Surgery for Obesity and Related Diseases 14 (2018) 39–46

Original article
Bariatric patients’ reported motivations for surgery and their relationship
to weight status and health
Jessica C. Peacock, M.A. Ph.D.a,*, Levi Perry, B.S.b, Kyle Moriena
a
Shenandoah University, Exercise Science Department, Levi Perry, Shenandoah University, Division of Physical Therapy, Winchester, Virginia
b
Shenandoah University, Division of Physical Therapy, Winchester, VA
Received August 1, 2017; accepted October 6, 2017

Abstract Background: Literature on patient motivation for bariatric surgery remains limited. A few studies
have examined relation to outcomes and found no established connection between motivation and
weight loss.
Setting: A retrospective convenience sample of 345 participants was recruited from an obesity
support website to complete an online survey.
Methods: Content analysis was used to describe motivations for surgery, and analysis of variance
and covariance were completed to compare groups of participants created from the qualitative
analysis on pre- and postsurgical factors like body mass index, number of co-morbidities, and
percentage of excess weight loss.
Results: A primary perceived affective response category for motivation was created that included
3 levels: desperate, tired, and pragmatic. Within these levels participants reported motivations
related to quality of life, prevent death, last option, and trigger. Participants in the desperate level
exhibited higher presurgical body mass index, greater number of presurgical co-morbidities, more
attempted methods for weight loss, and more negative perceptions of health before surgery. Par-
ticipants in the tired group experienced the greatest percentage of excess weight loss and participants
in desperate and tired showed greater weight loss, percentage of weight lost, and percentage of
excess weight lost compared with the pragmatic group when controlling for presurgical weight.
Conclusions: Most participants reported a physical health-related motivation, but participants with
greater perceived affective motivational responses cited prevention of death and viewing surgery as
their last option to a higher extent. Participants with greater perceived affective response exhibited
significantly better weight loss outcomes, indicating that some emotional component to motivation
may improve long-term success. Presurgical consultation might incorporate principles from the
Transtheoretical Model and Motivational Interviewing to connect the emotional impacts of obesity
on patients’ health and well being to health behaviors promoting weight maintenance. (Surg Obes
Relat Dis 2018;14:39–46.) r 2018 American Society for Metabolic and Bariatric Surgery. All rights
reserved.

