Patient Education and Informed Consent

  • Peter N. Benotti


The long-term success of bariatric surgery is dependent on patient motivation and the capability of patients to make changes in lifestyle and eating behavior. Bariatric surgery is not curative, but a simple change in gastrointestinal anatomy, which facilitates limitation of calories. The variable results of individual patient weight loss accomplishment and the 10–25 % of patients who struggle with weight loss and weight maintenance are largely a reflection of the inability of patients to successfully change lifestyle and eating behavior. This offers opportunities in patient education and patient selection as more is learned about behavioral and lifestyle factors that may interfere with weight loss success after bariatric surgery. The process of patient-centered informed consent is designed to provide the patient with details of those individual factors, which argue for and against bariatric surgery. The communication of this important information in a manner which patients can comprehend is essential as is the confirmation that the patient does understand the information. Patient education and the informed consent process are complicated by inadequate health literacy skill, a common problem in patients with extreme obesity. Enhanced communication strategies and teaching techniques including audiovisual and multimedia interventions, extended patient discussions, and feedback techniques will help in addressing health literacy issues.


Obstructive Sleep Apnea Bariatric Surgery Health Literacy Informed Consent Process Weight Loss Outcome 
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  1. 1.
    Wee C, Jones D, Davis R, Bourland A, Hamel M. Understanding patients’ value of weight loss and expectations for bariatric surgery. Obes Surg. 2006;16:496–500.PubMedCrossRefGoogle Scholar
  2. 2.
    Foster G, Wadden T, Phelan S, Sarwer D, Sanderson R. Obese patients’ perceptions of treatment outcomes and the factors that influence them. Arch Intern Med. 2001;161:2133–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Munoz D, Lal M, Chen E, Mansour M, Fischer S, Roehrig M, Sanchez-Johnsen L, Dymek-Valentine M, Alverdy J, le Grange D. Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation. Obes Surg. 2007;17:1487–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Libeton M, Dison J, Laurie C, O’Brien P. Patient motivation for bariatric surgery: characteristics and impact on outcomes. Obes Surg. 2004;14:392–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Kral J. Patient selection for treatment of obesity. Surg Obes Relat Dis. 2005;1:126–32.PubMedCrossRefGoogle Scholar
  6. 6.
    Wee C, Pratt J, Fanelli R, et al. Best practice updates for informed consent and patient education in weight loss surgery. Obesity. 2009;17:885–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Gould J, Ellsmere J, Fanelli R, et al. Panel report: best practices for the surgical treatment of obesity. Surg Endosc. 2011;25:1730–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Padwal R, Klarenbach S, Wang X, Sharma A, Karmali S, Birch D, Majumdar S. A simple prediction rule for all-cause mortality in a cohort eligible for bariatric surgery. JAMA Surg. 2013;148:1109–15.PubMedCrossRefGoogle Scholar
  9. 9.
    DeMaria E, Portnier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful risk score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3:134–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Benotti P, Wood C, Winegar D, Petrick A, Still C, Argyropoulos G, Gerhard G. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2013;00:1–8.Google Scholar
  11. 11.
    Berkman N, Sheridan S, Donaghue K et al. Health literacy interventions and outcomes: an updated systematic review. Evidence reports/technology assessments No 199. Agency for Healthcare Research and Quality. 2011.Google Scholar
  12. 12.
    Balduf L, Kohn G, Galanko J, Farrell T. The impact of socioeconomic factors on patient preparation for bariatric surgery. Obes Surg. 2009;19:1089–95.PubMedCrossRefGoogle Scholar
  13. 13.
    Schenker Y, Fernandez A, Sudore R, Schillinger D. Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review. Med Decis Making. 2013;31:151–73.CrossRefGoogle Scholar
  14. 14.
    Arteburn D, Westbrook E, Bogart A, Sepucha K, Bock S, Weppner W. Randomized trial of a video-based patient decision aid for bariatric surgery. Obesity. 2011;19:1669–75.CrossRefGoogle Scholar
  15. 15.
    Eaton L, Walsh C, Magnuson T, Schweitzer M, Lidor A, Nguyen H, et al. On-line bariatric surgery information session as effective as in-person information session. Surg Obes Relat Dis. 2012;7:225–9.CrossRefGoogle Scholar
  16. 16.
    Compher C, Kang H, Elkin L, Williams N. Attendance at clinical visits predicts weight loss after gastric bypass surgery. Obes Surg. 2012;22:927–34.PubMedCrossRefGoogle Scholar
  17. 17.
    El Chaar M, McDeavitt K, Sighardson S, Gersin K, Kuwada T, Stefanidis D. Does patient compliance with postoperative office visits affect postoperative weight loss? Surg Obes Relat Dis. 2011;7:743–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Sudore R, Landefeld S, Williams B, Barnes D, Lindquist K, Schillinger D. Use of a modified informed consent process among vulnerable patients. J Gen Intern Med. 2006;21:867–73.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Sabin J, Fanelli R, Flaherty H, Istfan N, Mariner W, Barnes J, et al. Best practice guidelines on informed consent for weight loss surgery patients. Obes Res. 2005;13:250–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Peter N. Benotti
    • 1
  1. 1.Obesity Institute, Geisinger Medical CenterSoutholdUSA

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