Elsevier

Surgery for Obesity and Related Diseases

Volume 6, Issue 1, January–February 2010, Pages 16-21
Surgery for Obesity and Related Diseases

Original article
Perceived barriers to bariatric surgery among morbidly obese patients

Presented as a poster at the 25th Annual Meeting of the American Society for Metabolic and Bariatric Surgery, Held on June 15–20, 2008, Washington, DC.
https://doi.org/10.1016/j.soard.2009.07.006Get rights and content

Abstract

Background

Obesity has become a worldwide problem. Surgery has been shown to be a safe and effective therapy. We sought to identify those factors that patients regard as barriers to undergoing a bariatric surgical procedure.

Methods

Morbidly obese patients were asked to complete a 2-page questionnaire during routine outpatient appointments or hospitalization for other reasons. Patients were enrolled from February 2007 to April 2008. The differences between groups were assessed using univariate analysis.

Results

A total of 77 patients (41 women and 36 men) were enrolled. Their median age was 51 years, and 49% of the patients were white, followed by Hispanic (23%), and other ethnicities. Of the 77 patients, 9% were supermorbidly obese (body mass index >50 kg/m2), and 62% reported having used dieting to lose weight, with greater reports among the women (P = .01). White patients and those >55 years old were more likely to be using some type of weight loss program. Only 40% were physically active. African Americans reported greater rates of regular exercise (P <.01). Of the 77 patients surveyed, 8% had never heard of bariatric surgery. Finally, only 30% of our patient population considered themselves to be morbidly obese.

Conclusion

The results from the present survey have demonstrated that a lack of insurance coverage is not the main reason for patients not consulting a center to be evaluated for bariatric surgery. Perceived barriers and lack of knowledge exist in both the minds of the general public and physicians.

Section snippets

Methods

This was a prospectively designed study. The survey was performed at the Cleveland Clinic Florida by the Bariatric and Metabolic Institute in conjunction with the Department of Internal Medicine. We developed a 2-page standard questionnaire that was offered to morbidly obese patients in our institution (Appendix). These patients were seen by internal medical residents for other medical problems that were not surgically related at the outpatient clinic or during a hospitalization. The study was

Results

A total of 77 patients (41 women and 36 men) were enrolled in the present study (Table 1). Their median age was 51 years. Of the 77 patients, 9% were supermorbidly obese (BMI >50 kg/m2). Also, 26% were single, 56% were married, and 18% were widowed or divorced; 49% were white, 23% were Hispanics, 16% were African American, 5% were Native American, and 7% were another ethnicity. Only 5% of the patients were unemployed at the time of the survey. Only 40% of the 77 patients were physically active.

Discussion

Obesity has been listed as a disease condition for the past 3 decades [13], [14], [15]. The overall mortality rate has been .1–1.0% [4]. The specific contraindications to bariatric surgery are few and include mental or cognitive impairment and very severe co-existing medical conditions [16], [17], [18], [19], [20].

Bariatric surgery is well known to be associated with the improvement or resolution of medical conditions such as diabetes [21], hypertension, dyslipidemia, and sleep apnea [22], [23]

Conclusion

The barriers to bariatric surgery are likely multifactorial, involving patient and physician factors, health system factors, and socioeconomic factors. Although one might have the impression that a lack of health insurance was not the main reason for patients to not consider bariatric surgery, the present series was too small and the questionnaire was not validated for such a conclusion to be drawn. However, a lack of health insurance was not the main reason for patients to not consider

Disclosures

Dr. Rosenthal is a consultant to and speaker for, and has received an honorarium/educational grant from Covidien, Ethicon Endosurgery, and Synovis. All other authors claim no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

We would like to thank Noam Rosenthal for suggesting the idea for the present study and Terence O'Keeffe for helping with the data analysis and manuscript revisions.

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