Bariatric or weight loss surgery (WLS) procedures are being performed less frequently worldwide.1 In the United States and Canada, the numbers of WLS procedures has decreased between 2008 and 2011 by nearly 54%, from 220 000 to 101 000. The decrease in gastric banding surgeries during the same period has been even greater, with a 71.5% decrease, from about 97 000 to 28 000 procedures.1 Bariatric surgery has the potential to improve metabolic changes associated with type 2 diabetes and cardiovascular disease, thereby effectively decreasing obesity-related morbidity and mortality.2 Therefore, factors affecting the acceptance of WLS require examination. Although patient expectations are important, they are sometimes overlooked, prompting a careful reconsideration of the attitudes of patients prior to obesity surgery in a timely article by Wee et al3 in a recent issue of JAMA Surgery, when they interviewed 654 patients who were 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. Most patients seeking surgical weight loss treatment in 2 Boston hospitals had higher expectations for weight loss than for improving their health. Only 57.5% of patients would undergo the surgery for a 20% weight loss, and on average they expected a weight loss of 38% of body weight.
Li Z, Heber D. Managing Weight Loss ExpectationsThe Challenge and the Opportunity. JAMA. 2014;311(13):1348-1349. doi:10.1001/jama.2014.1154