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“I Want to Lose Weight and it Has to Be Fair”: Predictors of Satisfaction After Bariatric Surgery

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Bariatric surgery (BS) is the most effective technique used to help patients with obesity achieve long-term weight loss. Although many patients report high levels of postoperative satisfaction after BS, some remain unsatisfied with their outcome. Studies of factors that predict postoperative satisfaction have yielded varying results. Weight loss has been identified as a predictor of satisfaction after BS, but debate remains concerning the impact of preoperative expectations and psychological variables. Furthermore, the relevance of attribution and perception of equity to postoperative satisfaction has not been evaluated in patients undergoing BS.

Materials and Methods

We assessed preoperative expectations and the levels of body dissatisfaction, anxiety, and depression in 80 patients undergoing BS. Satisfaction, attribution, feeling of equity, and psychological variables were evaluated 6 months, 1 year, and 2 years after BS.


Weight loss and equity were the two predictors of satisfaction 6 months after BS. Body dissatisfaction was the main factor predicting satisfaction 1 year after BS, with equity and anxiety having smaller influences. Weight loss and equity were the factors predicting satisfaction 2 years after BS.


Our findings support previous results concerning the influence of weight loss on satisfaction after BS. The identification of equity as a factor associated with postoperative satisfaction raises questions regarding the impact of the comparisons made by the patient with others and the consequences of the messages they receive about BS. Moreover, our results underscore the importance of considering the patient’s personal experience after BS and not just their weight loss.

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  1. Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62–70.

    Article  CAS  PubMed  Google Scholar 

  2. Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy – a systematic review. Obes Surg. 2016;26(6):1326–34.

    Article  PubMed  Google Scholar 

  3. Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33.

    Article  PubMed  Google Scholar 

  4. Livhits M, Mercado C, Yermilov I, et al. Preoperative predictors of weight loss following bariatric surgery: systematic review. Obes Surg. 2012;22(1):70–89.

    Article  PubMed  Google Scholar 

  5. Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract. 2014;8(4):e299–313.

    Article  PubMed  Google Scholar 

  6. Pontiroli AE, Ceriani V, Folli F. Patients’ expectations are important for success in bariatric surgery. Obes Surg. 2017;27(9):2469–70.

    Article  PubMed  Google Scholar 

  7. Homer CV, Tod AM, Thompson AR, et al. Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study. BMJ Open. 2016;6(2):e009389.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Faccio E, Nardin A, Cipolletta S. Becoming ex-obese: narrations about identity changes before and after the experience of the bariatric surgery. J Clin Nurs. 2016;25(11–12):1713–20.

    Article  PubMed  Google Scholar 

  9. Pereira da Silva SS, da Costa MA. Obesity and treatment meanings in bariatric surgery candidates: a qualitative study. Obes Surg. 2012;22(11):1714–22.

    Article  Google Scholar 

  10. Pfeil M, Pulford A, Mahon D, et al. The patient journey to gastric band surgery: a qualitative exploration. Bariatr Surg Pract Patient Care. 2013;8(2):69–76.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hult M, Bonn SE, Brandt L, et al. Women’s satisfaction with and reasons to seek bariatric surgery – a prospective study in Sweden with 1-year follow-up. Obes Surg. 2019;29(7):2059–70.

    Article  PubMed  Google Scholar 

  12. Shai I, Henkin Y, Weitzman S, et al. Determinants of long-term satisfaction after vertical banded gastroplasty. Obes Surg. 2003;13(2):269–74.

    Article  PubMed  Google Scholar 

  13. Wallace L, Horecki EK, Helm MC, et al. Buyer’s remorse: what predicts post-decision dissonance after bariatric surgery? Surg Obes Relat Dis. 2019;15(7):1182–8.

    Article  PubMed  Google Scholar 

  14. Zijlstra H, Larsen JK, de Ridder DTD, et al. Initiation and maintenance of weight loss after laparoscopic adjustable gastric banding. The role of outcome expectation and satisfaction with the psychosocial outcome. Obes Surg. 2009;19(6):725–31.

    Article  PubMed  Google Scholar 

  15. Oliver RL. Cognitive, affective, and attribute bases of the satisfaction response. J Consum Res. 1993;20(3):418–30.

    Article  Google Scholar 

  16. Wee CC, Hamel MB, Apovian CM, et al. Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg. 2013;148(3):264–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Karmali S, Kadikoy H, Brandt ML, et al. What is my goal? Expected weight loss and comorbidity outcomes among bariatric surgery patients. Obes Surg. 2011;21(5):595–603.

    Article  PubMed  Google Scholar 

  18. Price HI, Gregory DM, Twells LK. Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery. Obes Surg. 2013;23(12):1987–93.

    Article  PubMed  Google Scholar 

  19. Heinberg LJ, Keating K, Simonelli L. Discrepancy between ideal and realistic goal weights in three bariatric procedures: who is likely to be unrealistic? Obes Surg. 2010;20(2):148–53.

    Article  PubMed  Google Scholar 

  20. World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.

    Article  CAS  Google Scholar 

  21. Rousseau A, Knotter A, Barbe P, et al. Validation of the French version of the body shape questionnaire. Encephale. 2005;31(2):162–73.

    Article  CAS  PubMed  Google Scholar 

  22. Cooper PJ, Taylor MJ, Cooper Z, et al. The development and validation of the body shape questionnaire. Int J Eat Disord. 1987;6(4):485–94.<485::AID-EAT2260060405>3.0.CO;2-O.

