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

Introduction: Obesity is a global epidemic affecting over 650 million adults, with bariatric surgery emerging as a potent intervention for achieving long-term weight loss and mitigating associated comorbidities. [1] Among the various surgical options, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are widely performed in the United States. However, optimal surgical selection remains contentious, especially considering the increasing prominence of patient autonomy in healthcare decisions. Methods This prospective study, conducted from May 2021 to May 2022, included adults with obesity who were candidates for SG or RYGB. Patients completed a survey regarding their surgical choices and referral sources before receiving standardized education about both procedures. Patients with diabetes were subsequently presented with an evidence-based calculator predicting individual remission rates for diabetes post-surgery. Choices were compared pre- and post-consultation. Results Of the 429 patients surveyed, 74.1% had a pre-determined surgical choice, with SG being preferred by 81.4%. The majority of choices were influenced by internet searches. Post-education, despite a significant proportion of diabetic patients receiving alternate recommendations based on the evidence calculator, only 34% altered their initial choice. Discussion Findings indicate that patient decisions regarding bariatric surgery are heavily influenced by non-evidence-based internet sources, with a pronounced resistance to altering choices even when presented with objective data. Notably, perceived safety of procedures appears to outweigh considerations of diabetes remission rates. Conclusions The pervasive influence of the internet on surgical decision-making poses challenges for healthcare providers striving to balance patient empowerment with evidence-based recommendations. As patients often arrive with pre-determined surgical options, more effective strategies are needed to navigate these complex dynamics to enhance patient satisfaction and optimize surgical outcomes.