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Perceived Barriers in the Decision for Bariatric and Metabolic Surgery: Results from a Representative Study in Germany

  • C. Luck-SikorskiEmail author
  • F. Jung
  • A. Dietrich
  • C. Stroh
  • S. G. Riedel-Heller
Original Contributions

Abstract

Background

Attitudes of the general public may be an influencing factor for low surgery rates: When skepticism is high, support for individuals wanting or needing to undergo surgery may diminish. This study assesses the relevance of barriers to metabolic surgery.

Methods

The study was conducted using a representative sample of the German population (n = 1007). Participants were asked to imagine that they would have to decide for or against metabolic surgery and rate how this decision would be influenced by a number of reasons given to them (Likert scale). Results are presented by weight status.

Results

The barrier found most irrelevant is that surgery could be considered cheating across all weight groups. About a fourth of the sample state that not knowing enough about surgery (28.5%), being afraid of surgery (28.3%), and potential negative consequences after surgery (24.5%) are reasons against metabolic surgery that were rated extremely relevant. Having obesity was a significant predictor of endorsement in two variables: feeling like cheating (lower probability for relevance, OR = 0.58, p = 0.025) and a lack of knowledge (lower probability for relevance, OR = 0.59, p = 0.031).

Conclusions

In summary, the public’s view of weight loss surgery lacks information about post-surgical consequences. It is important to address these points in the public and in social networks of patients as they may be pre- or antecedent of surgery stigma.

Keywords

Metabolic surgery Bariatric surgery Attitudes Barriers General public 

Notes

Funding

This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ, 01EO1501.

Compliance with Ethical Standards

The study was approved by the Ethics Committee of the University of Leipzig (approval number 267-15-24082015).

Conflict of Interest

CLS has received honoraria from Ethicon (Johnson & Johnson) for talks and consultation. All other authors declare that they have no conflict of interest.

