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Lack of interest in surgery

Why patients are not interested in surgery

The most cited reasons for not being interested in surgery were fear of other complications from surgery (51.1%), the fact that they did not need surgery to lose weight (32.0%), and fear of dying (24.6%)
The most cited reasons for being interested in bariatric surgery (Table 2) are health benefits (94.3%), greater weight loss (89.7%), and improved mobility (85.1%)

There are a number of factors why patients are not interested bariatric surgery despite evidence showing that surgery is an effective intervention for weight loss and diabetes management, according to research from Canada. The study team from York University, Toronto and The Wharton Medical Clinic, Hamilton, ON, Canada, found that despite qualifying for surgery, patients were worried about the complications from surgery and claimed they did not need surgery to lose weight. The study authors stated that greater education regarding weight management goals and surgical interventions is required.

The objective of the study, ‘Receptivity to Bariatric Surgery in Qualified Patients’, published in the Journal of Obesity, was to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure and expands on previous research by examining the motivating factors behind those who are interested as well as those not interested in bariatric surgery.

From 387 patients who took part in the study, only 87 (23%) participants were interested in bariatric surgery. Participants had a mean age of 48.0+11.4 years, weight of 136.4+25.7kg, and BMI48.4+6.8. The prevalence of type 2 diabetes was 11%. The participants were predominately white (79%) and female (72%). There were no significant differences in sex, ethnicity, age, or prevalence of type 2 diabetes between those interested and not interested in bariatric surgery (p>0.05).

Outcomes

Individuals interested in bariatric surgery had a higher BMI than those not interested (48.0 versus 46.2, p>0.03 ). Additionally, individuals interested in bariatric surgery believed that they would lose more weight with surgery than those not interested (51 versus 44 kg, p+0.0069 or 37% versus 33% of body weight, p=0.01).

The most cited reasons for not being interested in bariatric surgery (Table 1) were fear of other complications from surgery (51.1%), the fact that they did not need surgery to lose weight (32.0%), and fear of dying (24.6%). Among those not interested in bariatric surgery, only 7.7% of respondents stated that they did not believe that bariatric surgery would work. The most cited reasons for being interested in bariatric surgery (Table 2) are health benefits (94.3%), greater weight loss (89.7%), and improved mobility (85.1%).

Table 1: Reasons respondents cited for being interested or not interested in bariatric surgery

The mean scores for Likert scale questions regarding bariatric surgery are listed under the 4 categories and presented in Table 2. After adjusting for BMI, sex, and age, those who scored high in past weight loss success (RR = 0.71 (0.57–0.87)) and financial concerns regarding surgery (RR = 0.49 (0.40–0.60)) were less likely to be interested in bariatric surgery while those who scored high in receptivity to surgery (RR = 1.90 (1.56–2.31)) or positive social support (RR = 1.86 (1.51–2.29)) were more likely to be interested in bariatric surgery (Table 2).

Table 2: Mean scores for responses to questions regarding receptivity to bariatric surgery. Data are presented as mean (SD) and as relative risk (95% confidence interval) adjusted for BMI, sex, and age. Scores are on a scale of 1 (strongly disagree) to 5 (strongly agree). (i) Signifies inverted score for category score calculation (i.e., 1 = strongly agree and 5 = strongly disagree). *Significantly different from being interested in bariatric surgery (p<0.05)

“To our knowledge this is the first study to demonstrate factors associated with receptivity to bariatric surgery in qualified patients within a publicly funded clinic. Individuals who were interested in bariatric surgery had a higher BMI and greater weight loss expectations for surgery than those not interested,” the authors write. “Those who report past weight loss success or financial concerns were less likely to be interested in bariatric surgery while those with high receptivity to surgery or positive social support regarding surgery were more likely to be interested in bariatric surgery.

Interestingly, cost was one of the most cited reasons as a barrier to surgery although it was unclear whether it was the costs of the actual surgery itself, such as taking time off work, additional childcare costs, or the cost of lifestyle adjustments that are factoring into these individuals receptivity to surgery.

“Our study suggests that several key issues require greater education regarding weight management goals and surgical interventions,” the authors conclude. “Although those interested in bariatric surgery had a higher BMI than those not interested, both groups still have unrealistic expectations regarding bariatric surgery as a weight loss intervention. It appears that weight loss expectations are not a major driving factor of interest in bariatric surgery, as there are still very low levels of interest in bariatric surgery.”

To access this paper, please click here

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