General Practitioner’s Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Questionnaire
2.3. General Treatment of Obese Patients
2.4. Stereotypes and Stigmatization
2.5. Weight Loss Surgery
2.6. Knowledge Regarding WLS
2.7. Data Analysis
3. Results
3.1. General Treatment of Obese Patients
3.2. Stereotypes and Stigmatization
3.3. WLS and Knowledge Regarding WLS
3.4. Referral Behavior
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Jung, F.U.; Luck-Sikorski, C.; Konig, H.H.; Riedel-Heller, S.G. Stigma and knowledge as determinants of recommendation and referral behavior of general practitioners and internists. Obes. Surg. 2016, 26, 2393–2401. [Google Scholar] [CrossRef] [PubMed]
- Rosemann, T.; Wensing, M.; Rueter, G.; Szecsenyi, J. Referrals from general practice to consultants in Germany: If the GP is the initiator, patients’ experiences are more positive. BMC Health Serv. Res. 2006, 6, 5. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Picot, J.; Jones, J.; Colquitt, J.L.; Gospodarevskaya, E.; Loveman, E.; Baxter, L.; Clegg, A.J. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: A systematic review and economic evaluation. Health Technol. Assess. 2009, 13, 215–357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rubino, F.; Nathan, D.M.; Eckel, R.H.; Schauer, P.R.; Alberti, K.G.; Zimmet, P.Z.; Del Prato, S.; Ji, L.; Sadikot, S.M.; Herman, W.H.; et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by international diabetes organizations. Diabetes Care 2016, 39, 861–877. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pontiroli, A.E.; Morabito, A. Long-term prevention of mortality in morbid obesity through bariatric surgery. A systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann. Surg. 2011, 253, 484–487. [Google Scholar] [CrossRef]
- Cardoso, L.; Rodrigues, D.; Gomes, L.; Carrilho, F. Short- and long-term mortality after bariatric surgery: A systematic review and meta-analysis. Diabetes Obes. Metab. 2017, 19, 1223–1232. [Google Scholar] [CrossRef] [PubMed]
- Sundbom, M.; Naslund, E.; Vidarsson, B.; Thorell, A.; Ottoson, J. Low overall mortality during 10 years of bariatric surgery: Nationwide study on 63,469 procedures from the Scandinavian Obesity Registry. Surg. Obes. Relat. Dis. 2020, 16, 65–70. [Google Scholar] [CrossRef] [Green Version]
- Singh, S.; Hourneaux de Moura, D.T.; Khan, A.; Bilal, M.; Ryan, M.B.; Thompson, C.C. Safety and efficacy of endoscopic sleeve gastroplasty worldwide for treatment of obesity: A systematic review and meta-analysis. Surg. Obes. Relat. Dis. 2020, 16, 340–351. [Google Scholar] [CrossRef]
- Surve, A.; Rao, R.; Cottam, D.; Rao, A.; Ide, L.; Cottam, S.; Horsley, B. Early outcomes of primary SADI-S: An Australian experience. Obes. Surg. 2020, 30, 1429–1436. [Google Scholar] [CrossRef]
- Angrisani, L.; Santonicola, A.; Iovino, P.; Ramos, A.; Shikora, S.; Kow, L. Bariatric Surgery Survey 2018: Similarities and disparities among the 5 IFSO chapters. Obes. Surg. 2021, 31, 1937–1948. [Google Scholar] [CrossRef]
- Stroh, C. Bariatrische Chirurgie: Magenbypass Bevorzugte Operation. 2016. Available online: https://www.aerzteblatt.de/archiv/179375/Bariatrische-Chirurgie-Magenbypass-bevorzugte-Operation (accessed on 26 July 2021).
