Patients' satisfaction with their physicians may influence their decisions to undergo bariatric surgery, according to a multicenter study involving UT Southwestern and the UTHealth School of Public Health published in JAMA Network Open.
The relationship that physicians have with their patients can have a powerful influence on the health care decision made by people with severe obesity and related complications. This is an important modifiable risk factor for widening disparities in bariatric surgery completion."
Jaime Almandoz, M.D., Associate Professor of Internal Medicine in the Division of Endocrinology, Medical Director of the Weight Wellness Program, and co-author of the study
Only about half of the patients eligible and referred for bariatric surgery complete the procedure despite its relatively low risk and high benefits. Bariatric surgery, commonly known as weight loss surgery, can reduce the risk of serious complications associated with obesity, including Type 2 diabetes, fatty liver disease, and hypertension. Notably, utilization of bariatric surgery is even lower among patients who are Hispanic or non-Hispanic Black compared with those who are non-Hispanic white.
"Obesity affects over 40% of U.S. adults, and bariatric surgery is the most effective treatment for severe obesity," Dr. Almandoz said. "Data show that, beyond improvement in body weight, people who undergo bariatric surgery are more likely to have a better quality of life and greater life expectancy than those who do not."
Lack of insurance coverage, concerns about surgical complications, and language barriers are known to affect utilization rates, but those do not entirely account for the low percentage of patients who elect to have the surgery. The relationship between patients and physicians for the treatment of obesity is of growing interest, but little is known about how this relationship affects patients' decisions.
Dr. Almandoz and colleagues sought to explore whether the relationship with the physician plays a role in a patient's choice to have bariatric surgery as part of a project funded by the National Institutes of Health and led by Sarah Messiah, Ph.D., M.P.H., and Luyu Xie, Ph.D., Pharm.D, of UTHealth School of Public Health. The study involved 408 patients referred to bariatric surgery clinics or a medical obesity program in the Dallas-Fort Worth area between July 2019 and May 2022; 124 completed the surgery. Researchers evaluated the patient relationship with the bariatric surgeon through a Patient Satisfaction Questionnaire and correlated the results with whether the patient had bariatric surgery.
The primary factors correlating with a completed surgery include the patient's perception of the physician, the ability of the physician's office to perform the surgery well, communication, accessibility, and convenience.
"These may identify areas to target for future interventions," said Dr. Xie, a postdoctoral research fellow at UTHealth School of Public Health and lead author of the study. "Indeed, future studies are needed to establish effective strategies for improving patient satisfaction among ethnically diverse bariatric patients."
Dr. Almandoz added, "Our findings suggest that focusing on these primary factors and building trust with the patient may help to increase the utilization of bariatric surgery for treating obesity."
Other UTSW researchers who contributed to this work include Jeffrey Schellinger, Carrie McAdams, and Benjamin Schneider.
This study was funded by a grant from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (R01MD011686). Dr. McAdams holds The Fisher Family Distinguished Professorship in Women's Mental Health Studies.
Xie, L., et al. (2022) Association Between Patient Satisfaction With Their Patient-Physician Relationship and Completion of Bariatric Surgery by Race and Ethnicity Among US Adults. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.47431.