Sex, Race, and Consideration of Bariatric Surgery Among Primary Care Patients with Moderate to Severe Obesity

ABSTRACT

BACKGROUND

Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery.

OBJECTIVE

To describe primary care patients’ consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation.

DESIGN, SETTING, AND PATIENTS

Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m² seen at four diverse primary care practices in Greater-Boston.

MEASUREMENTS

Patients’ consideration of bariatric surgery.

RESULTS

Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81–8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited.

LIMITATIONS

Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery.

CONCLUSION

African Americans and men were less likely to have considered bariatric surgery and were less likely to have been recommended surgery by their doctors. Differences in how obesity affects QOL appear to account for some of these variations. High perceived risk rather than financial barrier was the major deterrent for patients.

APPENDIX

Figure 1.

Recruitment of the primary care sample. (asterisk) The estimated probability of study eligibility is 29 % among those without documented height/weight in record and 63 % if documented. (dagger) Four participants were deemed ineligible after completing the interview leaving an analytical sample of 337. (double dagger) The calculated response rate accounts for probability of eligibility among those who declined based on whether they had a height and weight documented in the medical record.