    Article  Google Scholar 

  23. Melero Y, Ferrer JV, Sanahuja A, et al. Psychological changes in morbidly obese patients after sleeve gastrectomy. Cir Esp. 2014;92(6):404–9.

    Article  PubMed  Google Scholar 

  24. Adami GF, Gandolfo P, Campostano A, et al. Body image and body weight in obese patients. Int J Eat Disord. 1998;24(3):299–306.<299::AID-EAT7>3.0.CO;2-H.

    Article  CAS  PubMed  Google Scholar 

  25. White MA, Masheb RM, Rothschild BS, et al. The prognostic significance of regular binge eating in extremely obese gastric bypass patients: 12-month postoperative outcomes. J Clin Psychiatry. 2006;67(12):1928–35.

    Article  PubMed  Google Scholar 

  26. Hrabosky JI, Masheb RM, White MA, et al. A prospective study of body dissatisfaction and concerns in extremely obese gastric bypass patients: 6- and 12-month postoperative outcomes. Obes Surg. 2006;16(12):1615–21.

    Article  PubMed  Google Scholar 

  27. Rosen JC, Jones A, Ramirez E, et al. Body shape questionnaire: studies of validity and reliability. Int J Eat Disord. 1996;20(3):315–9.<315::aid-eat11>;2-z.

    Article  CAS  PubMed  Google Scholar 

  28. Williamson DA, Womble LG, Zucker NL, et al. Body image assessment for obesity (BIA-O): development of a new procedure. Int J Obes Relat Metab Disord. 2000;24(10):1326–32.

    Article  CAS  PubMed  Google Scholar 

  29. Beechy L, Galpern J, Petrone A, et al. Assessment tools in obesity - psychological measures, diet, activity, and body composition. Physiol Behav. 2012;107(1):154–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Grieco MP, Bertozzi N, Simonacci F, et al. Quality of life in post-bariatric surgery patients undergoing aesthetic abdominoplasty: our experience. Surg Chrn. 2016;21(1):5–8.

    Google Scholar 

  31. Friedman S, Samuelian JC, Lancrenon S, et al. Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Res. 2001;104(3):247–57.

    Article  CAS  PubMed  Google Scholar 

  32. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    Article  CAS  PubMed  Google Scholar 

  33. Thonney B, Pataky Z, Badel S, et al. The relationship between weight loss and psychosocial functioning among bariatric surgery patients. Am J Surg. 2010;199(2):183–8.

    Article  PubMed  Google Scholar 

  34. Osterhues A, von Lengerke T, Mall JW, et al. Health-related quality of life, anxiety, and depression in bariatric surgery candidates compared to patients from a psychosomatic inpatient hospital. Obes Surg. 2017;27(9):2378–87.

    Article  PubMed  Google Scholar 

  35. Karlsson J, Taft C, Rydén A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61.

    Article  CAS  Google Scholar 

  36. Roberge P, Doré I, Menear M, et al. A psychometric evaluation of the French Canadian version of the Hospital Anxiety and Depression Scale in a large primary care population. J Affect Disord. 2013;147(1–3):171–9.

    Article  PubMed  Google Scholar 

  37. Hayes AF. An introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York; 2012. doi:978–1–60918-230-4

  38. Cohen J, Cohen P, West S, Aiken L. Applied multiple regression/correlation analysis for the behavioral sciences (3rd Ed.). Mahwah; 2003.

  39. Libeton M, Dixon JB, Laurie C, et al. Patient motivation for bariatric surgery: characteristics and impact on outcomes. Obes Surg. 2004;14(3):392–8.

    Article  PubMed  Google Scholar 

  40. White MA, Masheb RM, Rothschild BS, et al. Do patients’ unrealistic weight goals have prognostic significance for bariatric surgery? Obes Surg. 2007;17(1):74–81.

    Article  PubMed  Google Scholar 

  41. Festinger L. A theory of cognitive dissonance. Standford; 1957.

  42. Schutz HK, Paxton SJ, Wertheim EH. Investigation of body comparison among adolescent girls. J Appl Soc Psychol. 2002;32(9):1906–37.

    Article  Google Scholar 

  43. Strahan EJ, Wilson AE, Cressman KE, et al. Comparing to perfection: how cultural norms for appearance affect social comparisons and self-image. Body Image. 2006;3(3):211–27.

    Article  PubMed  Google Scholar 

  44. Rothman AJ. Toward a theory-based analysis of behavioral maintenance. Health Psychol. 2000;19(1S):64–9.

    Article  CAS  PubMed  Google Scholar 

  45. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94.

    Article  PubMed  Google Scholar 

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B. Gaudrat thanks the “Groupement de Réflexion sur l’Obésité et le Surpoids” for its support of this study. This foundation did not exercise any editorial direction or censorship on any part of this manuscript. The authors thank the Nutrition Department for its help in recruiting participants for this study.

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Correspondence to Bulle Gaudrat.

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This study was approved by an Ethics Committee for Human Sciences and was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments [20] or comparable ethical standards.

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Informed consent was obtained from all patients included in the study.

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Gaudrat, B., Florent, V., Andrieux, S. et al. “I Want to Lose Weight and it Has to Be Fair”: Predictors of Satisfaction After Bariatric Surgery. OBES SURG 31, 763–772 (2021).

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