title: Tipping point: factors influencing a patient's decision to proceed with bariatric surgery.
abstract: BACKGROUND
  Despite the fact that bariatric surgery is the most effective intervention for morbid obesity, only a fraction of obese patients, even after undergoing evaluation for surgery, decide to undergo the surgery. Opting out by patients is fairly common yet little is known about factors that lead a patient to decide to undergo surgery.
  
  
  OBJECTIVE
  The purpose of this qualitative study was to identify factors that "tipped the scales" in the patient's experience leading to a decision to move ahead with surgery.
  
  
  METHODS
  The study was carried out in the bariatric surgical clinic of a southeastern regional medical center.
  
  
  METHODS
  This qualitative descriptive study utilized semistructured interviews with patients (n = 24) at the time of their "decision visit" to determine the factors related to their positive decision to move forward. A modification of Colaizzi's procedural steps of analysis was used to extract, organize, and analyze data for central themes.
  
  
  RESULTS
  Two main factors leading participants to decide to move ahead with bariatric surgery were their own worsening health issues and low energy levels that limited their activities. Participants also noted additional factors that impacted their "tipping point" such as financial considerations and family influences.
  
  
  CONCLUSIONS
  The decision to move ahead with bariatric surgery is influenced by many factors to which this research provides additional insight. Further research is warranted to fully understand this phenomenon and develop appropriate outreach and educational approaches.
authors.affiliation: College of Nursing, East Carolina University, Greenville, North Carolina.
authors.forename: Donna W
authors.initials: DW
authors.lastname: Roberson
authors.affiliation: College of Nursing, East Carolina University, Greenville, North Carolina.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Neil
authors.affiliation: College of Health and Human Performance, East Carolina University, Greenville, North Carolina.
authors.forename: Mary Lisa
authors.initials: ML
authors.lastname: Pories
authors.affiliation: College of Nursing, East Carolina University, Greenville, North Carolina. Electronic address: rosem@ecu.edu.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Rose
mesh_terms: D050110:Bariatric Surgery / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012959:Socioeconomic Factors
keywords: Bariatric surgery; Decision-making; Obesity; Qualitative research