Patients Who Could Benefit From Weight Loss Surgery May Be Deterred by Public Attitudes

Kelly Davio

The health benefits of weight loss surgery are substantial; recent research has demonstrated that patients with obesity may be able to cut their risk of heart failure by receiving weight loss surgery, or even put type 2 diabetes into remission. Yet, while weight loss surgery is safe and effective, only 0.4% of patients who qualify to receive such surgery actually go ahead with a procedure. Results of a new national survey, published today in JAMA Surgery, suggest that highly prevalent negative attitudes toward weight loss surgery may be keeping patients from receiving and benefitting from these procedures.

The survey, designed by researchers from the New York–Presbyterian Hospital, consisted of 3 questions that were part of the Cornell National Social Survey, which annually samples the views of English-speaking adults in the continental United States by telephone. Data were collected from September to December of 2017. According to the authors, this survey was the first to assess national attitudes toward weight loss surgery.

Of 1703 people contacted, 1000 individuals agreed to be interviewed. Of this group, 52 were eliminated because of incomplete data, resulting in 948 participants. The mean age of participants was 48 years, 49.3% were men, and 66.9% were white and non-Hispanic.

Results of the survey showed that 49.2% of people believed that most patients who receive weight loss surgery do so for cosmetic reasons, and 39.1% classified people who had weight loss surgery as choosing “the easy way out” of weight loss. Women were more likely than men to think that most weight loss surgeries were performed for health-related reasons (odds ratio [OR], 1.34; 95% CI, 1.02-1.75), and less likely to think that surgery was a choice made for ease (OR, 0.54; 95% CI, 0.40-0.71). Women were also less likely to think that such surgeries should not be covered by health insurance plans (OR, 0.48; 95% CI, 0.29-0.81). Non-Hispanic black respondents were more likely to call weight loss surgery an “easy way out” (OR, 1.61; 95% CI, 1.02-2.57).

According to the authors, the fact that a large percentage of the US population holds negative views of weight loss surgery creates a difficult social environment for patients who choose to have surgery. This fact compounds the problem of demographic and socioeconomic disparities among people who receive bariatric surgery, but may also explain, at least in part, why some demographic groups do not often opt to receive surgery.

“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," the authors wrote. "Further research is needed with respect to normalizing weight loss surgery as a reasonable option for managing obesity.”

They added that “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.”

Dolan P, Afaneh C, Symer M, Dakin GF, Pomp A, Yeo H. Assessment of public attitudes toward weight loss surgery in the United States. [published online December 12, 2018]. JAMA Surgery. doi:10.1001/jamasurg.2018.4650.
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