Patient and Referring Practitioner Characteristics Associated With the Likelihood of Undergoing Bariatric Surgery

Abstract

Importance Although bariatric surgery is the most cost-effective treatment for severe obesity, less than 1% of severely obese patients undergo it. Reasons for low utilization are unclear. Objectives To identify patient and referring provider characteristics associated with the likelihood of undergoing bariatric surgery. Evidence Review PubMed, PsycINFO, CINAHL, and the Cochrane databases were searched for reports published between January 1, 1998, and December 31, 2014. Reports were eligible if they presented descriptive data regarding facilitators or barriers to bariatric surgery or if they reported statistical associations between patient or provider characteristics and referral to or receipt of bariatric surgery. Frequency effect sizes were calculated as the proportion of studies reporting a finding. Findings Of the 7,212 reports identified in the initial search, 53 were included in full-text review. Nine reports met our inclusion criteria and were included in analyses. Of those, four included descriptive findings, six reported statistical associations, and one included both. One report included providers as study participants, whereas eight included patients. Four of nine studies identified an association between female gender and a greater willingness to undergo bariatric surgery. Lack of knowledge about bariatric surgery was a barrier in two studies. Five of nine cited patient concerns about the outcomes and safety of bariatric surgery as a barrier to undergoing it. Patients were more likely to pursue bariatric surgery when it was recommended by referring providers. Providers who believed that obesity treatment should be covered by insurance were more likely to recommend bariatric surgery. Conclusions and Relevance Limited patient and referring provider knowledge about the safety and effectiveness of bariatric surgery are important barriers to bariatric surgery utilization. Future efforts focused on improving knowledge and identification of the critical determinants of obesity treatment decision making from both the provider and patient perspectives would have an important public heath impact.

Comparison of Efficacy and Safety of Liraglutide 3.0 mg in Individuals with BMI above and below 35 kg/m²: A Post-hoc Analysis

“…Barriers to surgery can include regional variation in healthcare [28], contraindications from comorbidities [29,30], cost [31], and patient preference for nonsurgical interventions [32,33]. The increased risks to health and detrimental effects on quality of life associated with BMI ≥ 35 kg/m 2 highlight the importance of finding additional treatment options for these high-risk individuals [5,34].…”

Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study

“…A recently published systematic review found that both patients and referring practitioners had significant concerns about the outcomes and safety of bariatric surgery, although they admitted they had limited knowledge about obesity treatment options in general [12]. Only 1 study included practitioners as participants and did not assess how the providers made treatment decisions with regard to severe obesity.…”

“…Rather, it focused on barriers to referral faced by primary care physicians (PCPs) [13]. Another study included in the systematic review found that PCP recommendations were identified as an important predictor of whether a patient would consider bariatric surgery [12,14].…”

An Exploration of System-Level Factors and the Geographic Variation in Bariatric Surgery Utilization

“…Bariatric surgery has consistently been shown to be the most effective long-term obesity treatment [1]. Yet, it is extremely underutilized, with less than 1 % of eligible morbidly obese patients undergoing weight loss surgery [1].…”

“…Yet, it is extremely underutilized, with less than 1 % of eligible morbidly obese patients undergoing weight loss surgery [1]. A recent Dartmouth Atlas Report showed that while obesity and type-2 diabetes rates are highest in the Southeastern United States (as high as 34 and 26 %, respectively), the rate of bariatric surgery among all Medicare enrollees is as low as 0.02 % in parts of this region [2].…”