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Bariatric perception survey

Are PCPs in England prejudice against bariatric surgery?

Junior PCPs could also have a negative attitude towards surgery

Primary care practitioners (PCPs) may be prejudiced against bariatric surgery, according to the results of a small survey conducted in England. The study, thought to be the first of its kind in the UK, concluded that that PCPs have low referral rates for bariatric surgery, lack confidence and support managing bariatric surgery patients, and are not well informed regarding the risks and benefits of bariatric surgery. The paper, ‘A pilot study of primary care physicians’ attitude to weight loss surgery in England: are the young more prejudiced’, was published in Surgery for Obesity and Related Disorders.

Although PCPs are seen as the ‘gate-keepers’ for publically-funded bariatric surgery in the UK, their attitude towards surgery has not been studied. Therefore, the study which was led by Emma Rose McGlone and Omar Khan from the department of bariatric surgery at St George’s Hospital, London UK, aimed to specifically investigate the attitude and referral patterns of PCPs in England regarding obesity and bariatric surgery, as well as analyse any differences between junior and more senior PCPs.

Questionnaires were sent to PCP consortiums in different geographic areas of England (northwest London, Norfolk, and southwest Yorkshire) to ensure a diverse and representative sample of PCPs (n=382), and respondents were deemed ‘junior’ if they had ≤8 years’ practice as a PCP. Responses were provided by 35 PCPs (9.2%), of which 18 (51%) were male, 10 (29%) classified as junior and 25 (71%) as senior.

Outcomes

PCPs reported that approximately 30% of their patients were obese, although there was a difference between junior and senior PCPs regarding prevalence of obesity in their populations – junior PCPs estimated 22% were obese whereas senior PCPs estimated 34%. On average, PCPs estimated that two patients in the previous 12 months had come to them requesting information about bariatric surgery, and they had referred an average of one patient onwards for assessment for bariatric surgery. There was no difference in referral rates between junior and senior PCPs.

Although the vast majority of all PCPs acknowledged the weight loss benefits of bariatric surgery, a greater proportion of junior PCPs (vs senior PCPs) felt that it should not be publicly (NHS) funded (50% vs 8%; p<0.01).

Knowledge of bariatric surgery among PCPs was also limited, with seven PCPs replying ‘don’t know’ or ‘not known’ when estimating early mortality rate after bariatric surgery, and others giving an average estimate of 2%, which is more than 10-fold the actual mortality rate in the UK. They also underestimated the expected weight loss for bariatric patients, estimating around 25% of excess weight loss, whereas data shows that with gastric bypass and sleeve gastrectomy (the main bariatric operations performed in the UK) the rate is nearer to 70%.

Only 34% of PCPs felt confident providing long-term care to patients that had undergone bariatric surgery, and the vast majority felt poorly supported in managing medical and surgical problems of this cohort.  

The authors commented that their results indicate an urgent need to improve support and education offered to PCPs regarding obesity management and bariatric surgery.

Although the authors acknowledge that the pilot study’s conclusions are limited by its small sample size and low response rate, they feel the results are valuable.

“Given there are some 125,000 PCPs in England and approximately 6,000 bariatric operations take place annually, this would imply that on average each PCP in England is ‘generating’ approximately 0.05 bariatric operations per year,” the authors noted. “Even accounting for the fact that some referrals will not subsequently undergo surgery, this very low figure suggests that the responders to our study were more enthusiastic about bariatric surgery than the non-responders...This potentially strengthens our conclusions regarding the need to improve support and education provided by bariatric specialist healthcare providers to PCPs in England.”

“It appears that junior PCPs may have a particularly negative view regarding weight loss surgery (WLS),” the authors concluded. “The findings of this pilot study support the need for larger scale studies assessing and investigating the attitudes of PCPs toward obesity and WLS. Better understanding of this issue would facilitate improved education and support services for PCPs caring for patients with obesity.”

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