Table 2.
Knowledge of eligibility and procedure types for surgical management of obesity
| Author | Routinely weigh patients | Knowledge about eligibility criteria and indications for BSY | Knowledge about BSY procedure options | Statistical test |
|---|---|---|---|---|
| Avidor et al., 2007 |
• Average degree of familiarity with NIH eligibility guidelines (range 1–5; 1 = not familiar, 5 = very familiar): ○ BARI (3.9), OBGYN (2.3), IM (2.4), ENDO (3.3), CARD (2.5), FM (3) |
• Average degree of familiarity: ○ All physicians: RYGB (3.2), LRYGB (3.1), LAGB (3.0) ○ BARI: RYGB (3.9), LRYGB (3.9), LAGB (2.9) ○ OBGYN: RYGB (2.9), LRYGB (2.7), LAGB (2.5) ○ IM: RYGB (3.2), LRYGB (2.9), LAGB (2.6) ○ ENDO: RYGB (3.5), LRYGB (3.6), LAGB (3.6) ○ CARD: RYGB (2.7), LRYGB (2.5), LAGB (2.6) ○ FM: RYGB (3.3), LRYGB (3.1), LAGB (3.8) |
• 5-point Likert Scale • Descriptive statistics |
|
| Balduf et al., 2008 |
• Percentage who read the NIH 2000 guidelines ○ Referring (14.7%), non-referring (3%) (p = 0.02) |
• Average score from 10-question assessment of general knowledge ○ Referring (6.9 ± 1.4), non-referring (6.2 ± 1.8), (p = 0.006) |
• Descriptive statistics | |
| Ferrante et al., 2009 | • Knows “much” or “very much” about surgical interventions for obesity: 44% | • Descriptive statistics | ||
| Salinas et al., 2011 |
• Would refer patient with BMI > 40 kg/m2 with comorbidities for BSY as a next step in management: 17.4% agree ○ 15.5% FP, 19.3% IM |
• Descriptive statistics | ||
| Giaro et al., 2014 |
• Correctly answered question about indications: 77% • Able to use knowledge in practice: 53.1% |
• Correct knowledge concerning surgical methods applied in treatment of obesity: 92.3% • Assessment of knowledge: ○ 11.9% completely satisfactory ○ 21.7% insufficient but I study it myself ○ 58.7% inadequate, interested in learning more ○ 7.7% minor, but I do not need it in my practice |
• Descriptive statistics | |
| Glauser et al., 2015 |
• Mean familiarity scores (10 point scale): ○ USPSTF screening and management of obesity in adults: BARI (5.8), CARD (3.5), ENDO (5), PCP (5.6) ○ NHLBI guidelines for management of obesity: BARI (5.2), CARD (3.5), ENDO (5), PCP (4.6) ○ AACE/TOS/ASMBS guidelines for perioperative nutritional, metabolic, and nonsurgical support of BSY patients: BARI (6.5), CARD (2.8), ENDO (6.2), PCP (4) ○ ISCI guidelines of obesity: BARI (3.7), CARD (2.5), ENDO (3.2), PCP (3.7) |
• Correctly identified evidence-based excess weight loss for patient who is 150 pounds overweight 1 year after laparoscopic RYGB ○ 40% bariatricians, 20% cardiologists, 38% endocrinologists, 14% PCPs |
• Descriptive Statistics | |
| Stanford et al., 2015 | • Correctly identified qualifying BMI: No obesity related training (51.7%), previous obesity related training (65.9%) |
• Familiar with average expected excess body weight loss from RYGB: No obesity related training (27%), previous obesity related training (73%) • Familiar with the national 30 day mortality rate of RYGB: No obesity related training (32%), previous obesity related training (68%) • Correctly identified postoperative time frame within with patients are expected to achieve maximum weight loss: No obesity related training (43%), previous obesity related training (57%) • Correctly answered more than half of knowledge questions: No obesity related training (46%), previous obesity related training (54%), p < 0.05 • Younger PCPs (age 20–39) more likely to have obesity training than PCPs aged 40–49 or 50 + (OR: 0.08, 95% CI: 0.008–0.822 and OR: 0.03, 0.004–0.321, respectively) |
• Descriptive statistics • Chi-square test |
|