Keywords: Obesity; Bariatric surgery; Motivation; Outcomes

While often reserved for extreme cases of morbid obesity,

bariatric surgery continues to grow in popularity, with
*
approximately 196,000 procedures performed in the United
Correspondence: Jessica C. Peacock, M.A. Ph.D., Shenandoah Uni-
versity, Exercise Science Department, 1460 University Drive. Winchester,
States in 2015 [1]. However, despite its increased acceptance
VA 22601. as a treatment option, literature examining motivations for
E-mail: jpeacock@su.edu undergoing bariatric surgery remains somewhat limited.
http://dx.doi.org/10.1016/j.soard.2017.10.005
1550-7289/r 2018 American Society for Metabolic and Bariatric Surgery. All rights reserved.
40 J. C. Peacock et al. / Surgery for Obesity and Related Diseases 14 (2018) 39–46
Several existing studies have determined that a majority of
patients report physical health factors as being the primary
motivation for seeking weight loss surgery [2–4], such as to
improve co-morbidity status or to prevent ill health. These
most prominent reasons are often followed by emotional and
other social and environmental factors like improving inter-
personal relationships or mobility [5]. A few studies have
compared motivation with weight loss. Libeton, et al. [2]
concluded that a patient’s primary motivating factor had no
impact on weight outcomes, and Figura et al. [6] found no
significant differences in reported presurgical motivation
among participants categorized by percent of excess weight
lost approximately 20 months after surgery. Both of these
studies used closed questions and rating or Likert scale to
assess for motivation; however, that may have limited the
researchers’ ability to fully capture participants’ reasoning for
seeking surgery. The present study adds to the body of
literature by employing mixed methods to examine patients’
qualitative responses regarding their decision to have bari-
atric surgery and how these stated motivations related to
patients’ weight status and a variety of other health-related
factors both pre- and postsurgery.
Methods
Instrumentation and data collection
Participants were recruited from an online obesity
support website to complete a retrospective survey regard-
ing their experiences with bariatric surgery. Information on
the survey was sent to the website’s newsletter subscribers
and posted in online forums weekly on the website for the
duration of 1 month. The survey used both open and
closed questions to assess pre- and postoperative services
related to surgery, psychology, nutrition, exercise, and
lifestyle that were completed by participants. All partic-
ipants provided informed consent on the opening page of
the survey, and responses were submitted confidentially
and with no identifying information. The survey took
approximately 15 to 20 minutes to complete, and no
incentives for completion were offered. Detailed informa-
tion on the development of the survey has been published
previously, and discusses the use of principles of tailored
design to enhance reliability and accuracy [7]. The institu-
tional review board at West Virginia University approved
the study and data collection procedures and approval is on
file. A total of N ¼ 380 was originally generated, with
exclusionary criteria of obtaining surgery outside the
United States and having had surgery before January 1,
2006. Because the survey assessed for pre- and postsur-
gical services completed by patients, these exclusionary
criteria were implemented to ensure a sample of patients
having undergone surgery at an accredited facility and
after implementation of accreditation standards that dictate
provided services in the United States.
Participant characteristics
Survey respondents were predominantly Caucasian
(78.3%) and female (84.4%), and had at least some college
or a college degree (66.0%), which is largely representative
of the bariatric population as a whole [8]. Participants had
an average age of 47 ± 9.65 years at surgery and were
approximately 22 ± 13.75 months out from their surgical
procedure at the time of survey completion. The majority of
respondents reported having Roux-en-Y gastric bypass
(62.1%) or gastric band (19.7%).
Data analyses
A sample of N ¼ 345 responses were retained for current
data analyses, with 33 survey respondents omitted due to
meeting exclusionary criteria and 2 respondents excluded
due to nonresponse to the item “Please briefly describe why
you decided to have surgery.” Qualitative content analysis
was then used to examine all textual responses to this open
question. Content analysis uses systematic coding to
determine themes within large amounts of textual data [9].
Purposes of content analyses include to explore patterns in
word use and language, and to examine both what
participants say and with what effect. A benefit of content
analysis in the investigation of qualitative data is that is
allows for both description and quantification of coded data.
The authors followed procedures for content analysis as
described by Elo and Kyngäs [10] within the field of
nursing. The first step in this process was for each author to
read individually through all participant responses, to gain a
sense of the greater whole. The authors then met for the
organizing phase of analysis, in which a collective coding
schema that best explained phenomena occurring within the
data was created. A higher order category from the data was
identified, and specific lower level categories and their
coding criteria were collectively determined during this
process; participant responses were then grouped by each
individual author based on this schema. Agreement then
had to be reached by all 3 authors before a participant
response was placed definitively into a specific category.
The final stage of content analysis is the reporting phase, in
which the authors reviewed all categories and responses and
determined the overarching theme evident in the research
and created a model illustrating this theme.
After completion of qualitative analysis, participants were
grouped by the highest order category and quantitative data
was examined comparing these categoric groups on multi-
ple demographic-, weight-, and health-related items includ-
ing age, sex, type of surgery completed, pre- and
postsurgical body mass index (BMI), reported number of
pre- and postsurgical co-morbidities, reported number of
methods used for attempted weight loss before surgery, total
reported minutes of weekly physical activity pre- and
postsurgery, perceptions of healthfulness of nutritional
 Motivations, Weight, and Health / Surgery for Obesity and Related Diseases 14 (2018) 39–46 41

