Explanations for unsuccessful weight loss among bariatric surgery candidates.
BACKGROUND
Our objective was to analyze subjective explanations for unsuccessful weight loss among bariatric surgery candidates.


METHODS
This was a retrospective analysis of 909 bariatric surgery candidates (78.2% female, average body mass index [BMI] 47.3) at a university center from 2001 to April 2007 who answered an open-ended question about why they were unable to lose weight. We generated a coding scheme for answers to the question and established inter-rater reliability of the coding process. Associations with demographic parameters and initial BMI were tested.


RESULTS
The most common categories of answers were nonspecific explanations related to diet (25.3%), physical activity (21.0%), or motivation (19.7%), followed by diet-related motivation (12.7%) and medical conditions or medications affecting physical activity (12.7%). Categories related to time, financial cost, social support, physical environment, and knowledge occurred in less than 4% each. Men were more likely than women to cite a medical condition or medication affecting physical activity (19.2% vs 10.8%, P = 0.002, odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.28-2.99) but less likely to cite diet-related motivation (7.1% vs 14.2%, P = 0.008, OR = 0.46, 95% CI = 0.26-0.82).


CONCLUSIONS
Our findings suggest that addressing diet, physical activity, and motivation in a comprehensive approach would meet the stated needs of obese patients. Raising patient awareness of under-recognized barriers to weight loss, such as the physical environment and lack of social support, should also be considered. Lastly, anticipating gender-specific attributions may facilitate tailoring of interventions.
Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA. Kevin.O.Hwang@uth.tmc.edu
Kevin O
KO
Hwang
Joseph H
JH
Childs
G Ken
GK
Goodrick
Wael A
WA
Aboughali
Eric J
EJ
Thomas
Craig W
CW
Johnson
Sherman C
SC
Yu
Elmer V
EV
Bernstam
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D004038:Diet, Reducing / Q000523:psychology; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D012944:Social Support; D017211:Treatment Failure; D015431:Weight Loss / Q000502:physiology*