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Background
By better understanding patient motivations, patient education can be individualized for the most effective healthcare possible. The purpose of this study was to evaluate patient motivations for bariatric surgery.

Methods
Preoperative, three, six and twelve month postoperative data were prospectively obtained for 169 consecutive laparoscopic Roux-en Y gastric bypass surgery patients at a single academic institution. All patients were given a standardized multiple choice questionnaire which asked them about their primary motivations for bariatric surgery preoperatively, then 6 and 12 months postoperatively.

Results
Better health was the primary motivator preoperatively and at 12 months postoperatively (87, 89%, respectively). A better appearance was a primary motivation for only 15% of patients preoperatively and 20% of patients 12 months postoperative. Within health-related motivations for bariatric surgery, 29% of patients expressed a primary desire to live longer preoperative and, by 12 months postoperatively, this number increased to 38.7% of patients postoperatively. The primary motivation for bariatric surgery from a family perspective was to have more energy with children preoperatively and remained so at 12 months postoperatively (44 to 46%). The second most common familial motivation was to be a healthy role model which did not change from pre- to post-operatively (29.8 to 29.5%). Preoperatively, 65% of patients thought that diet and exercise would be the most important factor to maintain long-term weight loss; however, by 12 months postoperatively, only 56% of patients thought that diet and exercise would be the most important factor. Patients gave an increasingly greater role to surgery as an important factor for weight loss raising its importance from 45% preop to 58% at one year postoperatively. Observed to patient-expected (O:E) ratios of 12 month percent excess weight loss became more accurate as patients progressed from preop to 6 and 12 months postop (0.60, 0.70, 0.78). Pre-operative O:E Ratios of percent excess weight loss were strongly correlated with 12 postoperative excess weight loss (p<0.001).


Conclusions
Patients had increasingly, more realistic expectations for surgery's role and ideal weight. Preoperatively, accurate patient expectation of surgical weight loss resulted in better observed post-op weight loss. Patient motivation may be a prime factor for weight loss and should be harnessed for improved outcomes.