More than half of obese patients opt out of the bariatric surgical procedure process

November 03, 2014

CHICAGO (November 3, 2014): Researchers from the University Health Network in Toronto are hoping to improve the operational efficiency of bariatric surgery programs to increase access to care. Studies have shown that bariatric operations can alleviate chronic health issues like diabetes and arthritis for extremely obese people. Now the University Health Network researchers are trying to determine why many patients who are referred for a bariatric operation do not ultimately have the procedure performed, despite being in a publicly funded health care program. Findings from their single-site study are published in the November issue of the Journal of the American College of Surgeons.


For people who are severely obese, bariatric operations can provide a "treatment modality for obesity," the study authors noted. Severe obesity means the person has a basal metabolic index (BMI) of 40 or greater. That's about 240 lbs for a 5-foot, 5-inch person, according to the U.S. Center's for Disease Control BMI calculator.


"We often see patients who are older in life come to us with a spectrum of co-morbidities, like diabetes and osteoarthritis, as a result of their obesity," said Fayez Quereshy, MD, MBA, FRCSC, staff surgeon at the University Health Network in Toronto and a senior author on the study. Osteoarthritis, in particular, can make exercise-induced weight loss difficult because patients are often in too much pain to exercise,. People with a BMI of 35 or higher may also be candidates if they also have one or more chronic conditions. The person's primary care physician may refer him or her for a bariatric surgical procedure for those reasons.


At the University Health Network's program, patients then go through several assessments, including an orientation followed by a nursing consultation, a nutrition class and dietician assessment, and an evaluation by a social worker. They are then evaluated by a psychologist and have a final consultation with the surgeon before actually undergoing the procedure. At each of these steps in the process, clinical experts evaluate whether the patient is a candidate for the procedure.


However, many patients don't make it through the orientation process. Dr. Quereshy and his colleagues collaborated with University of Toronto's Rotman School of Management to identify which patients were more likely to quit the program and when.


The researchers analyzed data on 1,644 patients who were referred to the university's bariatric surgery program between June 2008 and July 2011. Among them, only 45 percent actually became bariatric surgical patients. Among those who didn't, 30 percent didn't even make it to the patient orientation session, the first step after getting the physician referral.


But it's not because patients are being turned away. "...The majority of attrition appears to be the result of patient self-removal," the authors wrote.


Least Likely Candidates


The patients who were least likely to have the operation included:Next Steps


For this Canadian study, payment is not an issue, since the authors studied surgical candidates for these procedures in a publicly funded program. So Dr. Quereshy said that the next step is to ask one question about the patients who drop out: Why? This step includes qualitative research to understand which factors lead candidates to not have the operation. Knowing why patients drop out could save resources for the hospital and prevent disappointment for the patients.


Dr. Quereshy and his colleagues are currently testing whether a 40-question patient survey, to be completed before orientation, will help identify patients at risk for not having the operation. Then, the evaluation experts can get the patient the proper support upfront to help them through the process to the procedure. "If a patient has signs and symptoms of depression, for example," Dr. Quereshy said, "we can make sure he or she sees the psychiatrist first."


In addition to saving hospital resources, this step could also prevent patients from experiencing a disappointing blow. "This operation is not a cosmetic procedure. It is medically necessary to help with other significant medical issues," Dr. Quereshy said. "Imagine being told after a year, 'Sorry, you're actually not a candidate.' If that's going to happen, I'd rather tell the patient at day 10, rather than at day 300."
-end-
Adam Diamant, MSc, Joseph Milner, PhD, Michelle Cleghorn, MSc, Sanjeev Sockalingam, MD, FRCPC, Allan Okrainec, MD, MHPE, FRCSC, FACS, Timothy D Jackson, MD, MPH, FRCSC, FACS, also participated in this study.


Citation: Journal of the American College of Surgeons, November 2014: Vol. 219 (5) 1047-1055.


About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org.

American College of Surgeons

Related Bmi Articles from Brightsurf:

How your BMI might affect your spontaneous food purchases
The degree to which spontaneous food purchases divert/attract attention may be related to your weight and the energy density of the food, according to a small, preliminary study using mobile eye-tracking technology to provide real information about consumers' food choice behaviour.

African American BMi associated with severe COVID-19 and ICU admission
Body mass index (BMI) is associated with the development of severe coronavirus disease 2019 (COVID-19) and admission to intensive care units (ICU) in African Americans, according to a single center, retrospective cross-sectional study published online in Obesity, the flagship journal of The Obesity Society.

BMI over time beats genetics in predicting future obesity
Genetic testing as a determinant of future obesity is not as effective as tracking a patient's BMI over time, a new study finds.

High BMI may improve cancer survival
Above average or high BMI -- often linked to cancers, diabetes, cardiovascular and other diseases -- may in some cases improve the chance of survival among certain cancers, new research from Flinders University indicates.

Fat mass index, not BMI, associated with cardiovascular events in people with diabetes
In people with diabetes, fat mass index, not body mass index (BMI), is associated with a higher risk of cardiovascular events, according to new research in CMAJ (Canadian Medical Association Journal).

How our genes and environment influence BMI and height
Environmental conditions influence our body mass index (BMI) by increasing or decreasing the effect of inherited genetic variations, University of Queensland researchers have discovered.

Fast-food availability near commute route linked to BMI
In a study of commuting workers, the number of different types of food stores available near residences and commute routes -- but not near workplaces -- had a significant association with body mass index (BMI).

Study shows a quarter of patients have never had their BMI recorded by their GP
New research presented at this year's European Congress on Obesity (ECO) in Glasgow, Scotland, reveals that a quarter of patients have never had their body mass index (BMI) recorded by their GP.

Defining obesity in children should be based on health issues, not just BMI
Details of the study called the Canadian Pediatric Weight Management Registry (CANPWR).

BMI, but not age at puberty, tied to risk of multiple sclerosis
Some studies have suggested that people who are younger when they enter puberty are more likely to later develop multiple sclerosis (MS).

Read More: Bmi News and Bmi Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.