Sex, Race, and the Quality of Life Factors Most Important to Patients’ Well-Being Among Those Seeking Bariatric Surgery

Abstract

Background Evidence suggests obesity-related social stigma and impairment in work function may be the two most detrimental quality of life (QOL) factors to overall well-being among patients seeking weight loss surgery (WLS); whether the relative importance of QOL factors varies across patient sex and race/ethnicity is unclear. Methods We interviewed 574 patients seeking WLS at two centers. We measured patient’s health utility (preference-based well-being measure) as determined via standard gamble scenarios assessing patients’ willingness to risk death to achieve weight loss or perfect health. Multivariable models assessed associations between patients’ utility and five weight-related QOL domains stratified by gender and race: social stigma, self-esteem, physical function, public distress (weight stigma), and work life. Results Depending on patients’ sex and race/ethnicity, mean utilities ranged from 0.85 to 0.91, reflecting an average willingness to assume a 9–15 % risk of death to achieve their most desired health/weight state. After adjustment, African Americans (AAs) reported higher utility than Caucasians (+ 0.054, p=0.03), but utilities did not vary significantly by sex. Among Caucasian and AA men, impairment in physical functioning was the most important factor associated with diminished utility; social stigma was also a leading factor for Caucasian men. Among Caucasian women, self-esteem and work function appeared equally important. Social stigma was the leading contributor to utility among AA women; QOL factors did not appear as important among Hispanic patients. Conclusion AAs reported higher utilities than Caucasian patients. Individual QOL domains that drive diminished well-being varied across race/ethnicity and sex.

Review: Sex-Specific Aspects in the Bariatric Treatment of Severely Obese Women

“…The authors suspected that men tend to seek treatment later [132]. This fits with the results of Wee et al, who found differences concerning self-evaluated quality of life, social stigma, and the utility of bariatric surgery in achieving personal goals depending on sex as well as ethnicity [134].…”

Motivations of Males with Severe Obesity, Who Pursue Medical Weight Management or Bariatric Surgery

“…16 Similarly, Wee's secondary analysis of patients with severe obesity found that males pursued bariatric surgery due to experiencing weight stigma. 9 However, no single-gender study of men with severe obesity describes improving psychological health as a motivator for seeking bariatric surgery. Improving body image is less common as a motivator for patients seeking MWM in the literature.…”

“…5 Two mixed-gender studies noted that functionality was a motivator for participants with obesity and severe obesity pursuing bariatric surgery. 8,9 In particular, Wee found that males were motivated by poor physical functioning. 9 Our study supports existing mixed-gender literature suggesting that patients were motivated to pursue surgery to prevent death or extend their lifespan.…”

“…8,9 In particular, Wee found that males were motivated by poor physical functioning. 9 Our study supports existing mixed-gender literature suggesting that patients were motivated to pursue surgery to prevent death or extend their lifespan. 15 Nevertheless, literature on fear of death as a motivator to pursue surgery is limited and there are no single-gender studies that describe the fear of death among males.…”

“…Several mixed-gender studies reported subanalyses of male patients' motivations for pursuing bariatric surgery, including medical conditions and health concerns, weight stigma, and reduced work functioning. [7][8][9] In this study, we analyzed 25 semistructured interviews with male Veterans with severe obesity, who participated in a Veteran Affairs (VA) weight loss program. We also identified and described patient motivations for pursuing either MWM or bariatric surgery.…”