Thursday, April 10, 2014
While diet and exercise generally provide an average long-term (3-5 years) sustainable weight loss or about 3-5% of initial weight, even bariatric surgery patients tend on average to sustain a weight loss of only 20-30% of their initial weight.
Surgery, although much safer than generally thought, still bears a risk of complications and the question is how much risk patients are willing to assume if they really knew and understood how much weight they are likely to lose with surgery.
This was the subject of a study by Christina Wee and colleagues, published in JAMA Surgery, in which they examined weight loss expectations and willingness to accept risk among patients seeking bariatric surgery.
The researchers interviews 650 patients interested in bariatric surgery at two bariatric centres in Boston.
On average, patients expected to lose as much as 38% of their weight after surgery and expressed disappointment if they did not lose at least 26%.
In fact, 40% of patients were unwilling to undergo a treatment that would result in only 20% weight loss.
Most patients (85%) accepted some risk of dying to undergo surgery, but the median acceptable risk was only 0.1%.
On the other hand, some patients (20%) appeared more desperate, willing to accept a risk of 10% or greater.
As one may expect, there were important gender differences in these findings: while women were more likely than men to be disappointed with a 20% weight loss, they were also less likely to accept a greater mortality risk.
An important finding for clinicians was that 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.
This study not only shows that most patients seeking bariatric surgery have rather unrealistic weight loss expectations but also that a substantial number may well be be disappointed with their weight loss after surgery.
It is also evident that many patients believe that they need to lose a rather substantial amount of weight to derive “ANY” health benefits, when in reality even rather modest (and certainly the average 20-30% weight loss seen with surgery) carries substantial health benefits for patients. (Many patients would in fact benefit substantially if they simply stopped gaining weight).
I certainly wonder what educational efforts may be necessary to align expectations with the clinical reality of bariatric surgery and whether better managing expectations is likely to alter current practice?