habits pre- and postsurgery, perceptions of mental and Table 1

physical health pre- and postsurgery, total number of Example inclusion criteria per perceived affective response group
kilograms lost, total percentage of weight lost, percentage Perceived affective response Inclusion language
of excess weight lost, and current satisfaction with surgery. group
SPSS v.24 (IBM Corp.; Armonk, NY) was used for all Desperate “desperate”
statistical analyses. Descriptive statistics including means “scared” and other synonyms implying
and standard deviations were generated for all items, and fear
analysis of variance and Tukey’s post hoc testing were used “need to”
“have to”
to compare group averages. χ2 analyses were implemented
Tired “unhappy”
to compare group differences on the categoric items of sex “don’t want to”
and type of surgery completed. Analysis of covariance was “sick of”
also completed for weight loss outcomes, using participant Pragmatic “want to”
reported presurgical weight in kilograms as the covariate.
Effect sizes are reported using eta squared (η2) and the
contingency coefficient (ϕ). Statistical significance was set Participant responses could be placed into multiple second-
at P o .05 for all analyses. and third-order categories.
Fig. 1 provides a visual representation of these catego-
ries, along with frequencies of participant response. Overall,
Results the most frequently reported motivation for surgery was
Description of qualitative results quality of life-physical health. For the desperate group,
47.0% of respondents cited this as a motivation, followed in
The highest order category evident within qualitative frequency by last option (40.0%), and prevent death
analysis of participant motivations was a continuum of (38.0%). Over 66.0% of the tired group discussed a
perceived degree of affective response within the partic- motivation related to quality of life-physical health, fol-
ipant’s textual data spanning from desperate to tired to lowed by last option (35.9%), and quality of life-independ-
pragmatic, and these levels were created based on differ- ence (27.4%). The pragmatic group overwhelmingly cited
ences in language choice and tone that were perceived quality of life-physical health as a motivator (71.3%),
within responses. While some participant responses were followed in frequency by last option (25.6%), and quality
very matter-of-fact (pragmatic), others indicated a higher of life-social (14.0%). The trigger category was used to
level of frustration or duress (tired), and still other responses group responses that indicated a specific event prompted the
related severe distress (desperate). Upon determination of participant to have surgery, including things, such as
these levels and criteria for inclusion in each, participant receiving diagnosis of co-morbidity or reaching a certain
responses were placed into only 1 level; participants who weight, among others.
might have met inclusion for multiple levels were placed
into the group representing their highest affective response
(i.e., a participant whose response included text that fit both
pragmatic and tired was placed only into tired). After all Table 2
responses were placed into only 1 of 3 levels, n ¼ 99 Example participant responses and coding
participants were in the desperate group, n ¼ 117 partic- Participant response Codes
ipants were in the tired group, and n ¼ 129 participants “I felt that not having the surgery was like Desperate; prevent death, last
were in the pragmatic group. Table 1 provides examples of committing PASSIVE SUICIDE. My option, physical health
language for inclusion into each perceived affective health was in danger, I had tried every
response group, and Table 2 provides examples of partic- diet…this was MY CHOICE for life.”
“I had tried many times to lose and Desperate; environment, last
ipant responses and how they were coded.
couldn't keep it off when I did. I option, trigger
Second-order themes that emerged were quality of life, couldn't fasten the airplane seatbelt and
prevent death, last option, and trigger. Quality of life that was the final straw.”
responses were further categorized into third-order groups “My obesity had reached a point where it Tired; physical and
of physical health, psychological health, independence, had a profound affect upon both my psychological health
health and my lifestyle. It had robbed
