Motivation and Weight Loss Expectations in Bariatric Surgery Candidates: Association with 1-and 2-Year Results After Bariatric Surgery

Purpose There are discrepancies between patients' expected weight loss and what is considered achievable after bariatric surgery. This study describes the association between patients' expectations and actual weight loss, 1 and 2 years postoperatively. Materials and Methods A prospective observational study was performed. The association between expectations and actual weight loss (% total weight loss) was explored using linear regression analyses, adjusting for baseline demographics, surgery types, and self-esteem (Rosenberg self-esteem scale) and repeated separately per gender. Gender differences in motivations were explored using Chi-square tests. Results Of 440 patients at baseline, results on 368 (84%) at 1 year and 341 (78%) patients at 2 years were available. Significant and opposite associations were found when analyzing genders separately. There was a significant negative association between expectations and %TWL in men at 1 year (beta- 0.23,p = 0.04) and 2 years postoperatively (beta- 0.26,p = 0.03), indicating smaller weight loss for greater expectations. In women, a significant positive association (beta 0.24,p < 0.01) was found 2 years postoperatively, indicating greater weight loss for greater expectations. Both genders were mainly motivated by health concerns, but women were also motivated by reduced self-confidence to lose weight. Conclusions Higher expectations were negatively associated with weight loss in men, but positively in women. This may be due to men being motivated by physical complaints, which improve with lower weight-loss. Women are also driven by reduced self-confidence, which may influence weight loss maintenance behaviors. Higher weight loss goals should not be considered as a contra-indication for surgery, but may be utilized to achieve patients' goals.