Online patient education resources in bariatric surgery: a systematic evaluation of quality, readability,...

The internet has become a central and increasingly influential source of health information for patients around the world. Patients commonly use the internet to seek information about specific treatments and to connect with others with similar health concerns. However, the quality, reliability, and integrity of online health information resources remain a concern as many websites often lack quality control, peer review, or compliance with up-to-date guidelines. We aimed to evaluate the quality and readability of online information regarding bariatric surgery.

A web-based search using the terms "bariatric surgery" and "weight-loss surgery" was performed on the top search engines. A review was carried out on the first 10 results from each search engine and was evaluated using validated instruments such as JAMA Benchmarks, DISCERN, EQIP, Global Quality Scale, and standardized readability and visibility indices. Visual content and images representing bariatric surgery were also evaluated regarding their context and representation.

Seventeen bariatric surgery websites were included. Quality and integrity of the websites across validated instruments were inconsistent with a median JAMA score 1 [IQR: 0-3], and 29.4% meeting no transparency criteria. Critical patient-centered content domains were frequently underrepresented, such as risk reporting (5.9%), long-term outcomes (41.2%), financial considerations (11.8%), and shared decision-making support (58.8%). Readability of content was a common issue (median Flesch-Kincaid Grade Level 12.0, [IQR:9.9-14.6]). Bariatric surgery-related visual content was mainly outcome-focused, and showed imbalances in gender and racial representation (71.4% female, and 83.0% lighter skin tones). More complex bariatric surgeries and non-surgical obesity treatments were inconsistently discussed (BPD/DS 41.2%, SADI-S 29.4%, medical therapy 23.5%).

Despite high visibility, popular web-based resources for bariatric surgery demonstrate major deficiencies in transparency, readability, and patient-centered content, and may hinder the informed consent and shared decision-making process highlighting the need for substantial improvement in the quality and integrity of bariatric surgery websites.