Background: Obesity is a major public health issue. Although metabolic bariatric surgery is recommended for patients with obesity and related comorbidities, several patients drop out after receiving surgical eligibility. This study aims to assess dropout rate and identify predictors of attrition before surgery. Methods: This retrospective monocentric study included patients enrolled between June 2007 and December 2019 at a metabolic bariatric surgery center. Sociodemographic, clinical, and psychopathological data were collected. Patients were divided into operated group and attrition group. Univariate analysis and multivariate binary logistic regression were performed to identify independent predictors of attrition. Results: Of the 447 patients, the dropout rate was 22.25%. Depressed mood, binge eating disorder, and impulsivity traits at the time of psychiatric evaluation were correlated with dropout from the bariatric pathway (p < 0.05), but these variables lost significance at multivariate analyses. Significant predictors of attrition included male gender (OR = 3.723, p = 0.001), active smoking (OR = 2.852, p = 0.009), and ex-smoker status (OR = 2.860, p = 0.044). Protective factors were socio-familial support (OR = 0.194, p = 0.003) and the metabolic syndrome (OR = 0.078, p = 0.047). The average waiting time for surgery was 11.57 ± 9.36 months. Conclusions: The study identifies key factors influencing patients’ dropout in the surgical pathway, emphasizing the need for targeted interventions to improve retention. Although the presence of depressed mood, binge eating disorder, and impulsivity traits lost statistical significance at the multivariate analyses, their potential clinical relevance should be considered. The findings offer valuable insights for developing strategies to reduce attrition, enhance health care resource to support patients in achieving better health outcomes.
