Obesity Surgery

, Volume 19, Issue 10, pp 1377–1383 | Cite as

Explanations for Unsuccessful Weight Loss Among Bariatric Surgery Candidates

  • Kevin O. HwangEmail author
  • Joseph H. Childs
  • G. Ken Goodrick
  • Wael A. Aboughali
  • Eric J. Thomas
  • Craig W. Johnson
  • Sherman C. Yu
  • Elmer V. Bernstam
Research Article



Our objective was to analyze subjective explanations for unsuccessful weight loss among bariatric surgery candidates.


This was a retrospective analysis of 909 bariatric surgery candidates (78.2% female, average body mass index [BMI] 47.3) at a university center from 2001 to April 2007 who answered an open-ended question about why they were unable to lose weight. We generated a coding scheme for answers to the question and established inter-rater reliability of the coding process. Associations with demographic parameters and initial BMI were tested.


The most common categories of answers were nonspecific explanations related to diet (25.3%), physical activity (21.0%), or motivation (19.7%), followed by diet-related motivation (12.7%) and medical conditions or medications affecting physical activity (12.7%). Categories related to time, financial cost, social support, physical environment, and knowledge occurred in less than 4% each. Men were more likely than women to cite a medical condition or medication affecting physical activity (19.2% vs 10.8%, P = 0.002, odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.28–2.99) but less likely to cite diet-related motivation (7.1% vs 14.2%, P = 0.008, OR = 0.46, 95% CI = 0.26–0.82).


Our findings suggest that addressing diet, physical activity, and motivation in a comprehensive approach would meet the stated needs of obese patients. Raising patient awareness of under-recognized barriers to weight loss, such as the physical environment and lack of social support, should also be considered. Lastly, anticipating gender-specific attributions may facilitate tailoring of interventions.


Morbid obesity Bariatric surgery Barriers 



Prevalence and bias adjusted kappa


Body mass index



This research was supported in part by a Clinical Investigator Award from The University of Texas Health Science Center at Houston Center for Clinical Research and Evidence Based Medicine, NIDDK Short-Term Research Training Grant 5T 35 DK007675-15, HRSA Bureau of Health Professions Grant D55HP00045, NLM grant 5 K22 LM008306 to E.V.B, and NIH/NCRR (1 UL1 RR 024148).


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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Kevin O. Hwang
    • 1
    Email author
  • Joseph H. Childs
    • 2
  • G. Ken Goodrick
    • 3
  • Wael A. Aboughali
    • 4
  • Eric J. Thomas
    • 1
  • Craig W. Johnson
    • 5
  • Sherman C. Yu
    • 6
  • Elmer V. Bernstam
    • 1
    • 5
  1. 1.Department of Internal MedicineThe University of Texas Medical School at HoustonHoustonUSA
  2. 2.The University of Texas Medical School at HoustonHoustonUSA
  3. 3.Department of Cardiothoracic and Vascular SurgeryUT PhysiciansHoustonUSA
  4. 4.Department of Family and Community MedicineThe University of Texas Medical School at HoustonHoustonUSA
  5. 5.The University of Texas School of Health Information Sciences at HoustonHoustonUSA
  6. 6.Department of SurgeryThe University of Texas Medical School at HoustonHoustonUSA

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