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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK073302-04
Application #
7880909
Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Everhart, James
Project Start
2007-08-01
Project End
2012-06-30
Budget Start
2010-07-01
Budget End
2011-06-30
Support Year
4
Fiscal Year
2010
Total Cost
$641,601
Indirect Cost
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
Wee, Christina C; Jones, Daniel B; Apovian, Caroline et al. (2017) Weight Loss After Bariatric Surgery: Do Clinical and Behavioral Factors Explain Racial Differences? Obes Surg 27:2873-2884
Wee, Christina C; Hamel, Mary B; Huskey, Karen W et al. (2017) The value of health and weight loss among primary care patients with moderate to severe obesity: Do quality of life factors have a larger influence than comorbidities? Obes Res Clin Pract 11:123-126
Wee, Christina C; Davis, Roger B; Jones, Dan B et al. (2016) Sex, Race, and the Quality of Life Factors Most Important to Patients' Well-Being Among Those Seeking Bariatric Surgery. Obes Surg 26:1308-16
Wee, Christina C; Davis, Roger B; Chiodi, Sarah et al. (2015) Sex, race, and the adverse effects of social stigma vs. other quality of life factors among primary care patients with moderate to severe obesity. J Gen Intern Med 30:229-35
Stanford, Fatima Cody; Jones, Daniel B; Schneider, Benjamin E et al. (2015) Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery. Surg Endosc 29:2794-9
Chacko, Sara A; Chiodi, Sarah N; Wee, Christina C (2015) Recognizing disordered eating in primary care patients with obesity. Prev Med 72:89-94
Wee, Christina C; Mukamal, Kenneth J; Huskey, Karen W et al. (2014) High-risk alcohol use after weight loss surgery. Surg Obes Relat Dis 10:508-13
Wee, Christina C; Huskey, Karen W; Bolcic-Jankovic, Dragana et al. (2014) Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med 29:68-75
Wee, Christina C; Hamel, Mary Beth; Apovian, Caroline M et al. (2013) Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg 148:264-71
Wee, Christina C; Davis, Roger B; Huskey, Karen W et al. (2013) Quality of life among obese patients seeking weight loss surgery: the importance of obesity-related social stigma and functional status. J Gen Intern Med 28:231-8

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