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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 6-11

Factors affecting decisions on choosing bariatric surgeons: A qualitative study


1 Department of Surgery, Kuwait University, Kuwait City, Kuwait
2 Department of Surgery, Al Amiri Hospital, Kuwait City, Kuwait

Date of Submission13-Sep-2020
Date of Acceptance15-Sep-2020
Date of Web Publication14-Jun-2022

Correspondence Address:
Dr. Salman Al Sabah
Kuwait University, Kuwait City
Kuwait
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SJL.SJL_8_20

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  Abstract 


Background: Despite the safety of bariatric surgery (BS), only 0.4% of patients that qualify for it proceed to undergo the procedure. One hypothesized reason is the selectiveness of patients for medical providers.
Methods: An online survey was distributed to bariatric surgeons around the world to identify what criteria they observed prospective bariatric patients found most important when selecting a medical provider. Questions were evaluated on a 10-point scale.
Results: Our survey was distributed to 76 surgeons practicing in 16 countries. The most influential factors that affect patients' decisions on choosing their bariatric provider were seen to be a recommendation received from others and surgeon reputation. The proximity of the hospital to the patients' home was seen to be of least importance. It was seen that the quality/accreditation of the surgeon was significantly more important in surgeons working in the public setting when the data were analyzed according to the setting of practice.
Conclusion: With the emergence of BS, choosing a provider has become of utmost importance. The most influential factors that were seen to affect patient's decisions were recommendations for the surgeons and reputation. This data could lay the groundwork for how medical providers market themselves when working in the BS field.

Keywords: Bariatric surgery, medical tourism, patients, providers


How to cite this article:
Al Sabah S, Al Haddad E. Factors affecting decisions on choosing bariatric surgeons: A qualitative study. Saudi J Laparosc 2021;6:6-11

How to cite this URL:
Al Sabah S, Al Haddad E. Factors affecting decisions on choosing bariatric surgeons: A qualitative study. Saudi J Laparosc [serial online] 2021 [cited 2022 Oct 3];6:6-11. Available from: https://www.saudijl.org/text.asp?2021/6/1/6/347479




  Introduction Top


The National Institute of Health defines morbid obesity as a body mass index >40 kg/m2 or 35 kg/m2 with obesity-related comorbidities.[1] The prevalence of obesity is rising worldwide, with a prominent increase seen in the Arab world.[2] While obesity itself is considered as a debilitating condition,[3] major studies have clearly correlated it with the development of multiple comorbidities that markedly impair life quality, reduce life expectancy, and increase health care cost.[4],[5],[6] This has ultimately caused bariatric surgery (BS) to be on the rise.[7]

Multiple options now exist for patients seeking BS, and those include laparoscopic Roux-en-Y Gastric Bypass, laparoscopic sleeve gastrectomy, gastric balloons, and gastric banding, all of which have demonstrated excellent long-term results in terms of weight loss and comorbidity resolution.[8],[9] Although the number of patients opting for the surgical options is increasing, recent studies have estimated that only 3 in 1,000 obese patients actually pursue surgical treatment.[10] Schauer et al.[11] in a recent study noted that of 200 patients enrolled in a BS interest group only 33 had undergone surgery over a 12-month period The reasoning behind this has been hypothesized to be due to the invasiveness of the procedures, possible surgical complications and nutritional deficiencies that may arise, and the irreversibility of some of these procedures, although these reasons have never been previously studied.[10] Well in fact, when reviewing the literature, there have been few studies that attempt to interpret the thought process of the average morbidly obese patient in search of treatment. Without the ability to understand this, clinicians have a limited effect in changing the course of severe obesity.

In this study, we attempt to gain an insight into what motivates obese patients into choosing medical providers when it comes to undergoing BS. We attempted to view this predicament from the perspective of bariatric surgeons as to achieve an understanding as to what their beliefs are regarding this topic.


  Methods Top


We developed an online, web-based survey that was sent out to bariatric surgeons around the world through multiple social media platforms. Participants were queried about background, demographics, setting of work, and attitudes toward their beliefs on what criteria they thought affected prospective bariatric patients' decisions. The goal of the questionnaire was to identify what they thought prospective bariatric patients found most important when selecting a medical provider for the surgery. Questions were evaluated on a 10-point scale, with one being “strongly disagree” and 10 being “strongly agree.” A sample of the survey can be seen in [Figure 1]. Data were analyzed by content analysis. IRB approval and consent were not required for this investigation.
Figure 1: A sample of the survey distributed to bariatric surgeons

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The work has been reported in line with the consolidated criteria for reporting qualitative research criteria.


  Results Top


A total of 76 surgeons that had practiced in 16 countries answered our survey, the majority of which came from the Arab world (94.75%) [Figure 2]. About 36.8% of the surgeons work primarily in the private sector, whereas 35.5% work in both private and public [Figure 3].
Figure 2: Participating surgeons based on country of practice

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Figure 3: Distribution of sectors in which the surgeons work

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When contemplating the most influential factors that affect patient's decisions, recommendation from other patients, surgeon reputation and safety of the procedure played the most significant role, having a weighted average of 8.19, 8.16, and 8.01, respectively. The proximity of the hospital to the patients home was seen to be of the least importance, with a weighted average of 5.09 [Figure 4] and [Table 1]. It was seen that quality/accreditation of the surgeon was significantly more important in surgeons working in the public setting when the data were analyzed according to the setting of practice, with a weighted importance average of 8.30 for those working in the public sector and 47.6% giving it importance of 10/10, versus a weighted average of 6.68 for those working in the private sector alone and only 3.6% giving it importance of 10/10 [Figure 5] and [Table 2].
Figure 4: Factors influencing patients' decisions on choosing a bariatric provider

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Figure 5: Influencing factors according to setting of practice

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Table 1: Factors influencing patients' decisions on choosing a bariatric provider

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Table 2: Influencing factors according to the setting of practice

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When looking at the pricing of bariatric procedures around the world, the USA and Australia were rated the highest for all procedures, while bariatric procedures in Egypt were seen to be the lease costing [Table 3].
Table 3: Cost of Bariatric procedures around the world in US Dollars

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  Discussion Top


The main findings from our study were able to demonstrate that patient recommendation of surgeons to others, and the surgeon's reputation had the biggest impact of patients' choice for their medical provider when it comes to BS, while the location of the hospital was of least importance. Another interesting finding was the fact that the quality/accreditation of the hospital and surgeon played a significantly more important role for surgeons working in the public sector as opposed to those working in the private.

