Background

Little is known about how risk preferences influence treatment decisions and satisfaction among adults with severe obesity. This study aimed to quantitatively assess the relationship between weight-related quality of life and the degree of risk that U.S. adults with severe obesity would tolerate in order to achieve their ideal body weight through pharmacological or surgical intervention.

Methods

A nationally-representative sample of U.S. adults (aged 18-65 years) with severe obesity completed a 35-question interview (n = 539). Regression models were used to examine the relationship between participants' expected improvements in weight-related quality of life at their ideal weight and willingness to accept a small, hypothetical risk of death to achieve this ideal weight via pharmacological or surgical intervention.

Results

Expected change in weight-related quality of life was significantly, positively associated with the degree of risk that participants would theoretically tolerate to achieve their ideal body weight through pharmacological or surgical treatment. Willingness to accept a small risk of death was lower for bariatric surgery than pharmacotherapy (15% vs.19% of participants). Risk acceptance and mean expected change in quality of life were higher among participants with prior use of anti-obesity medication (15% of participants) and/or bariatric surgery (4% of participants) than among those without prior treatment. Participants’ expected changes in quality of life aligned well with actual changes reported by adults from interventional studies who achieved clinically-significant weight loss.

Conclusions

Expected change in weight-related quality of life predicts treatment-related risk preferences among adults with severe obesity. Incorporating formal assessment of weight-related quality of life into clinical consultations may improve the quality of shared decision-making processes and increase the likelihood of treatment engagement and satisfaction among adults with severe obesity.