title: Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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 higher.
  
  
  METHODS
  Two WLS centers in Boston.
  
  
  METHODS
  Six hundred fifty-four patients.
  
  
  METHODS
  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
  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.
authors.forename: Christina C
authors.initials: CC
authors.lastname: Wee
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Hamel
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Apovian
authors.forename: George L
authors.initials: GL
authors.lastname: Blackburn
authors.forename: Dragana
authors.initials: D
authors.lastname: Bolcic-Jankovic
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Colten
authors.forename: Donald T
authors.initials: DT
authors.lastname: Hess
authors.forename: Karen W
authors.initials: KW
authors.lastname: Huskey
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Schneider
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D009765:Obesity / Q000523:psychology* / Q000601:surgery*; D012306:Risk; D012309:Risk-Taking; D015431:Weight Loss
references.citation: J Gen Intern Med. 2013 Feb;28(2):231-8
references.pmid: 22956443
references.citation: JAMA. 2008 Jan 23;299(3):316-23
references.pmid: 18212316
references.citation: JAMA. 1996 Oct 9;276(14):1172-7
references.pmid: 8827972
references.citation: Obes Surg. 2006 Aug;16(8):1032-40
references.pmid: 16901357
references.citation: Surg Obes Relat Dis. 2008 Jan-Feb;4(1):6-10
references.pmid: 18201668
references.citation: Obes Res. 2001 Feb;9(2):102-11
references.pmid: 11316344
references.citation: Obes Surg. 2004 Mar;14(3):392-8
references.pmid: 15072662
references.citation: JAMA. 2009 Sep 9;302(10):1097-104
references.pmid: 19671886
references.citation: Obesity (Silver Spring). 2009 May;17(5):941-64
references.pmid: 19165161
references.citation: Prev Med. 2002 Oct;35(4):390-6
references.pmid: 12453717
references.citation: Ann Surg. 2011 Aug;254(2):267-73
references.pmid: 21772127
references.citation: Arch Intern Med. 2001 Sep 24;161(17):2133-9
references.pmid: 11570944
references.citation: Evid Rep Technol Assess (Summ). 2004 Jul;(103):1-6
references.pmid: 15526396
references.citation: Int J Eat Disord. 1997 Sep;22(2):127-30
references.pmid: 9261649
references.citation: N Engl J Med. 2004 Dec 23;351(26):2683-93
references.pmid: 15616203
references.citation: Obes Surg. 2006 Apr;16(4):496-500
references.pmid: 16608617
references.citation: JAMA. 2005 Oct 19;294(15):1903-8
references.pmid: 16234496
references.citation: J Pediatr Adolesc Gynecol. 2003 Dec;16(6):349-54
references.pmid: 14642955
references.citation: JAMA. 2003 Apr 9;289(14):1761-2
references.pmid: 12684340
references.citation: Arch Intern Med. 1998 Sep 28;158(17):1855-67
references.pmid: 9759681
references.citation: N Engl J Med. 2009 Jul 30;361(5):445-54
references.pmid: 19641201
references.citation: Obes Res. 1998 Sep;6 Suppl 2:51S-209S
references.pmid: 9813653
references.citation: N Engl J Med. 2012 Apr 26;366(17):1567-76
references.pmid: 22449319
references.citation: Ann Surg. 2006 Nov;244(5):734-40
references.pmid: 17060766
references.citation: Int J Obes. 1991 Sep;15(9):577-9
references.pmid: 1835716
references.citation: Ann Surg. 2004 Oct;240(4):586-93; discussion 593-4
references.pmid: 15383786
references.citation: Curr Probl Surg. 2010 Feb;47(2):79-174
references.pmid: 20103467