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BMI levels within the sample, white women had the most impaired QOL, and African American men had
the least impairment. Within specific domains, black men (67%) and white men (63%) were more likely
to report physical functioning deficits, compared to black women (51%) and white women (46%). Obesity
related sexual limitations were identified as the most commonly reported impairment among both black
women (35%) and white women (24%) compared to only 11% of white men and no black men.

These studies suggest that psychosocial distress associated with obesity is more strongly experienced
by women and perhaps may explain part of the trend to presentation at a younger age, when social and
[25]
cultural pressures are strongest. As Tsai et al. suggested, culturally accepted ideal male body types may
permit a heavier weight without social detriment or decreased sense of self-esteem. However, it appears that
detriments to physical agency brought on by morbid obesity and its comorbidities do have an impact on
QOL for men and may be an important motivation for seeking treatment. Thus, a vital step in counseling
patients for weight loss and consideration of bariatric surgery may involve helping patients identify morbid
obesity as a serious health problem through its impact on aspects of day-to-day life that matter most to
the individual, with sensitivity to gendered patterns of self-perception and coping with obesity-related
impairments.

GENDER-SPECIFIC PERCEPTIONS OF WEIGHT LOSS SURGERY
In addition to gender-based differences in coping with morbid obesity and quality of life concerns,
perceptions of bariatric surgery itself and motivations to pursue surgery may differ between men and
[27]
2
women. Among 325 primary care patients with a BMI of 35 kg/m or higher, Wee et al. explored
demographic and quality of life factors affecting patient consideration of bariatric surgery and found that
the majority of patients were aware of weight loss surgery, and overall 37% had ever seriously considered
undergoing surgical treatment. Broken down by gender, 40% of women had ever considered surgery
compared to 22% of men (P < 0.05). Only 35% of this patient cohort reported ever having received
information about surgical weight loss options from a provider, with no gender differences. However,
women were more likely to have received a physician recommendation for surgery compared to men
(22% vs. 14%, P < 0.05). This is interesting given that nearly half of patients responded that they would
seriously consider weight loss surgery if recommended by their provider, and this held true for both men
and women. With regards to the other half, the perception of weight loss surgery as “too risky” was the
[27]
most commonly reported deterrent to considering bariatric surgery across gender and ethnicity groups .
Both patient perceptions of risk associated with weight loss surgery as well as physician behaviors related to
patient education and treatment recommendations influence individual and gender-specific consideration
of surgical treatment options.

Patient motivations for pursuing weight loss surgery have been shown to differ by gender, echoing
differences observed regarding self-perception of body weight and associated impairments in quality of
life. In an Australian study of 208 participants approximately one year postoperatively after laparoscopic
adjustable band placement, patients who reported distress related to appearance as a primary motivation to
pursue weight loss surgery were more likely to have a lower presenting BMI and to be female (P = 0.03 and
[28]
P < 0.001, respectively) . Additionally, patients who were motivated primarily by medical conditions were
more likely to be men (P = 0.007), to be older, and to have hypertension or diabetes. Similarly, in a majority
women (95%) United States survey study of 44 patients evaluated for bariatric surgery, 84% of participants
noted psychosocial concerns as an extremely important motivating factor for surgery, although health-
[29]
related reasons were also ranked by most as equally critical . Patients expressed high expectations for
sustained weight improvement on the order of about 80% of excess weight loss with surgical intervention.
The authors noted that this degree of weight loss cannot always be achieved postoperatively and suggested
that it is critical for patients to have more accurate weight loss expectations in order to achieve sustained
satisfaction and improved outcomes after surgery.