While bariatric surgery is one of few effective long-term treatments for obesity, it is neither risk-free nor universally effective. The costs associated with surgery and publicity surrounding surgery-related deaths and complications have left many clinicians and patients ambivalent about this potentially effective treatment. Despite the surgery's rising popularity, only a small fraction of medically eligible patients undergo bariatric surgery. Moreover, African and Hispanic Americans and the socioeconomically disadvantaged appear to be less likely to receive this treatment. Whether these variations in use are primarily driven by patient preferences or health disparities is unclear. Many factors including patient motivation and expectation impact patients'decisions about bariatric surgery and whether the benefits of surgery might outweigh its risks. Obesity's profound physical and psychosocial consequences may lead some patients to value quality of life (QOL) benefits more than clinical benefits whereas unrealistic expectations may cause others to accept higher than reasonable surgical risks and be dissatisfied with even the best outcomes. The goals of this project are 1) to better understand patients'preferences and value for weight loss and outcomes of bariatric surgery and 2) to identify barriers and factors that influence decision-making among those not already committed to this treatment. This project will examine the value of weight loss and bariatric surgery using health utility assessment,a valid means of quantifying how patients value different health outcomes that allows patients to consider all factors important to them. The project will include two distinct populations. The investigators will recruit and interview 650 patients from two bariatric centers and follow those (n~450) who proceed with surgery to assess their utility, QOL, and clinical outcomes over time. In doing so, they can quantify the value patients place on bariatric surgery by determining the change in utilities;they will also be able to examine the factors and outcomes that predict higher value. In addition, they will interview 600 sociodemographically diverse primary care patients from one hospital and three community practices to examine their views on weight loss and bariatric surgery and identify preferences and barriers that might explain current variations in treatment. Findings from this project will improve our understanding of how patients value bariatric surgery and its different outcomes and may help identify those most likely to benefit from surgery. This project will also provide the utility data needed to guide more accurate decision and cost-effectiveness analyses of bariatric surgery. Finally, findings from the study will allow patients and clinicians to make more informed decisions about weight loss surgery consistent with patient preferences, and help shape interventions and policy changes that might reduce racial and other disparities in bariatric surgical treatment.
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