Assessment of Public Attitudes Toward Weight Loss Surgery in the United States | Bariatric Surgery | JAMA Surgery | JAMA Network
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Table 1.  Cohort Characteristics and Answers to Survey Questions
Cohort Characteristics and Answers to Survey Questions
Table 2.  Multivariable Logistic Regression Analysis of Survey Responses by Demographics
Multivariable Logistic Regression Analysis of Survey Responses by Demographics
1.
Martin  M, Beekley  A, Kjorstad  R, Sebesta  J.  Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis.  Surg Obes Relat Dis. 2010;6(1):8-15. doi:10.1016/j.soard.2009.07.003PubMedGoogle ScholarCrossref
2.
Cornell University Survey Research Institute. Cornell National Social Survey. https://www.sri.cornell.edu/sri/cnss.reports.cfm. Accessed November 6, 2018.
3.
Bhogal  SK, Reddigan  JI, Rotstein  OD,  et al.  Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis.  Obes Surg. 2015;25(5):888-899. doi:10.1007/s11695-015-1595-9PubMedGoogle ScholarCrossref
4.
Fildes  A, Charlton  J, Rudisill  C, Littlejohns  P, Prevost  AT, Gulliford  MC.  Probability of an obese person attaining normal body weight: cohort study using electronic health records.  Am J Public Health. 2015;105(9):e54-e59. doi:10.2105/AJPH.2015.302773PubMedGoogle ScholarCrossref
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    Research Letter
    December 12, 2018

    Assessment of Public Attitudes Toward Weight Loss Surgery in the United States

    Author Affiliations
    • 1Department of Surgery, New York–Presbyterian Hospital, Weill Cornell Medicine, New York
    • 2Department of Healthcare Policy and Research, New York–Presbyterian Hospital, Weill Cornell Medicine, New York
    JAMA Surg. 2019;154(3):264-266. doi:10.1001/jamasurg.2018.4650

    Despite the safety and effectiveness of weight loss surgery, only 0.4% of patients who qualify based on National Institutes of Health criteria proceed to have a weight loss surgical procedure.1 One hypothesized reason is that negative public attitudes toward weight loss surgery prevent patients from considering it as an option. However, to our knowledge, no studies have assessed attitudes toward weight loss surgery in the US general population. We designed a national cross-sectional survey to assess these attitudes.

    Methods

    We developed 3 questions as part of the Cornell National Social Survey.2 The Cornell National Social Survey is an annual survey using random-digit dial telephone sampling of English-speaking adults 18 years and older, who are residents of the continental United States. Data were collected from September 11, 2017, to December 11, 2017. The survey is administered by the Survey Research Institute at Cornell University in Ithaca, New York. The study was approved by the Cornell University Institutional Review Board, Ithaca, New York. Interviewers obtained verbal consent from participants using a standardized script approved by the institutional review board. Data were deidentified and participants were given unique case-identification numbers. Logistic regression was used to identify demographic features associated with negative attitudes toward weight loss surgery. Statistical analysis was performed using Stata, version 13.0 (StataCorp).

    Results

    Of the 1703 persons contacted, 1000 were compliant with the interviews resulting in a cooperation rate of 58.7%. Of the 1000 respondents, 52 (5.2%) were eliminated because of incomplete data, resulting in 948 participants in the total cohort (Table 1). Of the 948 participants, the mean (SD) age was 48 (18) years, 447 were men (49.3%), and 634 (66.9%) were non-Hispanic white individuals. The results showed that 468 respondents (49.4%) thought that most people had weight loss surgery for cosmetic reasons and 371 (39.1%) thought that people who had weight loss surgery chose the “easy way out” (Table 1). Women were more likely to think that most weight loss surgical procedures were performed for health reasons (odds ratio, 1.34; 95% CI, 1.02–1.75), less likely to think that surgery was an easy way out (odds ratio, 0.54; 95% CI, 0.40–0.71), and less likely to think that it should not be covered by health insurance (odds ratio, 0.48; 95% CI, 0.29–0.81) (Table 2). Non-Hispanic black respondents were more likely to think that weight loss surgery was an easy way out (odds ratio, 1.61; 95% CI, 1.02–2.57) (Table 2).

    Discussion

    The results of our national survey are, to our knowledge, the first to suggest that a large percentage of the population has negative attitudes toward weight loss surgery. The high prevalence of these attitudes potentially creates a difficult social environment for patients who opt for weight loss surgery. Utilization of surgery for weight loss remains low overall in the United States, and there are demographic and socioeconomic disparities between persons who undergo weight loss surgery and those who do not. Patients receiving bariatric surgery are more likely to be female, to be white race/ethnicity, and to have private health insurance.3 The results revealed that men and non-Hispanic black survey respondents were more likely to think that people who chose weight loss surgery were taking the easy way out. The association between higher prevalence of negative attitudes and demographic groups not opting for weight loss surgery supports the hypothesis that these attitudes may be at least partly responsible for such low utilization of weight loss surgical procedures.

    Obesity is a major epidemic in the United States, and available data show that weight loss surgery may be the best way to maintain weight loss and improve health, with the likelihood of a person losing weight without surgery being exceedingly low.4 However, many patients who are eligible for weight loss surgery are either not being offered or not seeking it, with highly prevalent negative attitudes toward weight loss surgery being a potential reason. Further research is needed with respect to normalizing weight loss surgery as a reasonable option for managing obesity. There is no simple way to fix this problem, and it may take years of public and physician education regarding the health benefits of weight loss surgery to improve its perception and increase its utilization.

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    Article Information

    Accepted for Publication: September 14, 2018.

    Corresponding Author: Heather Yeo, MD, MHS, Department of Surgery, New York–Presbyterian, Weill Cornell Medicine, 525 E 68th St, PO Box 172, New York, NY 10065 (hey9002@med.cornell.edu).

    Published Online: December 12, 2018. doi:10.1001/jamasurg.2018.4650

    Author Contributions: Dr Yeo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Dolan, Afaneh, Symer, Pomp, Yeo.

    Acquisition, analysis, or interpretation of data: Dolan, Afaneh, Symer, Dakin.

    Drafting of the manuscript: Dolan.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Dolan, Symer, Yeo.

    Administrative, technical, or material support: Dolan, Afaneh, Symer.

    Supervision: Dolan, Afaneh, Dakin, Pomp, Yeo.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This work was supported by grant T32HS000066-24S1 from the Agency for Healthcare Research and Quality (Drs Dolan and Symer).

    Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    Martin  M, Beekley  A, Kjorstad  R, Sebesta  J.  Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis.  Surg Obes Relat Dis. 2010;6(1):8-15. doi:10.1016/j.soard.2009.07.003PubMedGoogle ScholarCrossref
    2.
    Cornell University Survey Research Institute. Cornell National Social Survey. https://www.sri.cornell.edu/sri/cnss.reports.cfm. Accessed November 6, 2018.
    3.
    Bhogal  SK, Reddigan  JI, Rotstein  OD,  et al.  Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis.  Obes Surg. 2015;25(5):888-899. doi:10.1007/s11695-015-1595-9PubMedGoogle ScholarCrossref
    4.
    Fildes  A, Charlton  J, Rudisill  C, Littlejohns  P, Prevost  AT, Gulliford  MC.  Probability of an obese person attaining normal body weight: cohort study using electronic health records.  Am J Public Health. 2015;105(9):e54-e59. doi:10.2105/AJPH.2015.302773PubMedGoogle ScholarCrossref
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