Background

The ideal bariatric operation is heavily debated. Our study is the first to objectively measure the influence of internet searches, surgeon recommendations, and evidence-based digital tools on patient's surgical choice.All candidates for gastric sleeve (GS) and bypass (GB) completed questionnaires about referral source, choice of surgery and rationale, under IRB-approved protocol. Patients were educated in standardized fashion about mechanism of action, risks, and benefits of each operation. Diabetics were then presented with evidence-based calculator predicting individual remission rates with GS versus GB. We recorded patients' original choice, change in heart after consultation and after calculator for diabetics. Of 334 patients, 77.8% were female, average BMI 45.3. Comorbidities prevalence: 24.5% diabetes, 36% hypertension, 19% sleep apnea, 16% hyperlipidemia, 40.4% GERD symptoms (36% on medications). Referral sources were mostly internet searches (50.9%), 34.1% primary-care, 15% word-of-mouth. Most patients (75.4%) had predetermined decisions (81.4% GS), mostly from social media (67%), followed by friend/relative recommendation (28%). After consultation, only 38/334 patients (11.3%) changed their minds, 26 changed to GS due to its 'simplicity,' 12 changed to GB, mostly for GERD symptoms.Though the calculator recommended the opposite choice for more than half of diabetics (53%), most (63.6%) refused to revise their choice despite clearly presented evidence-based recommendations. Of those who complied with calculator, 81% switched to GB. Patients with severe obesity are largely self-referred from internet searches with strongly predetermined choices. They tend stick to their decisions despite surgeons' guidance otherwise. Furthermore, evidence-based tools predicting healthcare outcomes are largely ineffective in optimizing decisions.