Most participants reported a physical health-related motivation, but participants with greater perceived affective motivational responses cited prevention of death and viewing surgery as their last option to a higher extent. Participants with greater perceived affective response exhibited significantly better weight loss outcomes, indicating that some emotional component to motivation may improve long-term success. Presurgical consultation might incorporate principles from the Transtheoretical Model and Motivational Interviewing to connect the emotional impacts of obesity on patients’ health and well being to health behaviors promoting weight maintenance.