Objective To identify multidimensional needs in metabolic bariatric surgery （MBS） treatment decisions among obesity patients based on patient journey map, providing references for optimizing surgical decision-making in this population.Methods A descriptive qualitative study was conducted using semi-structured interviews with 16 obesity patients who underwent MBS.Content analysis was used for data analysis, and a patient journey map was created.Results Along the treatment timeline, patients′ decision-making needs were categorized into 30 themes across four dimensions （behaviors, thoughts, emotions, and pain points）, including health crisis, surgical stigma, ethical confusion, and financial burden.These themes were distributed in three phases:pre-decision phase （12 themes）, decision-making phase （8 themes）, and treatment phase （10 themes）.Conclusion The treatment decision journey for MBS for obese patients is complex, with challenges such as difficulty in discerning network information, economic pressure, and complex postoperative dietary management.It is recommended to establish a weight management information platform and optimize healthcare coverage policies to address the clinical needs of patients requiring MBS interventions.