title: Is there a Reason Why Obese Patients Choose Either Conservative Treatment or Surgery?
abstract: The effects of bariatric surgery on excess weight loss (EWL) and comorbidities are proven. Still, a significant number of patients prefer conservative therapy (ConsP).
  
  
  
  The goal of this study was to examine why ConsP and patients awaiting bariatric surgery (SurgP) choose which therapy, and to define the differences in their expectations.
  
  
  
  Prospective study, 1 university hospital, 1 general hospital, Germany.
  
  
  
  ConsP and SurgP were asked to complete a questionnaire. Statistical analysis including all patients and a BMI-matched cohort was performed using the chi-square and Wilcoxon rank-sum test.
  
  
  
  Overall, 151 patients participated in this study (50 ConsP, 101 SurgP, 69.4% females). The mean age was 41.1 years (SD ± 12.2 years). ConsP had a significant lower body mass index (BMI, 44.7 kg/m2vs. 49.3 kg/m2, p < 0.01). The educational level was significantly higher in ConsP. SurgP suffered significantly more often from depression (21.6% vs. 36.6%, p = 0.02) and joint pain (45.1% vs. 68.7%, p = 0.02). ConsP completed significantly more diets that were supervised by physicians or considered well-structured (56.3% vs. 31.0%, p = 0.04). SurgP considered their chosen therapy a last resort significantly more often (p < 0.01). A BMI-matched analysis between ConsP and SurgP revealed no significant differences in the prevalence of comorbidities but showed that fear of surgery plays a major role in the decision-making processes of obese patients.
  
  
  
  A higher BMI and a greater prevalence of comorbidities had driven patients to seek a more radical solution for their obesity, i.e., surgery. The BMI-matched analysis suggests that fear of surgery is a relevant factor in why obese patients do not decide to undergo bariatric surgery lightly.
authors.affiliation: Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. lars.fischer@med.uni-heidelberg.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Fischer
authors.affiliation: Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Anna-Laura
authors.initials: AL
authors.lastname: Wekerle
authors.affiliation: Obesity Clinic, Schön Klinik Hamburg Eilbek, 22081, Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Sander
authors.affiliation: Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Nickel
authors.affiliation: Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Billeter
authors.affiliation: Department of Internal Medicine, Endocrinology and Metabolism, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Zech
authors.affiliation: Institute for Medical Biometry and Informatics, University Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.affiliation: Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000523:psychology*; D015992:Body Mass Index; D015897:Comorbidity; D000072700:Conservative Treatment / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology* / Q000601:surgery*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D015431:Weight Loss
keywords: Bariatric surgery; Conservative treatment; Obesity; Patient expectations