Factors influencing a patient's decision to undergo bariatric surgery

A patient’s decision to undergo bariatric surgery is often driven by a combination of complex factors such as health concerns, impaired quality of life and societal pressure, according to researchers from the University College Cork, Cork, Ireland.

They found that health concerns were the primary motivator, with participants seeking to address comorbidities, mitigate health risks, and enhance their quality of life. In addition, body image, psychological well-being, and resistance from family members also presented obstacles. In addition, barriers to accessing bariatric surgery included financial constraints, lack of insurance coverage, work-related obligations and logistical challenges.

The study authors noted that no recent reviews have addressed the combined motivators and barriers affecting individuals’ decisions to undergo bariatric surgery. Therefore, the aim of their systematic review was to investigate factors that influence an individual’s decision to undergo bariatric surgery. This review asked: what are the factors that motivate an individual to undergo bariatric surgery and what are the factors that prevent an individual from undergoing bariatric surgery?

A total of 3,689 records were identified after a literature search with a total of 13 studies (302 participants) included in the systematic review. The included studies comprised 202 females and 73 males, with one study not specifying gender for 27 participants. While all studies were qualitative, the exact study design was not specified in seven studies.

Health emerged as the primary motivator for undergoing bariatric surgery across all the included studies. Participants spoke of three main concerns: (i) the risk of acquiring a comorbidity due to being obese, (ii) exacerbation of a present condition, and/or (iii) fear of a new health condition.

Participants in 12 of the included studies spoke about the effect of obesity on their lifestyle and daily activities. They hoped bariatric surgery would help them overcome social and physical barriers that they experienced in their daily lives.

Many participants reported limitations in engaging in their desired lifestyles or activities including challenges with social engagements, eating out, going on vacations and fitting into aeroplane seats. Several studies reported that individuals were unable to participate in activities with their families or peers and often experienced exhaustion or fatigue.

Most studies (n=10) addressed body image as a significant motivator for undergoing bariatric surgery. Both, men and women highlighted their desire to improve their body image. Participants spoke of body image avoidance and challenges regarding travel and eating due to their size.

Psychological health was identified in nine of the studies as a motivator for undergoing bariatric surgery. Frustration and dissatisfaction were common among participants, with feelings of being fed up due to unsuccessful weight loss attempts or their current weight status emerging as a recurring theme in two studies. They viewed obesity as a barrier to leading a normal life and perceived it as carrying a social stigma.

Healthcare professionals such as primary care physicians, fertility specialist consultants and orthopaedic surgeons played a key role in motivating participants to undergo bariatric surgery in six of the included studies.

Family members also played a role in motivating participants to undergo bariatric surgery, with advice from family members noted in three studies and concerns over family members were expressed in nine studies. Several participants pursued bariatric surgery after a family member initiated a conversation about weight and health or suggested bariatric surgery as an option.

In one study, participants viewed bariatric surgery as a last resort, either because previous weight loss methods had failed or their condition had worsened. One participant expressed anxiety about losing their life due to obesity, drawing on experiences with their family. While family support motivated some participants to undergo bariatric surgery, some studies found that family influence also served as a barrier.

Fertility was a key motivator for undergoing bariatric surgery in three studies. In two studies, participants reported significant issues with their reproductive system. Women living with obesity or overweight reported experiencing anovulation, infertility, menstrual disorders, difficulties in assisted reproduction, miscarriage and adverse pregnancy outcomes.

Some studies found that finances, transportation and work obligations were barriers to undergoing bariatric surgery. Of the 24 participants in one study, nine indicated that a lack of medical insurance prevented them from seeking surgery. Four participants specifically mentioned either “Obamacare” or the Affordable Care Act as being critical to their decision to pursue bariatric surgery. Work obligations also featured as a barrier, with some participants feeling the need to inform their employer about their surgery to account for their absence from work.

The researchers explained that their systematic review highlights how patients’ insights surrounding obesity can be used to guide actions and to encourage clinicians to provide empathic care to patients with this disease.

“Findings from this review underscore the importance of a comprehensive, empathetic approach by healthcare professionals when addressing motivators and barriers,” the authors concluded. “Providing tailored support, using inclusive language and improving access to resources may facilitate informed decision-making and potentially lead to better outcomes for patients considering bariatric surgery.”

The findings were reported in the paper, ‘Factors that influence an individual’s decision to undergo bariatric surgery: A qualitative systematic review’, published in PLOS One. To access this paper, please click here