social, environmental, and general based in part on the
me of my joy.”
World Health Organization’s [11] dimensions of quality of “I was tired of feeling sick and being a Tired; physical health,
life. Last option responses included statements that surgery social outcast because of my fat.” environment
was perceived to be the only remaining option participants “I survived cancer and didn't want to die Pragmatic; prevent death
had to lose weight, and prevent death responses indicated because I was fat.”
“Wanted to be able to keep up with Pragmatic; social
that the participant elected to have surgery to prevent
grandkids.”
mortality or otherwise significantly extend the lifespan.
42 J. C. Peacock et al. / Surgery for Obesity and Related Diseases 14 (2018) 39–46
Fig. 1. Qualitative categorizations of patient motivations for strategy.
Comparison of perceived affective response group and
demographic and presurgical factors
Participants within the higher order desperate group had a
significantly higher presurgical BMI than participants in both
the tired (P o .0005) and pragmatic (P o .0005) groups,
F2,341 ¼ 11.824, P o .0005, η2 ¼ .065. However, significant
differences in starting BMI were not found between the tired
and pragmatic groups (P ¼ .997) and overall effect size was
small. The desperate group reported significantly more negative
perceptions of mental health in the 3 months before surgery
compared with the pragmatic group (P ¼ .034), but there was
no significant difference in these perceptions between either
group and the tired group (P ¼ .874 and P ¼ .090,
respectively), F2,336 ¼ 3.734, P ¼ .025, η2 ¼ .022. Again,
the effect size associated with these differences was small.
There were small but significant differences between
number of reported presurgical co-morbidities among the 3
groups, F3,342 ¼ 3,321, P ¼ .037, η2 ¼ .019, and post hoc
testing showed participants in the desperate group reported
significantly more co-morbidities than the pragmatic group
(P ¼ .029), but that there were no significant differences
between desperate and tired (P ¼ .248) or tired and
pragmatic (P ¼ .590). Small but significant differences
were also identified when examining number of reported
weight loss attempt methods before surgery, F3,342 ¼ 5.103,
P ¼ .007, η2 ¼ .029, and post hoc tests showed that
participants in the desperate group reported significantly
more methods for attempted weight loss than the pragmatic
group (P ¼ .005). Again, no significant differences were
found between desperate and tired (P ¼ .059) or tired and
pragmatic (P ¼ .690). See Table 3 for descriptive statistics
on all variables.
Table 4 shows results of χ2 analysis comparing groups on
type of surgery. Results showed a significant but weak
relationship between reported type of surgery completed
and perceived affective response group, χ26,342 ¼ 23.32, P ¼
.001, ϕ ¼ .253, with participants in the pragmatic group
undergoing gastric banding with greater frequency than the
other groups and participants in the desperate group
reporting higher frequency of biliopancreatic diversion or
“other.” No significant differences in reported sex, age,
minutes of weekly physical activity, perceptions of physical
health in the 3 months before surgery, and perceived
healthfulness of nutritional habits before surgery were
determined.
Comparison of perceived affective response group and
weight loss outcomes
Significant differences in reported weight loss after
surgery were found, F2,341 ¼ 12.887, P o .0005, η2 ¼
.070, with participants in the desperate category losing more
weight in kilograms than the tired (P ¼ .003) and pragmatic
(P o .0005) groups; effect sizes were small regarding these
differences. No significant difference was found between
the weight loss of the tired and pragmatic groups (P ¼
.196). Some differences in percentage of total weight loss
were significant (F2,341 ¼ 10.161, P o .0005, η2 ¼ .056),
with the desperate and tired groups exhibiting higher total
percentage of weight loss compared with the pragmatic
group (P o .0005 and P ¼ .024). However, significant
differences were not found between the desperate and tired
groups (P ¼ .138) and overall effect size was small. For
examination of percentage of excess weight lost (F2,340 ¼
3.892, P ¼ .021, η2 ¼ .022), post hoc testing showed only
 Motivations, Weight, and Health / Surgery for Obesity and Related Diseases 14 (2018) 39–46 43

