Dear Editor,

We deeply appreciated the letter by Pouwels, Smelt, and Smulders and the enclosed comments and statements [1] in connection to our previous letter [2]. As the authors state, when addressing patient expectations, a multidisciplinary approach is required, where psychologists and educators probably play the major role. There are ample reasons to use new technology opportunities, be it web-based approach [3], or social networks [4], as well as traditional bariatric care groups [2]. The methods chosen can depend on local facilities and cultural attitudes. However, one should also consider the validity of the messages conveyed, and we are afraid that in the past several messages were probably not adequately received by people, be it bariatric patients, or general population. For instance, although educated people used to have a healthier lifestyle than less educated people [5], from 1988 to 2006 in the USA, there was a significant halving of adherence to healthy lifestyle habits [6]. Therefore, a great effort is required to improve knowledge and to induce correct expectations in bariatric patients, and methods and contents of the messages should be modernized together.