Biology Trumps Motivation in Bariatric Surgery

November 14, 2012 — A recent study in Surgical Endoscopy examined whether payment sources (public-pay versus self-pay) resulted in different outcomes for patients receiving laparoscopic adjustable gastric banding (LAGB) weight loss surgery. Self-funding was used as a potential indicator of higher motivation.

Since behavior change plays a role in obesity outcomes, many assume that patients who pay out of pocket for their procedure will be more motivated and have more success. The study examined the effect of public funding versus self-pay on patients undergoing LAGB over time periods of 1, 2, and 3 years. The authors conclude that while patient motivation may affect early weight loss results at 1 and 2 years post-surgery, but the operation itself is the main determinant of weight loss at 3 years.

The study by Jonathan Afoke et al. looked at a consecutive non-randomized group of patients undergoing LAGB over 5 years (September 2003 to December 2008). Age, sex, funding manner, body mass index (BMI), and complications were recorded. The authors examined percent excess weight loss (EWL) and the Reinhold criterion for success of lap-band surgery (proportion achieving 50% EWL).
The results were that 99 patients were publicly funded, and 250 patients were self-payers. Initial BMI was significantly higher in the publicly funded patients with a higher proportion of males. Mean percent EWL was significantly less for publicly funded patients at 1 year (38.1 vs. 53.5 %) and 2 years (49.6 vs. 64.1 %), but not at 3 years (59.7 vs. 61.8 %). Fewer publicly funded patients achieved 50 % EWL at 1 year (24.5 vs. 50.2 %), but with no significant difference at 2 years (54.8 vs. 67.0 %) or 3 years (55.2 vs. 66.0 %).
Read the abstract from Surgical Endoscopy here.