- Memarian, E.; Carrasco, D.; Thulesius, H.; Calling, S. Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: A Swedish survey study. BMC Endocr. Disord. 2021, 21, 62. [Google Scholar] [CrossRef]
- Stolberg, C.R.; Hepp, N.; Juhl, A.J.A.; Deepti, D.C.; Juhl, C.B. Primary care physician decision making regarding referral for bariatric surgery: A national survey. Surg. Obes. Relat. Dis. 2017, 13, 807–813. [Google Scholar] [CrossRef]
- Tork, S.; Meister, K.M.; Uebele, A.L.; Hussain, L.R.; Kelley, S.R.; Kerlakian, G.M.; Tymitz, K.M. Factors Influencing primary care physicians’ referral for bariatric surgery. JSLS 2015, 19, e2015.00046. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Funk, L.M.; Jolles, S.A.; Greenberg, C.C.; Schwarze, M.L.; Safdar, N.; McVay, M.A.; Whittle, J.C.; Maciejewski, M.L.; Voils, C.I. Primary care physician decision making regarding severe obesity treatment and bariatric surgery: A qualitative study. Surg. Obes. Relat. Dis. 2016, 12, 893–901. [Google Scholar] [CrossRef]
- Lopez, E.K.H.; Helm, M.C.; Gould, J.C.; Lak, K.L. Primary care providers’ attitudes and knowledge of bariatric surgery. Surg. Endosc. 2020, 34, 2273–2278. [Google Scholar] [CrossRef]
- Phelan, S.M.; Burgess, D.J.; Yeazel, M.W.; Hellerstedt, W.L.; Griffin, J.M.; van Ryn, M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes. Rev. 2015, 16, 319–326. [Google Scholar] [CrossRef]
- Hansson, L.M.; Naslund, E.; Rasmussen, F. Perceived discrimination among men and women with normal weight and obesity. A population-based study from Sweden. Scand. J. Public Health 2010, 38, 587–596. [Google Scholar] [CrossRef] [PubMed]
- Rubino, F.; Puhl, R.M.; Cummings, D.E.; Eckel, R.H.; Ryan, D.H.; Mechanick, J.I.; Nadglowski, J.; Ramos Salas, X.; Schauer, P.R.; Twenefour, D.; et al. Joint international consensus statement for ending stigma of obesity. Nat. Med. 2020, 26, 485–497. [Google Scholar] [CrossRef] [Green Version]
- von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gotzsche, P.C.; Vandenbroucke, J.P. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J. Clin. Epidemiol. 2008, 61, 344–349. [Google Scholar] [CrossRef] [Green Version]
- Bacon, J.G.; Scheltema, K.E.; Robinson, B.E. Fat phobia scale revisited: The short form. Int. J. Obes. Relat. Metab. Disord. 2001, 25, 252–257. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- W.H.O. Obesity and Overweight. 2021. Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 17 August 2021).
- Statistisches Bundesamt. Mikrozensus-Körpermaße der Bevölkerung 2017. 2018. Available online: https://de.statista.com/statistik/daten/studie/256599/umfrage/bmi--anteil-der-uebergewichtigen-in-deutschland-nach-bundeslaendern/ (accessed on 6 April 2021).
- Ng, M.; Fleming, T.; Robinson, M.; Thomson, B.; Graetz, N.; Margono, C.; Mullany, E.C.; Biryukov, S.; Abbafati, C.; Abera, S.F.; et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014, 384, 766–781. [Google Scholar] [CrossRef] [Green Version]
- Withrow, D.; Alter, D.A. The economic burden of obesity worldwide: A systematic review of the direct costs of obesity. Obes. Rev. 2011, 12, 131–141. [Google Scholar] [CrossRef]
- Foster, G.D.; Wadden, T.A.; Makris, A.P.; Davidson, D.; Sanderson, R.S.; Allison, D.B.; Kessler, A. Primary care physicians’ attitudes about obesity and its treatment. Obes. Res. 2003, 11, 1168–1177. [Google Scholar] [CrossRef] [PubMed]
- Balduf, L.M.; Farrell, T.M. Attitudes, beliefs, and referral patterns of PCPs to bariatric surgeons. J. Surg. Res. 2008, 144, 49–58. [Google Scholar] [CrossRef] [PubMed]
