DO WE HAVE ENOUGH EVIDENCE TO SUPPORT BARIATRIC SURGERY (PART IV)What do we really know from the motivation of the patients seeking an obesity-treatment? A recent survey has brought some answers concerning patients who were candidates to obesity surgery: understandably, there are looking for a resolution of their morbidities, as well as a significant weight-loss. 40 out 44 patients would willingly put their life in danger in order to obtain their 'dream weight', whereas they were more reluctant to do so (32/44) in order to achieve a mere 20% sustained  weight loss… This study underlines the fact that candidates for bariatric surgery are different from other obese subjects, including patients who would benefit from surgery but are not ready to undertake such treatments. Although one foresees the same expectations, there are indeed large variations in terms of priorities: improvement of related diseases, body image, quality of life, etc. Other variations exist when it comes to other persons: patient relatives and friends, public audience, journalist, endocrinologist, bariatric surgeon…
The French example has many specifics. Alhough often critized from the inside, it looks generous and efficient from the outside. After a steep increase during the years 1998-2002, there has been a decrease in 2003 and 2004**. A plateau is observed now, that can be explained in the aftermaths of a momentum caused by a new procedure. Can we contemplate that the proportion of morbid obese who will be operated is meant to stay at this level, which is still far from satisfactory: around 15000 operations are performed each years, whereas 360000 morbid obese are acounted for?
Actually, the French health system looks attractive in many respects that are very often absent in other rich countries : funding and reimbursement processes are correct, there is no waiting list, a relevant information is provided to the public audience through the media. Interdisciplinary meetings and surgical training are well organized. Then we have to assume that most obese patients are still reluctant to get surgery, even if this is mini-invasive surgery, because it entails general anaesthesia, operative risk and potential sequellaes.

*WEE CC, JONES DB, DAVIS RB, BOURLAND AC, HAMEL MB. Understanding patients’ value of weight-loss and expectations for bariatric surgery. Obes Surgery, 2006; 16: 496-500.
**OBERLIN P, MOUQUET MC. Etudes et résultats. La chirurgie de l’obésité en France de 1997 à 2003. Direction de la Recherche des Etudes, de l’Evaluation et des  Statistiques- Ministère des Solidarité, de la Santé et de la Famille, n° 410, Juillet 2005.