Bariatric patients' reported motivations for surgery and their relationship to weight status and health

Background: Literature on patient motivation for bariatric surgery remains limited. A few studies have examined relation to outcomes and found no established connection between motivation and weight loss.

Setting: A retrospective convenience sample of 345 participants was recruited from an obesity support website to complete an online survey.

Methods: Content analysis was used to describe motivations for surgery, and analysis of variance and covariance were completed to compare groups of participants created from the qualitative analysis on pre- and postsurgical factors like body mass index, number of co-morbidities, and percentage of excess weight loss.

Results: A primary perceived affective response category for motivation was created that included 3 levels: desperate, tired, and pragmatic. Within these levels participants reported motivations related to quality of life, prevent death, last option, and trigger. Participants in the desperate level exhibited higher presurgical body mass index, greater number of presurgical co-morbidities, more attempted methods for weight loss, and more negative perceptions of health before surgery. Participants in the tired group experienced the greatest percentage of excess weight loss and participants in desperate and tired showed greater weight loss, percentage of weight lost, and percentage of excess weight lost compared with the pragmatic group when controlling for presurgical weight.

Conclusions: Most participants reported a physical health-related motivation, but participants with greater perceived affective motivational responses cited prevention of death and viewing surgery as their last option to a higher extent. Participants with greater perceived affective response exhibited significantly better weight loss outcomes, indicating that some emotional component to motivation may improve long-term success. Presurgical consultation might incorporate principles from the Transtheoretical Model and Motivational Interviewing to connect the emotional impacts of obesity on patients' health and well being to health behaviors promoting weight maintenance.