Explanations for Unsuccessful Weight Loss Among Bariatric Surgery Candidates
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Our objective was to analyze subjective explanations for unsuccessful weight loss among bariatric surgery candidates.
This was a retrospective analysis of 909 bariatric surgery candidates (78.2% female, average body mass index [BMI] 47.3) at a university center from 2001 to April 2007 who answered an open-ended question about why they were unable to lose weight. We generated a coding scheme for answers to the question and established inter-rater reliability of the coding process. Associations with demographic parameters and initial BMI were tested.
The most common categories of answers were nonspecific explanations related to diet (25.3%), physical activity (21.0%), or motivation (19.7%), followed by diet-related motivation (12.7%) and medical conditions or medications affecting physical activity (12.7%). Categories related to time, financial cost, social support, physical environment, and knowledge occurred in less than 4% each. Men were more likely than women to cite a medical condition or medication affecting physical activity (19.2% vs 10.8%, P = 0.002, odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.28–2.99) but less likely to cite diet-related motivation (7.1% vs 14.2%, P = 0.008, OR = 0.46, 95% CI = 0.26–0.82).
Our findings suggest that addressing diet, physical activity, and motivation in a comprehensive approach would meet the stated needs of obese patients. Raising patient awareness of under-recognized barriers to weight loss, such as the physical environment and lack of social support, should also be considered. Lastly, anticipating gender-specific attributions may facilitate tailoring of interventions.
KeywordsMorbid obesity Bariatric surgery Barriers
Prevalence and bias adjusted kappa
Body mass index
This research was supported in part by a Clinical Investigator Award from The University of Texas Health Science Center at Houston Center for Clinical Research and Evidence Based Medicine, NIDDK Short-Term Research Training Grant 5T 35 DK007675-15, HRSA Bureau of Health Professions Grant D55HP00045, NLM grant 5 K22 LM008306 to E.V.B, and NIH/NCRR (1 UL1 RR 024148).
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