Table 3
Descriptive statistics for analysis of the variance of presurgical health and weight factors
n Mean Standard deviation Significant differences

Desperate Tired Pragmatic

Body mass index, kg/m 2

Desperate 98 51.208 10.292 P o .0005 P o .0005
Tired 117 46.345 6.947 P o .0005
Pragmatic 129 46.424 7.719 P o .0005
Perception of mental health, −2 to 2* Desperate 96 −.23 1.30 P ¼ .034
Tired 116 −.15 1.18
Pragmatic 127 .18 1.16 P ¼ .034
Number of reported co-morbidities, 0–8 Desperate 99 5.10 1.81 P ¼ .029
Tired 117 4.73 1.54
Pragmatic 129 4.51 1.79 P ¼ .029
Number of reported methods for attempted weight loss, 0–12 Desperate 99 7.19 2.45 P ¼ .005
Tired 117 6.44 2.32
Pragmatic 129 6.19 2.44 P ¼ .005
⁎
Assessed via Likert scale from “not at all good” (−2) to “very good” (2).

the tired and pragmatic groups were significantly different
(P ¼ .021), with the average percentage of excess weight
loss being highest in the tired group. See Table 5 for
descriptive statistics on all variables.
Comparison of weight loss outcomes when controlling for
presurgical weight
When controlling for participant presurgical weight,
analysis of covariance showed that participants in the
desperate and tired groups lost significantly more weight
than the pragmatic group (P o .0005 and P ¼ .269), but
did not differ significantly from one another (P ¼ 1.88),
F2,341 ¼ 89.078, P o .0005, η2 ¼ .44. Reported effect size
for these differences was large. The same pattern held true
for total percentage of weight lost and percentage of excess
weight lost when controlling for presurgical weight. No
significant differences were identified between the desperate
and tired groups (P ¼ .403 and P ¼ 1.00), but means for
both groups were significantly higher than the mean for
the pragmatic group (P o .0005, P ¼ .022, and P ¼ .005,
P ¼ .021), F2,341 ¼ 8.699, P o .0005, η2 ¼ .71 and
F2,340 ¼ 19.79, P o .0005, η2 ¼ .149. Effect sizes were
large for the differences in total percentage of weight lost and
moderate for differences in percentage of excess weight lost.
Table 4
Descriptive statistics for chi-square analysis comparing perceived affective
response group and type of surgery
Desperate Tired
n % n %
Roux-en-Y gastric bypass 61 62.9 81 69.2
Gastric band 17 17.5 14 12.0
Sleeve gastrectomy 6 6.2 15 12.8
Biliopancreatic diversion or “other” 13 13.4 7 6.0
No significant differences were found when comparing
the groups on other postsurgical factors, including BMI,
perceptions of current mental and physical health, number
of co-morbid diagnoses, weekly minutes of physical activ-
ity, perceptions of healthfulness of current nutrition, and
satisfaction with surgery.
Discussion
The present study confirms previous research showing
that physical health reasons are a major motivating factor
for patients seeking bariatric surgery [1–4]. However, this
study also determined potential differences among patients,
even those with similar motivations, such that some patients
may feel they are at or reaching a critical threshold
regarding their weight and health status when seeking
surgery. The textual responses of participants in this study
regarding the decision to have surgery ran the gamut from
being stated in a concise and objective fashion to more
clearly involving an affective reaction that indicated
increased distress and desperation for change. The partic-
ipants categorized into the desperate group exhibited a
higher average presurgical BMI than the other 2 groups, and
also reported significantly more co-morbid conditions
before having surgery. Therefore, it appears that the larger
in size one becomes, and the greater impact this increased
weight has on health, the more likely it may affect the
individual’s emotional reaction to his or her weight status
and the decision to seek surgery. Participants in the
desperate category also reported trying significantly more
Pragmatic weight loss methods than did the pragmatic group, which
may have further enhanced a feeling of despair associated
n %
with common weight “yo-yoing,” or an inability to lose
73 57.0 significant amounts of weight on one’s own. Size, co-
37 28.9 morbidities, and reported attempts at weight loss may also
15 11.7
help to explain the small relationship found between the
3 2.3
different groups and type of surgery completed. Patients in
44 J. C. Peacock et al. / Surgery for Obesity and Related Diseases 14 (2018) 39–46
Table 5
Descriptive statistics for analysis of the variance of postsurgical weight outcomes
n Mean
Total weight lost, kg Desperate 99 56.44
Tired 117 48.52
Pragmatic 128 44.64
Total percentage of weight lost, % Desperate 99 40.63
Tired 117 38.04
Pragmatic 128 34.69
Percentage of excess weight lost, % Desperate 98 84.61
Tired 117 86.71
Pragmatic 128 78.04
the desperate group may have been recommended for
biliopancreatic diversion or “other” surgery more frequently
than the other groups due to larger size and the need for
greater excess weight loss, and participants in the pragmatic
group may have been deemed better candidates for gastric
banding due to lower presurgical BMI.
The only significant difference in perceptions of mental
and physical health in the 3 months before surgery was
between the desperate and pragmatic groups, with the
desperate group perceiving much more negative impacts
on mental health than the pragmatic group. This is
supported in the qualitative data by the fact that 19.0%
and 20.5% of the desperate and tired groups cited psycho-
logical health as a motivation for surgery while only 13.2%
of the pragmatic group did. It would appear for this sample
of bariatric patients that a shift in motivation occurs across
the continuum from pragmatic to tired to desperate; while
all focus heavily on physical health-related motivations,
there is also an increased emphasis on more psychologically
influenced and affective motivators as one moves across the
spectrum, including the need to prevent mortality and the
perception that surgery is the only remaining option.
Postsurgical differences among the groups were not
unexpected. Given a higher presurgical BMI, it follows
that participants in the desperate group would exhibit
greater weight loss in kilograms. However, when presur-
gical weight was controlled for the difference in weight loss
