Primary Care Physician Perceptions of Bariatric Surgery and Management of Morbidly Obese Patients

Derrick Wu, MA, Ambar Banerjee, MD, Annabelle Butler, MD, Jennifer Choi, MD, Don Selzer, MD, MS. Indiana University School of Medicine

Introduction: Bariatric surgery provides effective, long-term weight loss and improves co-morbid conditions with reduced five-year mortality. However, many candidates are never referred to bariatric surgery. The aim of this study was to assess and compare perceptions of bariatric surgery and management practices for severe obesity in a diverse population of community-based and academic primary care physicians (PCP).

Methods: Upon obtaining IRB approval, an electronic survey was distributed to PCPs in four centers with local access to bariatric services. Questionnaire items explored comfort level with and perceptions of both operative and non-operative strategies. Data was compiled on a secure REDCap database. Descriptive statistics and Chi-square test were applied using SPSS 24. A p value < 0.05 was considered significant.

Results: The majority of respondents were male, in practice for over 15 years, and reported an in practice morbid obesity prevalence of 10-25%. Overall, 80% of PCPs referred less than 10% of their morbidly obese patients to surgery with 58% citing the invasive nature of surgery as very/extremely important in avoiding surgical referrals. Moreover, 79% stated vitamin and mineral deficiencies were common following surgery, but the majority (55.3%) felt they were easy to address. For PCPs who refer to surgery, 66% of respondents did not recommend a specific procedure to their patients. PCP referral to non-medical resources is displayed in the bar graph. In a comparison between PCP groups, those PCPs with a practice prevalence of morbid obesity greater than 25% were more likely to refer a patient to surgery (p=.05) or a medical bariatrician (p=.02) than those with less prevalent obesity. Younger PCPs, practicing 15 or fewer years, perceived dietary interventions as being more effective (p=.03).Conclusions: PCPs refer few of their morbidly obese patients for bariatric surgery. This scarcity of referrals may stem from the importance PCPs assign the invasive nature of bariatric surgery. Both percentage of morbidly obese patients seen as well as years of practice play a part in surgery referral rate and perception of the effectiveness of dietary management. As the prevalence of obesity continues to increase in the general population and physician practices and population health receives greater emphasis, it is possible that referrals to both surgical and non-surgical programs will increase.