Sex, Race, and Consideration of Bariatric Surgery Among Primary Care Patients with Moderate to Severe Obesity

Abstract

BACKGROUND: Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery. OBJECTIVE: To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation. DESIGN, SETTING, AND PATIENTS: Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m 2 seen at four diverse primary care practices in Greater-Boston. MEASUREMENTS: Patients' consideration of bariatric surgery. RESULTS: Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited. LIMITATIONS: Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery. CONCLUSION: African Americans and men were less likely to have considered bariatric surgery and were less likely to have been recommended surgery by their doctors. Differences in how obesity affects QOL appear to account for some of these variations. High perceived risk rather than financial barrier was the major deterrent for patients.

Interest in bariatric surgery among obese patients with obstructive sleep apnea

“…Though not previously assessed in an OSA population, this finding is consistent with overall bariatric utilization data, where women comprise 76–83% of bariatric patients. (13–15) Nevertheless, because of the high prevalence of men with OSA, our study is unique among bariatric surgery studies in that men comprised nearly half of the interested population.…”

Racial Disparities in Obesity Treatment

“…Research has shown that men are less likely than women, and African Americans are less likely than Whites, to have considered bariatric surgery [81], while data on other racial and ethnic groups is lacking. Men and African Americans may be less likely to consider bariatric surgery because men and African Americans generally report higher quality of life scores relative to their BMI [82].…”

Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists

“…This in turn might have an impact on the perception of the general public and patients themselves. Out of the group of patients eligible for surgery, half of the patients would consider WLS as a treatment option if it had been recommended by their physician, but only 20 % stated that they have actually been recommended for WLS by their physician [15]. In addition, when asking physicians whether they would advise a patient who meets criteria for WLS to see a surgeon, only 23.8 % would recommend this [16].…”