The Impact of Bias and Stigma on Patient Referral for Metabolic/Bariatric Surgery: An Algerian Experience

Abstract

Obesity is a chronic disease causing a major public health challenge, particularly in Algeria, yet in patient referrals for metabolic/bariatric surgery (MBS), the most effective treatment remain low. This study aims to analyze the factors influencing referrals for MBS, focusing on the impact of obesity bias and stigma among primary care physicians. A survey questionnaire was sent electronically to 250 physicians across four regions in Algeria. The questionnaire evaluated their knowledge, attitudes, perceptions, and practices regarding MBS including questions on indications for MBS, operative techniques, physicians' attitudes toward patients with obesity, and factors influencing patient referrals for MBS. Survey response rate was 37.2% (93/250 physicians), most physicians (89%) recognized obesity as a chronic disease, and majority (60%) of physicians were aware that hunger regulation centers are involuntary and located in the hypothalamus; 34.4% believed that lifestyle changes were sufficient to treat severe obesity. Significant knowledge gaps were observed regarding MBS indications, 83% expressed a willingness to help their patients achieve ideal weight, but only 10% of physicians referred patients for MBS. Many physicians showed negative attitudes toward patients with obesity, and 68% held stereotypes about obesity, attributing it to a lack of personal willpower. These stigmas may have contributed to the low referral rates for MBS. Additional barriers were economic barriers, such as the high cost of MBS and limited or absent insurance coverage. A lack of knowledge about metabolic/bariatric surgery, coupled with stigmatizing attitudes and economic constraints, hinders patient referrals for MBS, which is the most effective treatment for severe obesity. The study highlights the need for more education of primary care physicians, promoting an empathetic and interprofessional approach and implementing health policies that improve financial accessibility to MBS in Algeria.

Keywords: Bariatric surgery; Obesity; Patient care; Primary care physicians; Stigma; Training.