Buyer's remorse: what predicts post-decision dissonance after bariatric surgery?

Abstract

Background: Bariatric surgery continues to be the most effective long-term treatment for obesity and its associated co-morbidities. Despite the benefits, not all patients may repeat the decision to undergo bariatric surgery based on their postoperative experience (postdecision dissonance).

Objectives: In this study, we explore the predictors of postdecision dissonance following bariatric surgery.

Setting: Accredited bariatric center at an academic medical center.

Methods: Patients at an accredited Bariatric Center who underwent bariatric surgery between 2011 and 2017 were surveyed to determine factors predictive of postdecision dissonance, as well as expectations, well-being, and overall satisfaction.

Results: A total of 591 patients were sent surveys, of whom 184 (31.1%) responded. Of the 184 responders, 20 (10.9%) patients would not choose to undergo bariatric surgery if they had it do to over again (postdecision dissonance). There was no difference in the time since surgery, age, sex, or type of bariatric surgery among groups. Dissonant patients were less likely to be married and privately insured. Dissonant patients were more likely to feel they had inadequate preoperative education on postoperative expectations (P < .001). These patients also had significantly greater postoperative weight regain, failed weight loss expectations, depression, and dissatisfied body image.

Conclusion: Postdecision dissonance is driven in part by a patient's perceived inadequacy of preoperative preparation for postoperative outcomes coupled with postoperative weight regain, depression, dissatisfied body image, and failed weight loss expectations. This highlights the importance of preoperative counseling on managing expectations and outcomes after surgery, as well as the need for continued postoperative engagement with a bariatric program to address weight regain and provide mental health support.

Keywords: Bariatric surgery; Body image; Surgery dissonance; Weight loss outcomes.