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Patient-Provider Discussions About Bariatric Surgery Beneficial, but Rare

NEW YORK (Reuters Health) – Fewer than 10% of potentially eligible patients have conversations with their healthcare providers about bariatric surgery, yet those who do are more likely to undergo the procedure and achieve greater weight loss than those who don’t, researchers say.

“As a physician who treats many patients with obesity, I often find that when I bring up weight loss surgery, it’s the first time the patient discussed it with their doctors,” Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston told Reuters Health by email. “However, until now, this was ‘anecdotal evidence’ – ‘rumors,’ in plain English. What our study does is show that his holds true when we examine a large population of patients.”

“Overweight / obesity is the elephant in the room when it comes to public health,” he said. “We need to talk to our patients about overweight / obesity and all available treatment options, from lifestyle changes to medications to surgery.”

“A public health campaign to bring this to the fore is long overdue,” he added.

As reported in Obesity, Dr. Turchin and colleagues studied electronic records on adults with a BMI of 35 kg/m2 or greater treated between 2000 and 2015 to analyze the relationship between a discussion of bariatric surgery in the first year after study entry and weight changes (primary outcome) and receipt of bariatric surgery (secondary outcome) over two years after study entry.

The team developed computer programs that analyzed physicians’ notes in the records to determine whether a discussion took place.

Among more than 30,000 patients (mean age, 43; about 65% women), 2,659 (8.7%) had a discussion about bariatric surgery with their providers. The BMI of patients who discussed bariatric surgery decreased on average by 2.18 versus 0.21 for patients who did not.

After adjustment, a bariatric surgery discussion was associated with a BMI decrease of 1.43, and patients who had these discussions had greater odds (10.2) of undergoing bariatric surgery.

Dr. Turchin added, “We are planning to extend the current study to analyze the specialties of physicians who wrote the notes to determine whether, for example, primary care doctors discussed bariatric surgery with eligible patients more or less frequently than cardiologists did.”

Dr. Cheguevara Afaneh, a bariatric surgeon at Weill Cornell Medicine and NewYork-Presbyterian in New York City commented in an email to Reuters Health that the study “highlights a recurrent theme with regards to obesity and bariatric surgery. Most patients are unaware of their treatment options to combat obesity.”

“Moreover,” he added, “most practitioners outside of bariatric medicine are also unaware of the options available to their patients, as evidenced by the fact that only 2% of all patients eligible for surgery undergo treatment.”

“Increasing awareness of treatment options is key to improving health conditions and combating obesity,” he said. “Initiating conversations with patients at the primary care level is a very effective first-line of defense against obesity.”

SOURCE: Obesity, online June 10, 2021.

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