Indications and Patient Referrals for Bariatric Surgery

Abstract

The American Medical Association now recognizes obesity as a disease at a time when updated guidelines for referral and triage of patients to bariatric surgery and enhanced involvement of primary care physicians in obesity care are badly needed. The current body mass index-based eligibility criteria for bariatric surgery frequently exclude disabled severely obese patients for whom there is little else to offer for weight loss. In addition, patients with extreme obesity who have minimal health issues have uninhibited access to bariatric surgery. It is evident that updated guidelines based more on medical need than pure weight criteria are badly needed to improve access of deserving patients to bariatric surgery. The patients who actually receive bariatric surgery today are not a true reflection of the population of deserving patients with extreme obesity with respect to gender, race, insurance coverage, socioeconomic status, and comorbid disease burden. The vast majority of minority group patients with extreme obesity, limited education, limited income, and poor insurance coverage regularly obtain medical care at clinics and emergency rooms and currently have no access to bariatric surgery. This has created a major health problem because of the huge costs of inadequately treated extreme obesity and the potential cost-effectiveness of bariatric surgery. One-fifth of patient visits to primary care physicians relate to health problems caused by extreme obesity. Despite this, primary care physicians are reluctant to refer eligible patients to bariatric surgery programs and do not provide patient education concerning alternative obesity treatments. Improved communication and collaboration between primary care physicians and bariatric treatment programs are essential in order to improve physician education and eliminate individual bias.