- Martini, F.; Lazzati, A.; Fritsch, S.; Liagre, A.; Iannelli, A.; Paolino, L. General practitioners and bariatric surgery in France: Are they ready to face the challenge? Obes. Surg. 2018, 28, 1754–1759. [Google Scholar] [CrossRef] [PubMed]
- Auspitz, M.; Cleghorn, M.C.; Azin, A.; Sockalingam, S.; Quereshy, F.A.; Okrainec, A.; Jackson, T.D. Knowledge and perception of bariatric surgery among primary care physicians: A survey of family doctors in Ontario. Obes. Surg. 2016, 26, 2022–2028. [Google Scholar] [CrossRef] [PubMed]
- Schwenke, M.; Luppa, M.; Pabst, A.; Welzel, F.D.; Lobner, M.; Luck-Sikorski, C.; Kersting, A.; Bluher, M.; Riedel-Heller, S.G. Attitudes and treatment practice of general practitioners towards patients with obesity in primary care. BMC Fam. Pract. 2020, 21, 169. [Google Scholar] [CrossRef]
- Sikorski, C.; Luppa, M.; Brahler, E.; Konig, H.H.; Riedel-Heller, S.G. Obese children, adults and senior citizens in the eyes of the general public: Results of a representative study on stigma and causation of obesity. PLoS ONE 2012, 7, e46924. [Google Scholar] [CrossRef] [Green Version]
- Brewis, A.; Sturtz Sreetharan, C.; Wutich, A. Obesity stigma as a globalizing health challenge. Glob. Health 2018, 14, 20. [Google Scholar] [CrossRef] [PubMed]
- Wu, Y.K.; Berry, D.C. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J. Adv. Nurs. 2018, 74, 1030–1042. [Google Scholar] [CrossRef]
- Alizai, P.H.; Akkerman, M.K.; Kaemmer, D.; Ulmer, F.; Klink, C.D.; Ernst, S.; Mathiak, K.; Neumann, U.P.; Perlitz, V. Presurgical assessment of bariatric patients with the Patient Health Questionnaire (PHQ)—A screening of the prevalence of psychosocial comorbidity. Health Qual. Life Outcomes 2015, 13, 80. [Google Scholar] [CrossRef] [Green Version]
- Romain, A.J.; Marleau, J.; Baillot, A. Association between physical multimorbidity, body mass index and mental health/disorders in a representative sample of people with obesity. J. Epidemiol. Community Health 2019, 73, 874–880. [Google Scholar] [CrossRef]
- Vartanian, L.R.; Novak, S.A. Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise. Obesity 2011, 19, 757–762. [Google Scholar] [CrossRef] [PubMed]
- Neumark-Sztainer, D.; Falkner, N.; Story, M.; Perry, C.; Hannan, P.J.; Mulert, S. Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors. Int. J. Obes. Relat. Metab. Disord. 2002, 26, 123–131. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wadden, T.A.; Anderson, D.A.; Foster, G.D.; Bennett, A.; Steinberg, C.; Sarwer, D.B. Obese women’s perceptions of their physicians’ weight management attitudes and practices. Arch. Fam. Med. 2000, 9, 854–860. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Drury, C.A.; Louis, M. Exploring the association between body weight, stigma of obesity, and health care avoidance. J. Am. Acad. Nurse Pract. 2002, 14, 554–561. [Google Scholar] [CrossRef] [PubMed]
- Hebl, M.R.; Xu, J. Weighing the care: Physicians’ reactions to the size of a patient. Int. J. Obes. Relat. Metab. Disord. 2001, 25, 1246–1252. [Google Scholar] [CrossRef] [Green Version]
- Huizinga, M.M.; Cooper, L.A.; Bleich, S.N.; Clark, J.M.; Beach, M.C. Physician respect for patients with obesity. J. Gen. Intern. Med. 2009, 24, 1236–1239. [Google Scholar] [CrossRef]
- Vartanian, L.R.; Fardouly, J. The stigma of obesity surgery: Negative evaluations based on weight loss history. Obes. Surg. 2013, 23, 1545–1550. [Google Scholar] [CrossRef]
- Mattingly, B.A.; Stambush, M.A.; Hill, A.E. 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, 128–144. [Google Scholar] [CrossRef]
