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Background <p>Obesity affects over 650 million adults worldwide, with bariatric surgery being the most effective long-term treatment. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed procedures in the USA. Increased access to online information allows patients to self-educate, often leading to predetermined surgical choices. This study evaluates how self-education influences decision-making and whether specialist consultation alters patient preferences.</p> Methods <p>A prospective cohort study (May 2021–May 2022) included adults eligible for SG or RYGB. Patients completed surveys on surgical preferences and educational sources before receiving standardized consultations. Those with diabetes were presented with an evidence-based diabetes remission calculator (Cleveland Clinic, Individualized Metabolic Surgery Score). Final surgical choices were analyzed before and after consultation.</p> Results <p>Among 429 patients, 74.1% had a predetermined surgical choice, with 81.4% preferring SG. Internet searches influenced 67%, and 51% self-referred via online research. Despite evidence-based recommendations, only 34% of diabetic patients changed their predetermined choice after consulting a specialist. Many remained committed to their preference despite objective data suggesting a more optimal option.</p> Conclusions <p>Patient self-education, often based on non-evidence-based sources, significantly influences surgical decision-making, sometimes contradicting medical recommendations. This presents a challenge for healthcare providers striving to balance patient autonomy with evidence-based care. More patients are arriving with predetermined surgical choices, effective strategies are needed to navigate these dynamics, enhance patient understanding, and optimize both surgical outcomes and satisfaction.</p>

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Freedom of Choice in the United States: Patient Autonomy Is Driving Decision-Making in Bariatric Surgery

  • 期刊论文

  • 发表日期：

    2025年5月31日

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  • Peter Habib,
  • Christen Chaconas,
  • Vadim Lyuksemburg,
  • Marc Sarran,
  • Francisco Quinteros,
  • Rami Lutfi

摘要

Background

Obesity affects over 650 million adults worldwide, with bariatric surgery being the most effective long-term treatment. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed procedures in the USA. Increased access to online information allows patients to self-educate, often leading to predetermined surgical choices. This study evaluates how self-education influences decision-making and whether specialist consultation alters patient preferences.

Methods

A prospective cohort study (May 2021–May 2022) included adults eligible for SG or RYGB. Patients completed surveys on surgical preferences and educational sources before receiving standardized consultations. Those with diabetes were presented with an evidence-based diabetes remission calculator (Cleveland Clinic, Individualized Metabolic Surgery Score). Final surgical choices were analyzed before and after consultation.

Results

Among 429 patients, 74.1% had a predetermined surgical choice, with 81.4% preferring SG. Internet searches influenced 67%, and 51% self-referred via online research. Despite evidence-based recommendations, only 34% of diabetic patients changed their predetermined choice after consulting a specialist. Many remained committed to their preference despite objective data suggesting a more optimal option.

Conclusions

Patient self-education, often based on non-evidence-based sources, significantly influences surgical decision-making, sometimes contradicting medical recommendations. This presents a challenge for healthcare providers striving to balance patient autonomy with evidence-based care. More patients are arriving with predetermined surgical choices, effective strategies are needed to navigate these dynamics, enhance patient understanding, and optimize both surgical outcomes and satisfaction.