References

  1. 1.
    Mensink GBM, Schienkiewitz A, Scheidt-Nave C. Overweight and obesity in Germany. Results of the German health interview and examination survey for adults (DEGS1). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz [Internet]. 2013;56:786–94.CrossRefGoogle Scholar
  2. 2.
    Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie. 1 S3-Leitlinie: Chirurgie der Adipositas und metabolischer Erkrankungen [Internet]; 2018 [cited 2019 Feb 13]. Available from: https://www.awmf.org/uploads/tx_szleitlinien/088-001l_S3_Chirurgie-Adipositas-metabolische-Erkrankugen_2018-02.pdf. Accessed 19 Feb 2019.
  3. 3.
    Lee W-J, Almalki O. Recent advancements in bariatric/metabolic surgery. Ann Gastroenterol Surg. 2017;1(3):171–9.  https://doi.org/10.1002/ags3.12030.CrossRefGoogle Scholar
  4. 4.
    Lenzen-Schulte M. Therapie der Fettleibigkeit: Nur Hürden statt Hilfe für Adipöse; [Treatment for obesity: barriers instead of help]. Dtsch Arztebl Int. 2018;115(11):A–484.Google Scholar
  5. 5.
    Gasoyan H, Tajeu G, Halpern MT, et al. Reasons for underutilization of bariatric surgery: the role of insurance benefit design. Surg Obes Relat Dis. 2019;15(1):146–51. 0(0).  https://doi.org/10.1016/j.soard.2018.10.005.CrossRefGoogle Scholar
  6. 6.
    Jung FU, Luck-Sikorski C, Konig H-H, et al. Stigma and knowledge as determinants of recommendation and referral behavior of general practitioners and internists. Obes Surg. 2016;26(10):2393–401.  https://doi.org/10.1007/s11695-016-2104-5.CrossRefGoogle Scholar
  7. 7.
    Jung FU, Dietrich A, Stroh C, et al. Changes in attitudes towards bariatric surgery after 5 years in the German general public. Obes Surg. 2017;27(10):2754–8.  https://doi.org/10.1007/s11695-017-2822-3.CrossRefGoogle Scholar
  8. 8.
    Imbus JR, Voils CI, Funk LM. Bariatric surgery barriers: a review using Andersen’s model of health services use. Surg Obes Relat Dis. 2018;14(3):404–12.  https://doi.org/10.1016/j.soard.2017.11.012.CrossRefGoogle Scholar
  9. 9.
    Funk LM, Jolles S, Fischer LE, et al. Patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery: a systematic review. JAMA Surg. 2015;150(10):999–1005.  https://doi.org/10.1001/jamasurg.2015.1250.CrossRefGoogle Scholar
  10. 10.
    Ju T, Rivas L, Arnott S, et al. Barriers to bariatric surgery: factors influencing progression to bariatric surgery in a U.S. metropolitan area. Surg Obes Relat Dis. 2019;15(2):261–8. 0(0).  https://doi.org/10.1016/j.soard.2018.12.004.CrossRefGoogle Scholar
  11. 11.
    Leroux JS, Moore S, Dube L. Beyond the “I” in the obesity epidemic: a review of social relational and network interventions on obesity. J.Obes. 2013;2013(2090–0708 (Linking)):348249.  https://doi.org/10.1155/2013/348249.Google Scholar
  12. 12.
    Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, et al. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. England; 2011.Google Scholar
  13. 13.
    Dolan P, Afaneh C, Symer M, et al. Assessment of public attitudes toward weight loss surgery in the United States. JAMA Surg. 2019;  https://doi.org/10.1001/jamasurg.2018.4650.
  14. 14.
    Hansen B, Dye MH. Damned if you do, damned if you don’t: the stigma of weight loss surgery. Deviant Behav. 2018;39(2):137–47.  https://doi.org/10.1080/01639625.2016.1263081.CrossRefGoogle Scholar
  15. 15.
    Behr D, Harkness JA, Fitzgerald R, et al. Round 4 ESS translation strategies and procedures. London: European Social Survey, Centre for Comparative Social Surveys, City University; 2008.Google Scholar
  16. 16.
    StataCorp LP. Stata statistical software: release 14. College Station, TX: StataCorp; 2015.Google Scholar
  17. 17.
    Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. AmJPublic Health. 2010;100(6):1019–28.  https://doi.org/10.2105/AJPH.2009.159491.Google Scholar
  18. 18.
    Mattingly BA, Stambush MA, Hill AE. Shedding the pounds but not the stigma: negative attributions as a function of a target’s method of weight loss. J Appl Biobehav Res. 2009;14(3):128–44.  https://doi.org/10.1111/j.1751-9861.2009.00045.x.CrossRefGoogle Scholar
  19. 19.
    Vartanian LR, Fardouly J. The stigma of obesity surgery: negative evaluations based on weight loss history. Obes Surg. 2013;23(10):1545–50.  https://doi.org/10.1007/s11695-013-0918-y.CrossRefGoogle Scholar
  20. 20.
    Raves DM, Brewis A, Trainer S, et al. Bariatric surgery patients’ perceptions of weight-related stigma in healthcare settings impair post-surgery dietary adherence. Front Psychol. 2016;7:1497.  https://doi.org/10.3389/fpsyg.2016.01497.CrossRefGoogle Scholar
  21. 21.
    Han S, Agostini G, Brewis AA, et al. Avoiding exercise mediates the effects of internalized and experienced weight stigma on physical activity in the years following bariatric surgery. BMC Obes. 2018;5:18.  https://doi.org/10.1186/s40608-018-0195-3.CrossRefGoogle Scholar
  22. 22.
    Coblijn UK, Lagarde SM, Raaff d, et al. Patients’ preferences for information in bariatric surgery. Surg Obes Relat Dis. 2018;14(5):665–73.  https://doi.org/10.1016/j.soard.2018.01.029.CrossRefGoogle Scholar
  23. 23.
    Cheng Y-L, Shu J-H, Hsu H-C, et al. High health literacy is associated with less obesity and lower Framingham risk score: sub-study of the VGH-HEALTHCARE trial. PLoS One. 2018;13(3):e0194813.  https://doi.org/10.1371/journal.pone.0194813.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Integrated Research and Treatment Center AdiposityDiseases (IFB)University of LeipzigLeipzigGermany
  2. 2.SRH University of Applied Health SciencesGeraGermany
  3. 3.Department of General, Abdominal and Pediatric SurgerySRH Municipal Hospital GeraGeraGermany
  4. 4.Institute of Social Medicine, Occupational Health and Public Health (ISAP)University of LeipzigLeipzigGermany
  5. 5.Integrated Research and Treatment Center AdiposityDiseases (IFB), Department of SurgeryUniversity of LeipzigLeipzigGermany

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