- Jung, F.U.; Luck-Sikorski, C.; Stroh, C.; Riedel-Heller, S.G. Zuweisungsverhalten der Hausärzte bei Patienten mit Adipositas. Chirurg 2018, 89, 577–582. [Google Scholar] [CrossRef]
- Salinas, G.D.; Glauser, T.A.; Williamson, J.C.; Rao, G.; Abdolrasulnia, M. Primary care physician attitudes and practice patterns in the management of obese adults: Results from a national survey. Postgrad. Med. 2011, 123, 214–219. [Google Scholar] [CrossRef]
- Ma, J.; Xiao, L.; Stafford, R.S. Underdiagnosis of obesity in adults in US outpatient settings. Arch. Intern. Med. 2009, 169, 313–314. [Google Scholar] [CrossRef] [Green Version]
- Critchlow, N.; Rosenberg, G.; Rumgay, H.; Petty, R.; Vohra, J. Weight assessment and the provision of weight management advice in primary care: A cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom. BMC Fam. Pract. 2020, 21, 111. [Google Scholar] [CrossRef]
- Busetto, L.; Dicker, D.; Azran, C.; Batterham, R.L.; Farpour-Lambert, N.; Fried, M.; Hjelmesaeth, J.; Kinzl, J.; Leitner, D.R.; Makaronidis, J.M.; et al. Practical recommendations of the obesity management task force of the european association for the study of obesity for the post-bariatric surgery medical management. Obes. Facts 2017, 10, 597–632. [Google Scholar] [CrossRef] [PubMed]
- Fried, M.; Yumuk, V.; Oppert, J.M.; Scopinaro, N.; Torres, A.J.; Weiner, R.; Yashkov, Y.; Fruhbeck, G. Interdisciplinary European Guidelines on metabolic and bariatric surgery. Obes. Facts 2013, 6, 449–468. [Google Scholar] [CrossRef]
- Moroshko, I.; Brennan, L.; Warren, N.; Brown, W.; O’Brien, P. Patients’ perspectives on laparoscopic adjustable gastric banding (LAGB) aftercare attendance: Qualitative assessment. Obes. Surg. 2014, 24, 266–275. [Google Scholar] [CrossRef]
- Parretti, H.M.; Hughes, C.A.; Jones, L.L. ‘The rollercoaster of follow-up care’ after bariatric surgery: A rapid review and qualitative synthesis. Obes. Rev. 2019, 20, 88–107. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Perlman, S.E.; Reinhold, R.B.; Nadzam, G.S. How do family practitioners perceive surgery for the morbidly obese? Surg. Obes. Relat. Dis. 2007, 3, 428–433. [Google Scholar] [CrossRef] [PubMed]
Mean ± SD | Number | Percentage [%] | |
---|---|---|---|
Age | 53.8 ± 10.4 | ||
<45 years | 32 | 15.7 | |
≥45 years | 144 | 70.6 | |
not answered | 28 | 13.7 | |
Gender | |||
female | 83 | 40.7 | |
male | 99 | 48.5 | |
not answered | 22 | 10.8 | |
BMI | 24.6 ± 3.6 | ||
<25 kg/m2 | 104 | 50.9 | |
≥25 kg/m2 | 75 | 36.8 | |
not answered | 25 | 12.3 |
Normal Weight GPs vs. Overweight/Obese GPs | Male GPs vs. Female GPs | Younger GPs vs. Older GPs | |
---|---|---|---|
How frequently do you calculate your patients’ BMI? | |||
mean score ± SD | 3.34 ± 0.8 vs. 3.36 ± 0.8 | 3.27 ± 0.9 vs. 3.45 ± 0.8 | 3.31 ± 1.0 vs. 3.39 ± 0.7 |
p-value | 0.992 | 0.099 | 0.661 |
How confident are you in approaching obese patients concerning their weight and related risks? | |||
mean score ± SD | 4.44 ± 0.7 vs. 4.47 ± 0.7 | 4.45 ± 0.7 vs. 4.46 ± 0.7 | 4.35 ± 0.8 vs. 4.48 ± 0.7 |
p-value | 0.756 | 0.947 | 0.538 |
How confident are you in educating obese patients regarding their obesity if they ask you? | |||
mean score ± SD | 4.22 ± 0.9 vs. 4.32 ± 0.8 | 4.30 ± 0.8 vs. 4.24 ± 0.9 | 3.90 ± 1.0 vs. 4.38 ± 0.8 |
p-value | 0.549 | 0.783 | 0.009 |
How many patients did you provide with follow-up care after their weight loss surgery? | |||
mean score ± SD | 3.20 ± 1.3 vs. 3.58 ± 1.4 | 3.59 ± 1.4 vs. 3.06 ± 1.2 | 2.77 ± 1.2 vs. 3.49 ± 1.3 |
