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

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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.


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.


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.

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We would like to thank Monique de Kort, specialist nurse for bariatric surgery, for her diligent work in the follow-up of our patient group.


The department of surgery was funded for this research by the VGZ Healthcare Insurance Innovation Fund (P6500/D3957) and CZ Healthcare Insurance Fund (201500203), the Netherlands. The authors declare that they have no other conflicts of interest.

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Correspondence to Caroline M. J. Theunissen.

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Conflict of Interest

This study was funded by the VGZ Healthcare Insurance Innovation Fund (P6500/D3957) and CZ Healthcare Insurance Fund (201500203), the Netherlands. The authors declare that they have no other conflicts of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Theunissen, C.M.J., van Vlijmen, A., Tak, D.J.A.M. et al. Motivation and Weight Loss Expectations in Bariatric Surgery Candidates: Association with 1- and 2-Year Results After Bariatric Surgery. OBES SURG 30, 4411–4421 (2020).

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