OBJECTIVES: While bariatric surgery is being increasingly employed as a cost-effective option for treatment of obesity, it has not yet realized its full potential. Patient participation in the full treatment cycle is key to adoption and outcomes. To that end, the objectives of this study were three-fold: 1) Determine how patients are expected to share the burden of bariatric surgery treatment efficacy, 2) Characterize factors that influence patient willingness to adopt and pay, and 3) Identify approaches to improve patient outcomes. METHODS: Global clinical guidelines and HTAs published from 2008-2013 were analyzed. These results were collated with a survey of 2,784 patients across 12 countries, representing major markets in the Americas, Europe, Middle East, and Asia. Surveyed patients were in 26 – 50 age-groups and with BMI in the 34.3 – 43.4 kg/m range. It evaluated patients’ perception of barriers in terms of cost and safety, and motivators to adopt surgical procedures for treatment of obesity. RESULTS: Clinical guidelines and HTAs recommended that pre-treatment patients comply with weight-loss regimens, and post-treatment adhere to severe dietary restrictions, life-style changes, and life-long follow-up. The survey indicated that while patient age, income level, and physicians’ opinion were strong indicators of patients’ likelihood of considering surgery, BMI was not. Importantly, three significant barriers to adoption were identified: a) lack of understanding of safety and efficacy, b) the perceived out-of-pocket cost of treatment, and c) the extent of sustainable life style changes expected of patients. CONCLUSIONS: Although bariatric surgery is considered potentially clinically- and cost-effective, patient willingness to undertake surgery indicates a chasm between perception and reality. To aid in bridging that gap, findings suggested that three key issues must be addressed: a) improve patient education and physician engagement, b) expand the evidence base to demonstrate long-term clinical benefits of surgery, including metabolically-related risk factors, and c) demonstrate economic benefits to price-sensitive patients.