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Patients Have High Hopes for Bariatric Surgery

Patients Have High Hopes for Bariatric Surgery
Study also shows they are willing to accept high risks for the procedure

by Ed Susman, Contributing Writer, MedPage Today
November 03, 2017
This article is a collaboration between MedPage Today® and: Medpage Today
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NATIONAL HARBOR, Maryland -- Patients considering bariatric surgery expect that the procedure will help them lose far more weight than is realistic -- and the patients say they are willing to put their lives on the line to accomplish it, researchers said here.
In a survey of 200 prospective bariatric surgery patients with a mean body mass index (BMI) of 42.2, participants said they expected that the surgery would allow them to lose at least 33% of their body weight, while the usual weight loss is actually closer to 25%, reported Anne-Sophie van Rijswijk, MD, of Medical Center Slotervaart in Amsterdam.

In her "Quickshot" oral presentation at Obesity Week, a joint meeting of The Obesity Society and the American Society for Metabolic & Bariatric Surgery, she said that 75% of the cohort reported that they would be disappointed if their weight loss was 25%. In addition, participants with a BMI of 50 or greater said they would accept a mortality risk of 10% to undergo the operation -- a risk that is about 50 times higher than the actual surgical mortality.
"We found that patients are willing to accept prodigious risks for unrealistic weight loss expectations," van Rijswijk said. "No health inspection or surgeon would accept these numbers, but patients do. These results display the burden of being morbidly obese and underline the patient's urge for bariatric surgery. These results also reinforce the importance of thorough and extensive counseling.
"Although information and education can be challenging in the bariatric population, the recognition of patients who are willing to pay a high price for unreal expectations is important to prevent disappointment after bariatric surgery, which, after all, can be considered as an effective but radical treatment of morbid obesity."
The patients in the study were 56% women, and the overall mean age was 45.1. About 35% of the patients had been diagnosed with hypertension, 12% had type 2 diabetes, 16% had dyslipidemia, and 70% were classified as having an intermediate level of education.
The 200 patients in the study were adults who were planning to undergo Roux-en-Y gastric bypass procedures after multidisciplinary pre-bariatric screening, which included standardized explanations on the meaning of side effects and adverse effects.

As a group, the patients said they expected a total long-term weight loss of 32.2% of their baseline weight, which would reduce their BMI to about 28.5. A total of 88.5% of the patients had higher expectations of weight loss than their doctors, Van Rijswijk noted: "What would normally be expected with this surgery is a 25% weight loss over 10 years."
In addition, participants said that if their total long-term weight loss turned out to be less than 24.2% – 25% is what doctors would suggest was the best they could do -- they would be disappointed in the outcome.
"When we asked them how they really felt, the patients said they thought that a 29% weight loss was what they expected -- and that would leave 75% of patients disappointed."
The patients estimated that the serious adverse event rate in undergoing the surgery would be about 5%, which van Rijswijk noted was close to the 4% that doctors expect from the procedure. But when she asked about the highest risk they would accept, the acceptance was "off the charts."
Overall, patients said they would accept a serious adverse events risk rate of 35.7% -- but 75 of the 200 participants said that even a 50% serious adverse event risk would be acceptable to them.

When asked about the risk of mortality, patients estimated it at 0.55%, which is close to the actual rate of 0.2% in centers where the operation is performed, van Rijswijk said. "When we asked what was the highest risk of mortality they would accept and still want to go through with the surgery, the median was 4.5%," she said, adding that 59 patients said they would accept a mortality risk of 10%.
Those patients who were willing to accept that risk were more likely to be men, to have higher BMIs, to have more comorbidities, and to have scored poorly on numeracy tests.
The moderator of the session at which the study was presented, Edward Lin, DO, director of the Gastroesophageal Treatment Center at Emory University School of Medicine in Atlanta, commented: "I really like this study. What the researchers have done is quantify what a desperate patient looks like."
Now, he said, the challenge is how to educate patients so they will have more realistic ideas of what to expect in weight loss as well as for the adverse events.
Approximately 5,100 researchers, physicians, and allied health care professionals attended the meeting, which concluded on Thursday.

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