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

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.

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.

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.

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.