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. 2023 Sep;33(9):2874-2883.
doi: 10.1007/s11695-023-06761-6. Epub 2023 Aug 4.

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

Callie Hlavin  1   2 , Romano S Sebastiani  3 , Robert J Scherer  3 , Tanya Kenkre  4 , Karla Bernardi  5 , Douglas A Reed  5 , Bestoun Ahmed  5 , Anita Courcoulas  5
Affiliations

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

Callie Hlavin et al. Obes Surg. 2023 Sep.

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.

Keywords: Bariatric surgery; Public health; Quality of care.

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Conflict of interest statement

Conflict of Interest

The senior author has a research grant from Allurion Technologies. The remaining authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Survey - Knowledge about bariatric surgery
Figure 2.
Figure 2.
Survey - Knowledge about insurance/approval process for bariatric surgery
Figure 3.
Figure 3.
Survey - Patient expectation about the insurance/approval process for bariatric surgery
Figure 4.
Figure 4.
Survey - Expectation and reality of clinic processes
Figure 5.
Figure 5.
Survey - Reasons for not having bariatric surgery
See this image and copyright information in PMC

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