Long-Term Satisfaction with the Choice to Complete Metabolic and Bariatric Surgery: The Hindsight 20/20 Study

OBJECTIVE: Despite proven benefits, metabolic and bariatric surgery (MBS) remains underutilized. This study assessed long-term satisfaction among individuals after MBS and identified predictors of sustained satisfaction. RESEARCH DESIGN AND METHODS: In this cross-sectional survey with retrospective EHR linkage, adults with prior MBS identified through electronic health records at a large academic medical center completed a satisfaction survey. LASSO regression was used for variable selection, followed by an exploratory multivariable logistic regression model. RESULTS: Among 2,385 respondents (mean age 55.1 +/- 12.2 years; 84.7% female; mean 12.0 +/- 7.5 years post-MBS), 74.2% would choose MBS again, 7.3% were unsure, and 18.5% would not. Overall health benefit was the most commonly reported reason for willingness to choose MBS again, whereas weight recurrence was the most commonly reported reason for uncertainty or unwillingness. In the exploratory adjusted model, greater pre-MBS BMI and maximum percent total weight loss were associated with higher odds of choosing MBS again, whereas longer time since MBS and higher current BMI were associated with lower odds. Percent recurrence of lost weight was not independently associated with the outcome. CONCLUSIONS: Most respondents remained satisfied long-term with their decision to undergo MBS. Time since surgery and current and historical weight measures were associated with willingness to choose MBS again, although these exploratory, mutually adjusted associations should not be interpreted as independent causal effects. These findings may inform counseling about the long-term benefits and limitations of MBS.