The data gathered concerning the importance of referral are essential because the referral source may influence the way the patient understands the whole treatment program. Patients who have another patient's familiarity to draw upon may be more confident than patients who do not know anyone with previous experience of similar operations. Furthermore, given the importance of the Internet nowadays, patients have the ability to research bariatric procedures and their outcomes when considering undergoing BS. However, many sources found online are not of a credible nature, and patients do not have the knowledge and ability to differentiate between credible and noncredible sources. Moreover, given the ease of access to these internet sources, most eligible patients opt out of undergoing BS because of the negative perception toward this procedure.[10] In addition, the Internet was cited as one of the three most common sources of referral in the US. This may reflect that patients in the US are more active in their search for treatment options and may be influenced by website contents, as opposed to those in the Arab world, where a recommendation from others played the most important role.

Previous research has demonstrated that bariatric patients usually view surgery as a last resort when it comes to dealing with their obesity.[12],[13] This was seen to be either because other weight loss methods had failed or because their problems related to obesity had worsened to a significant degree. This finding is consistent with a previous reported literature.[12],[13],[14] Another contributing factor is the fear expressed by patients from complications that may arise from these surgeries. This was also seen in our study, where the safety of the procedure played an important role in patients choosing the medical provider for their bariatric procedure. This brings into play the importance of the effort needed to be put in to educate both clinicians and patients on bariatric procedures and how to deliver information regarding them. With proper promotion and education from bariatric surgeons and clinicians, patients will have the means to make informed decisions regarding their weight loss journey, without being influenced by false external factors.

The cost of these surgeries and their coverage by insurance has been proven to be an important factor in patients deciding to move forward with undergoing BS. As seen in our study, the cost of these procedures differed significantly between countries, with the USA and Australia having the highest cost and countries in the Arab world fairing on the cheaper side. Furthermore, most public hospitals in the Gulf cover the majority of the cost of bariatric procedures. In a study conducted by Roberson et al.[12] was able to show that when patients had aid with the financial aspects of the surgery, it critically contributed to their decision to undergo BS. This suggests that if the government and/or other third-party payors decline to provide coverage for bariatric procedures in the future, the impact will be substantial on patients' health and well-being. It argues for the continued importance of lobbying efforts such as those of the ASMBS ObesityPac that are directed toward legislators, government officials, and insurance companies on the importance of reimbursement for BS.


  Conclusion Top


With the emergence of BS, choosing a provider has become of utmost importance. Multiple factors were seen to affect patient's selectiveness of a medical provider for BS, especially in the Arab world. The most influential factors that were seen to affect patients' decisions were recommendations for the surgeons and reputation. This data could lay the groundwork for how medical providers market themselves when working in the BS field.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr 1992;55:615S-9S.  Back to cited text no. 1
    
2.
World Health Organization. Obesity and Overweight. World Health Organization; 2016. p. 17. Availsable from: http://www.who.int/mediacentre/factsheets/fs311/en/. [Last Retrieved on 2020 Jan 17].  Back to cited text no. 2
    
3.
State of Victoria Victorian Burden of Disease Study: Morbidity Public Health Division. Australia: Department of Human Services Melbourne Victoria; 1999.  Back to cited text no. 3
    
4.
Lehnert T, Sonntag D, Konnopka A, Riedel-Heller S, König H. Economic costs of overweight and obesity. Best Practice Res Clin Endocrinol Metabol 2013;27:105-15.  Back to cited text no. 4
    
5.
Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Obstetrical Gynecol Survey 2009;64:602-4.  Back to cited text no. 5
    
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Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies. Lancet 2008;371:569-78.  Back to cited text no. 6
    
7.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013;23:427-36.  Back to cited text no. 7
    
8.
Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Datab Syst Rev 2009;15:CD003641.  Back to cited text no. 8
    
9.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: A systematic review and meta-analysis. JAMA 2004;292:1724-37.  Back to cited text no. 9
    
10.
O'Brien PE, Dixon JB. Laparoscopic adjustable gastric banding in the treatment of morbid obesity. Arch Surg 2003;138:376-82.  Back to cited text no. 10
    
11.
Schauer P, Arterburn D, Wise R, Boone W, Fischer D, Eckman M. Predictors of bariatric surgery among an interested population. Surg Obes Rel Dis 2013;10:547-52.  Back to cited text no. 11
    
12.
Roberson DW, Neil JA, Pories ML, Rose MA. Tipping point: Factors influencing a patient's decision to proceed with bariatric surgery. Surg Obesity Related Dis 2016;12;1086-90.  Back to cited text no. 12
    
13.
Lynch CS, Chang JC, Ford AF, Ibrahim SA. Obese African-American women's perspectives on weight loss and bariatric surgery. J Gen Intern Med 2007;22:908-14.  Back to cited text no. 13
    
14.
Wysoker A. The lived experience of choosing bariatric surgery to lose weight. JAPNA 2005;11:26-34.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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