outcomes was further elucidated: participants who exhibited
some affective response in reporting their motivation to
have surgery (those in the tired and desperate groups) had
significantly higher weight loss, total percentage of weight
loss, and percentage of excess weight loss than did
participants who did not present with any emotional
component to their reported motivation (those in prag-
matic). This indicates that some level of affective response
toward one’s motivation and weight status may improve
weight loss outcomes.
Because weight loss outcomes appeared slightly better in
the groups showing more perceived affective response and
motivation, helping patients further consider the impact
their current behaviors have on their weight, health, and
Standard deviation Significant differences
Desperate Tired Pragmatic
20.19 P ¼ .003 P o .0005
16.13 P ¼ .003
16.43 P o .0005
9.76 P o .0005
9.86 P ¼ .024
10.19 P o .0005 P ¼ .024
22.29
25.85 P ¼ .021
27.06 P ¼ .021
overall well-being may assist patients in improving their
readiness for engagement in new health behaviors that are
more supportive of positive outcomes and long-term weight
loss maintenance. This idea corresponds to the experiential
processes of “dramatic relief” and “self-reevaluation” under
the Transtheoretical Model (TTM) of change [12], wherein
an emotional response related to a problem (in this case
obesity) can help the individual move closer to committing
to and making change (in this case engaging in behaviors
that promote weight loss maintenance). While it may be
assumed that patients seeking surgery are in the “action”
stage in regards to their readiness for change, consideration
must be given for readiness to change individual behaviors
that will impact weight, including both dietary and physical
activity behaviors, as weight loss itself is an outcome and
not a behavior.
Both psychological and medical professionals working
with bariatric clientele can use knowledge of the TTM and a
related style of counseling known as Motivational Inter-
viewing (MI) [13] to further understand and enhance patient
motivation for success. MI focuses on eliciting self-motiva-
tional statements and “change talk” via guided conversation
regarding the patient’s desires, reasons for, and perceived
need and ability to enact change. Understanding techniques
from MI and the TTM and incorporating them into
presurgical counseling sessions could assist patients in more
deeply considering how their current behaviors have led to
the weight-related physical and mental health issues that
are motivating them and promote increased readiness for
long-term behavioral change that supports weight loss
maintenance.
One recent qualitative study of patient motivation found
that patients whose motivation was more self-determined or
intrinsic in nature had more positive or optimistic expect-
ations for their surgical outcomes [14]. Supporting self-
efficacy and developing patient autonomy are foundational
principles of the TTM and MI, so it could be hypothesized
that using both might help enhance expected and actual
outcomes by connecting engagement in positive health
behaviors postsurgery to the individual’s personal motiva-
tions, goals, and sense of worth.
 Motivations, Weight, and Health / Surgery for Obesity and Related Diseases 14 (2018) 39–46
A primary limitation to this study was the potential bias
in the qualitative analyses. To decrease the impact of
subjectivity in inferring tone and meaning from text data,
the authors followed several guidelines for improving
trustworthiness of analysis as described by Elo et al. [15]
including systematic coding schema that provided definition
and inclusion criteria for each category. In addition, agree-
ment had to be found among the 3 authors in order for a
participant response to be placed into a category, thus
achieving investigator triangulation and reducing bias.
Another limitation was the use of convenience sampling
and self-report survey methodology; however, the use of
convenience sampling and self-report was necessary for the
generation of a larger sample size, thus enhancing the
amount of data available for qualitative analyses. Partic-
ipants largely represented the bariatric population as a
whole [8], but generalizability is therefore still limited
primarily to Caucasian female patients. Finally, recall bias
could have impacted participant responses on the retro-
spective survey. On average, participants were approxi-
mately 22 months out from surgery, and therefore responses
regarding motivation for surgery could have been less
accurate due to the length of time that had passed.
Furthermore, this recall bias may also be influenced by
weight loss results. Participants who lost less weight, such
as some of those found in the Pragmatic group, may have
intoned less emotion in their responses due to disappoint-
ment surrounding their results. However, even these partic-
ipants were highly successful by most standards, losing an
average percentage of excess weight loss of 78.04%, so the
impact of weight loss results on reported motivations at the
time of survey may be nominal.
Conclusions
Future research is warranted to further examine the
relationship between motivation and outcomes. In partic-
ular, additional studies assessing how to use the TMM to
best assist the bariatric population in successful weight
change would be useful. While previous research has found
no relationship between readiness to change and weight
outcomes [16], results of the present study indicate that
using elements of the model such as dramatic relief could be
beneficial for enhancing motivation and weight loss suc-
cess. Finally, studies of a prospective and longitudinal
nature would also further promote better understanding of
relationships between patient motivation for surgery and
long-term weight loss results, and might consider assessing
for additional variables affecting these relationships such as
45
personality traits and readiness for and engagement in pre-
and postsurgical health behaviors.
Disclosures
The authors have no commercial associations that might
be a conflict of interest in relation to this article.
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