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October 2015

Patient and Referring Practitioner Characteristics Associated With the Likelihood of Undergoing Bariatric Surgery: A Systematic Review

Author Affiliations
  • 1Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
  • 2William S. Middleton Veterans Affairs Memorial Hospital, Madison, Wisconsin
  • 3Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
  • 4Department of Medicine, Duke University Medical Center, Durham, North Carolina
JAMA Surg. 2015;150(10):999-1005. doi:10.1001/jamasurg.2015.1250

Importance  Although bariatric surgery is the most cost-effective treatment for severe obesity, less than 1% of severely obese patients undergo it. Reasons for this low use are unclear.

Objectives  To identify patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery.

Evidence Review  The PubMed, PsycINFO, CINAHL, and Cochrane databases were searched for articles published from January 1, 1998, through December 31, 2014. Studies were eligible if they presented descriptive data regarding facilitators or barriers to bariatric surgery or if they reported statistical associations between patient or practitioner characteristics and referral to or receipt of bariatric surgery. Frequency effect sizes were calculated as the proportion of studies reporting a finding.

Findings  Of the 7212 records identified in the initial search, 53 were included in full-text review. Nine studies met our inclusion criteria and were included in analyses. Of those, 4 included descriptive findings, 6 reported statistical associations, and 1 included both. One study included practitioners as participants, whereas 8 included patients. Four of 9 studies identified an association between female sex and a greater willingness to undergo bariatric surgery. Lack of knowledge about bariatric surgery was a barrier in 2 studies. Five of 9 cited patient concerns about the outcomes and safety of bariatric surgery as a barrier to undergoing it. Patients were more likely to pursue bariatric surgery when it was recommended by referring practitioners. Practitioners who believed that obesity treatment should be covered by insurance were more likely to recommend bariatric surgery.

Conclusions and Relevance  Limited patient and referring practitioner knowledge about the safety and effectiveness of bariatric surgery are important barriers to bariatric surgery use. Future efforts focused on improving knowledge and identification of the critical determinants of obesity treatment decision making from the practitioner and patient perspectives would have an important effect on public health.