–5]. Accredited weight management centers (WMC) must provide educational programs and support patients in lifestyle changes before and after surgery. Educational programs, however, may not be evidence-based or patient-centered and may vary in curriculum, approach, and educator type [6].
To obtain patient descriptions about the weight loss surgery (WLS) experience, including education, satisfaction, and recommendations for improvement.
Participants were recruited from a university hospital–based WMC in Pennsylvania.
This qualitative descriptive study used purposive sampling and inductive content analysis.
A NEW ME-VERSION 2.0, encompassed themes from semistructured interviews with 11 participants (36% male). Theme 1: Programming and Tools, explained how individuals undergoing WLS found support through educational programming. Theme 2: Updates and Upgrades, identified issues surrounding quality of life and challenges before and after surgery. Theme 3: Lessons Learned and Future Considerations, identified satisfaction levels and recommendations for improving the WLS experience. Participants reported positive experiences, acknowledging educational programs and extensive WMC resources, yet also offered recommendations for improving educational programming.
Patient narratives provided evidence about the WLS experience. Achievement of weight goals, adherence to rules, and improved health status contributed to perceptions of WLS success. Participants encouraged educators to identify expected outcomes of educational programming, monitor holistic transformations, foster peer support, and use technology in WMC programming. Results also validated the need for the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program’s education requirement (standard 5.1). Future educational research could help develop best practices in WLS patient education and assess associations between education and clinical outcomes.
Surgery type and psychosocial factors contribute to poorer weight loss outcomes in persons with a body mass index greater than 60 kg/m<sup>2</sup>
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Perhaps men do not self-identify as needing surgery until much higher BMIs or are not referred by their physicians until they have reached a state of super-morbid obesity. This sex difference may play an important role as past work has demonstrated that men presenting for bariatric surgery tend to be older and have significantly more medical co-morbidities [25]. Such factors could help explain the poorer weight loss outcomes reported in men compared with women [26,27].
The current investigation aims to predict 3-year postoperative percent total weight loss among a sample of bariatric surgery patients with super-super obesity.
Previous research implies that persons with presurgical super-super obesity (body mass index [BMI] ≥60 kg/m²) tend to have poorer loss outcomes compared with those with a lower presurgical BMI after bariatric surgery.
Cleveland Clinic, Bariatric & Metabolic Institute, Cleveland, OH.
Bariatric surgery candidates (N = 1231; 71.9% female; 65.8% Caucasian) completed a presurgical psychological evaluation and the Minnesota Multiphasic Personality Inventory–2–Restructured Form. Participants with a baseline BMI ≥60 (n = 164) were compared with BMI<60 (n = 1067) on psychosocial and demographic factors, the Minnesota Multiphasic Personality Inventory–2–Restructured Form, and in the subset that had surgery (n = 870), percent total weight loss extending to the 3-year follow-up.
Patients with a BMI ≥60 were younger, less educated, and more likely to be male compared with lower BMI patients. Patients with a BMI ≥60 had greater psychosocial sequelae as evidenced by being more likely to have a history of sexual abuse, history of psychiatric hospitalization, more binge eating episodes, and higher prevalence of major depression disorder and binge eating disorder. On the Minnesota Multiphasic Personality Inventory–2–Restructured Form, those with BMI ≥60 reported greater demoralization, low positive emotions, ideas of persecution, and dysfunctional negative emotions. After controlling for surgery type, weight loss for individuals with BMI ≥60 did not greatly differ from weight loss in patients with BMI<60. Variables predictive of less weight loss at 3 years regardless of presurgical BMI, included being older, having a sexual abuse history, and higher ideas of persecution scores.
Although patients with BMI ≥60 evidenced more psychopathology before surgery, findings suggest that the relationship between higher BMI and poorer outcome may better be explained by other co-morbid factors.
Self-Reports Do Not Tell the Whole Story: A Study of Candidates for Bariatric Surgery Using A Multimethod Approach
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View all citing articles on Scopus

View full text

Integrated health articlePatient expectations of bariatric surgery are gender specific—a prospective, multicenter cohort study

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Surg Obes Relat Dis

Lancet Oncol

J Gastrointest Surg

J Gastrointest Surg

Surg Obes Relat Dis

J Am Coll Surg

Surg Obes Relat Dis

Systematic review of medium-term weight loss after bariatric operations

Obes Surg

A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass

Obes Surg

Bariatric surgery and long-term cardiovascular events

JAMA

Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects

N Engl J Med

Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis

Am J Med

Bariatric surgery: a systematic review and meta-analysis

JAMA

The effect of overweight and nutrition on prognosis in breast cancer

Dtsch Arztebl Int

Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis

PLoS One

Surgery for obesity

Cochrane Database Syst Rev

Review of the key results from the Swedish Obese Subjects (SOS) trial: a prospective controlled intervention study of bariatric surgery

J Intern Med

Trends in mortality in bariatric surgery: a systematic review and meta-analysis

Surgery

Bariatric surgery versus conventional medical therapy for type 2 diabetes

N Engl J Med

Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization-results of a prospective cohort study (DiaSurg 1 Study)

Ann Surg

DiaSurg 2 trial - surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial - DRKS00004550

Trials

Effects of biliopanceratic diversion on type 2 diabetes in patients with BMI 25 to 35

Ann Surg

Bariatric surgery versus intensive medical therapy in obese patients with diabetes

N Engl J Med

Integrated health article
Patient expectations of bariatric surgery are gender specific—a prospective, multicenter cohort study