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 (β - 0.23, p = 0.04) and 2 years postoperatively (β - 0.26, p = 0.03), indicating smaller weight loss for greater expectations. In women, a significant positive association (β 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.