How Much Are People Willing To Risk For Bariatric Surgery?
Wednesday, April 17, 2013
Regular readers will be familiar with my general support of bariatric weight loss surgery for appropriate patients.
This is not only due to the documented health benefits but also because in experienced hands, modern laparoscopic surgery clearly has a positive risk/benefit ratio.
But what risk are patients willing to take and how much weight loss do they expect?
This issue was now examined by Christina Wee and her Boston colleagues in a paper published in JAMA Surgery.
Based on interviews with over 600 individuals seeking bariatric surgery, most patients (84.8%) would accepted some risk of dying with with a mean acceptable mortality risk of about 7%. Alarmingly, however, almost one in five patients were willing to accept a risk as high as one in ten of dying as a result of the surgery.
This surprisingly high acceptance of potential risk was accompanied by a largely unrealistic weight loss expectation of almost 40% of their initial weight (the actual efficacy of surgery is within the 20-30% range) and stated that they would be disappointed if they did not lose at least 25% of their initial weight.
Not surprisingly, 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.
Thus, it is apparent that most patients seeking bariatric weight loss surgery have unrealistically high weight loss expectations and believe they need to lose substantial weight to derive any health benefits.
As the authors note,
“Educational efforts may be necessary to align expectations with clinical reality.”
Be that as it may, the results certainly speak not only to the dangers of “overselling” the potential weight-loss to be derived with surgery but also to ensure that patients understand that significant health and quality of life benefits can be derived even from rather modest weight loss.
AMS
Edmonton, Alberta
p.s. to my friends and colleagues in Boston: hope all your loved ones are safe!
Wee CC, Hamel MB, Apovian CM, Blackburn GL, Bolcic-Jankovic D, Colten ME, Hess DT, Huskey KW, Marcantonio ER, Schneider BE, & Jones DB (2013). Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA surgery, 148 (3), 264-71 PMID: 23553327
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Wednesday, April 17, 2013
But isn’t the risk/benefit ratio for many people skewed due to the hysteria over obesity? I think of it like any surgery — you do it only in severe cases. But based on the ubiquity of WLS billboards I see, I’m guessing there’s more than a few people who are a 0 or 1 on the Edmonton scale (right name?) who are getting it simply because they’re fat and they’re getting the you’re going to die, die, die lecture. At least it seems that way here in the U.S.
Wednesday, April 17, 2013
I think it’s an understandably difficult concept why the weight wouldn’t just keep coming off and off, hopefully the bariatric programs do a lot of education about this as it would be a big disappointment to not lose the amount you had hoped for.
Wednesday, April 17, 2013
I would be most curious as to whether the quality of life scores reflect challenges associated with weight bias. As many of your posts reflect, weight related stigma and bias are associated with significant psychological distress. How sad that this distress may in fact propell an individual to risk thier lives to achieve weight loss. Desperation indeed.