p-value | 0.089 | 0.014 | 0.007 |
Mean ± SD | Percentage [%] | |
---|---|---|
Overall | 3.3 ± 0.6 | 100 |
Obese patients… | ||
are lazy | 3.8 ± 1.0 | |
disagree (4–5) | 53.0 | |
neutral (3) | 41.2 | |
agree (1–2) | 4.9 | |
not answered | 0.9 | |
have no self-control | 3.4 ± 0.9 | |
disagree (4–5) | 41.2 | |
neutral (3) | 46.1 | |
agree (1–2) | 11.8 | |
not answered | 0.9 | |
are unattractive | 3.0 ± 1.0 | |
disagree (4–5) | 27.5 | |
neutral (3) | 40.2 | |
agree (1–2) | 31.8 | |
not answered | 0.5 | |
are self-responsible | 3.0 ± 0.8 | |
disagree (4–5) | 20.1 | |
neutral (3) | 55.4 | |
agree (1–2) | 24.0 | |
not answered | 0.5 | |
have no self confidence | 3.2 ± 0.9 | |
disagree (4–5) | 33.8 | |
neutral (3) | 47.5 | |
agree (1–2) | 18.2 | |
not answered | 0.5 |
Mean ± SD | Percentage [%] | |
---|---|---|
Overall | 3.6 ± 0.8 | 100 |
Informing patients about WLS in the last 6 months | 2.3 ± 1.1 | |
≥5 patients | 12.3 | |
3–4 patients | 18.1 | |
≤2 patients | 69.1 | |
not answered | 0.5 | |
Knowledge about criteria for WLS | 3.7 ± 1.2 | |
familiar (4–5) | 65.2 | |
neutral (3) | 15.3 | |
unfamiliar (1–2) | 18.6 | |
not answered | 0.9 | |
Knowledge about pre- operative multimodal program | 3.7 ± 1.1 | |
familiar (4–5) | 63.7 | |
neutral (3) | 20.2 | |
unfamiliar (1–2) | 15.2 | |
not answered | 0.9 | |
Knowledge about surgical procedures | 4.5 ± 0.8 | |
familiar (4–5) | 86.3 | |
neutral (3) | 9.8 | |
unfamiliar (1–2) | 3.0 | |
not answered | 0.9 |
Normal Weight GPs vs. Overweight/Obese GPs | Male GPs vs. Female GPs | Younger GPs vs. Older GPs | |
---|---|---|---|
How many patients have you educated on the possibility of weight loss surgery in the last six months? | |||
mean score ± SD | 2.14 ± 1.0 vs. 2.69 ± 1.3 | 2.43 ± 1.2 vs. 2.27 ± 1.1 | 2.31 ± 1.2 vs. 2.40 ± 1.2 |
p-value | 0.003 | 0.367 | 0.495 |
Are you familiar with the regarded criteria for undergoing weight loss surgery? | |||
mean score ± SD | 3.64 ± 1.3 vs. 3.85 ± 1.0 | 3.76 ± 1.2 vs. 3.65 ± 1.2 | 3.16 ± 1.3 vs. 3.86 ± 1.1 |
p-value | 0.454 | 0.445 | 0.005 |
Are you familiar with the multimodal weight loss program for treating obese patients? | |||
mean score ± SD | 3.68 ± 1.2 vs. 3.85 ± 1.0 | 3.77 ± 1.1 vs. 3.72 ± 1.2 | 3.61 ± 1.1 vs. 3.83 ± 1.1 |
p-value | 0.482 | 0.975 | 0.286 |
Do you know surgical procedures such as Roux-en Y gastric bypass and sleeve gastrectomy? | |||
mean score ± SD | 4.41 ± 0.8 vs. 4.59 ± 0.7 | 4.58 ± 0.7 vs. 4.33 ± 0.9 | 4.39 ± 0.8 vs. 4.55 ± 0.7 |
p-value | 0.185 | 0.036 | 0.305 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Egerer, M.; Kuth, N.; Koch, A.; Schmitz, S.M.-T.; Kroh, A.; Neumann, U.P.; Ulmer, T.F.; Alizai, P.H. General Practitioner’s Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers. Int. J. Environ. Res. Public Health 2021, 18, 10055. https://doi.org/10.3390/ijerph181910055
Egerer M, Kuth N, Koch A, Schmitz SM-T, Kroh A, Neumann UP, Ulmer TF, Alizai PH. General Practitioner’s Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers. International Journal of Environmental Research and Public Health. 2021; 18(19):10055. https://doi.org/10.3390/ijerph181910055
Chicago/Turabian StyleEgerer, Mara, Nicole Kuth, Alexander Koch, Sophia Marie-Therese Schmitz, Andreas Kroh, Ulf P. Neumann, Tom F. Ulmer, and Patrick H. Alizai. 2021. "General Practitioner’s Knowledge about Bariatric Surgery Is Associated with Referral Practice to Bariatric Surgery Centers" International Journal of Environmental Research and Public Health 18, no. 19: 10055. https://doi.org/10.3390/ijerph181910055