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Barriers to Bariatric Surgery: a Mixed Methods Study Investigating Obstacles Between Clinic Contact and Surgery

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Abstract

Purpose

Populations most affected by obesity are not reflected in the patients who undergo bariatric surgery. Gaps in the referral system have been studied, but there is a lack of literature investigating obstacles patients encounter after first contact with bariatric surgery clinics. We aim to identify patient populations at risk for attrition during bariatric surgery evaluation and determine patient reported barriers to bariatric surgical care.

Materials and Methods

This study was a single institution, retrospective, mixed methods study from 2012 to 2021 comparing patients who underwent bariatric surgery to those that withdrew. Surveys were performed of patients who withdrew, collecting information on patient knowledge, expectations, and barriers.

Results

This study included 5982 patients evaluated in bariatric surgery clinic. Those who attained bariatric surgery (38.8%) were more likely to be White (81.2 vs. 75.6%, p<0.001), married (48.5 vs. 44.1%, p=0.004), and employed full time (48.2 vs. 43.8%, p=0.01). They were less likely to live in an area with low income (37.1 vs. 40.7%, p=0.01) or poverty (poverty rate 15.8 vs. 17.4, p<0.001). Of the 280 survey respondents, fear of complications, length of insurance approval process, and wait time between evaluation and surgery were the most reported barriers.

Conclusion

Patients who undergo bariatric surgery were more likely to be White, married, employed full time, and reside in more resourced environments which is not reflective of communities most affected by obesity. The complexity of insurance coverage requirements was a major barrier to bariatric surgery and should be a focus of future healthcare reform.

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Funding

This research was supported in part by the grant T32GM075770 from the National Institutes of Health (Bethesda, MD) grant.

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Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh, 200 Lothrop St, F677 Presbyterian Hospital, Pittsburgh, PA, 15213, USA

    Callie Hlavin, Karla Bernardi, Douglas A. Reed, Bestoun Ahmed & Anita Courcoulas

  2. Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, A-1305 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Callie Hlavin

  3. University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA

    Romano S. Sebastiani & Robert J. Scherer

  4. University of Pittsburgh Epidemiology Data Center, 4420 Bayard Street, Suite 600, Pittsburgh, PA, 15260, USA

    Tanya Kenkre

Authors
  1. Callie Hlavin
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  8. Anita Courcoulas
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Contributions

CH and AC developed the study concept and design. CH, RSS, and RJS acquired the data. TK performed the statistical analyses. All authors were involved in interpreting the data, drafting the manuscript, and had final approval of the submitted version.

Corresponding author

Correspondence to Callie Hlavin.

Ethics declarations

Ethical Approval

The University of Pittsburgh Medical Center Quality Review Committee reviewed and approved this study. For this type of study, additional IRB oversight and formal consent is not required. Informed consent does not apply.

Conflict of Interest

Dr. Anita Courcoulas has a research grant from Allurion Technologies. The remaining authors have no conflicts of interest.

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Key Points

• Patients having bariatric surgery were more likely from well-resourced backgrounds.

• Barriers to surgery were fear of complications and insurance process complexity.

• Addressing insurance barriers is imperative for communities affected by obesity.

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Hlavin, C., Sebastiani, R.S., Scherer, R.J. et al. Barriers to Bariatric Surgery: a Mixed Methods Study Investigating Obstacles Between Clinic Contact and Surgery. OBES SURG 33, 2874–2883 (2023). https://doi.org/10.1007/s11695-023-06761-6

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  • DOI: https://doi.org/10.1007/s11695-023-06761-6

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