| Tork et al., 2015 |
• Not familiar with indications: 46% disagree, 19% strongly disagree • BMI > 35 kg/ and comorbidities related to obesity are an indication to refer patient: 85% strongly agree/agree |
• Descriptive statistics • 5-point Likert scale |
||
| Auspitz et al., 2016 |
• Every visit: 10.7% • Every year: 80.7% |
• Correct identification of 30-day mortality rate: LRYGB (11.2%), LSG (12.6%), LAGB (28.9%) • Correct identification of 30-day morbidity rate: LRYGB (13%), LSG (14.3%), LAGB (30.6%) • “I feel comfortable explaining the procedural options to a patient”: All FPs (23.8%) ○ Previously referred (33.9%), non-referring (5.6%) (p = 0.013) |
• Descriptive statistics | |
| Funk et al., 2016 |
• Most PCPs were not sure which BSY approach, open vs. laparoscopic, was performed routinely • Limited familiarity with laparoscopic vertical sleeve gastrectomy ○ Most commonly performed BSY type in the US |
• Qualitative | ||
| Hirpara et al., 2016 | • All surgeons (33%), BS (75%), non-BS (47.6%), p = 0.039 |
• Correctly identify NIH eligibility criteria: All Surgeons (36.3%), ○ BS (85%), non-BS (46.9%) (p = 0.002) |
• Correctly identify 30-day mortality risk: ○ LRYGB: All surgeons (22.2%), BS (45%), non-BS (16.5%) (p = 0.006) ○ LSG: All surgeons (14.3%), BS (70%), non-BS (10.3%) (p = 0.024) ○ LAGB: All surgeons (48%), BS (90%), non-BS (37.2%) (p < 0.001) • Correctly identify 30-day morbidity: ○ LRYGB: All surgeons (32.7%), BS (35%), non-BS (32.1%) (p = 0.546) ○ LSG: All surgeons (18.6%), BS (20%), non-BS (18.2%) (p = 0.314) ○ LAGB: All surgeons (35.1%), BS (40%), non-BS (33.8%) (p = 0.241) |
• Descriptive Statistics • Pearson Chi-Square Test |
| Jung et al., 2016 | • Rated their knowledge as moderate to good: > 70% |
• Linear regression • Logistic regression |
||
| Major et al., 2016 | • Knows the indications: 81.8% |
• Can explain to their patient how the most common procedures are conducted: 75.5% • Can name the most popular procedure: 69.8% |
• Descriptive Statistics | |
| Stolberg et al., 2017 | • Have good knowledge of national referral criteria: 70% agree/strongly agree |
• Descriptive statistics • 5-point Likert Scale |
||
| Zacharoulis et al., 2017 |
• Level of familiarity with various procedure types: ○ Intragastric balloon: 31.7% not at all, 56.7% a little, 11.7% a lot ○ Adjustable gastric banding: 28.7% not at all, 57.7% a little, 13.7% a lot ○ Laparoscopic sleeve gastrectomy: 40.3% not at all, 49.0% a little, 10.7% a lot ○ Roux-en-Y gastric bypass: 56.0% not at all, 38.7% a little, 5.3% a lot ○ Mini-gastric bypass: 63.3% not at all, 32.0% a little, 1.7% a lot ○ Biliopancreatic diversion with or without duodenal switch: 73.7% not at all, 25.3% a little, 1.0% a lot |
• Descriptive Statistics | ||
| Falvo et al., 2018 | • “Always” calculate BMI: 88.9% | • Correctly identified > 2 eligibility criteria: 57.1% |
• Above average knowledge of obesity in respective region vs national average: 74.4% • Correctly identified medical problems that can be improved by BSY: 66.7% |
• Descriptive Statistics |
| Martini et al., 2018 | • Measure weight “each visit”: 74.3% | • Aware of national guidelines for bariatric surgery: 32.3% |
• Familiarity with surgical procedures: ○ Gastric banding: 87.9% ○ Sleeve gastrectomy: 92% |
• Descriptive Statistics |
| McGlone et al., 2018 | • Median estimated early mortality rate reported as greater than 10 times the actual rate (reported as 2%) | • Descriptive Statistics | ||
| Simon et al., 2018 |
• Aware of indications: 88.6% “yes”, 11.4% “no” • Offer surgical option to eligible patients: ○ 0–25% of eligible patients: 32.7% ○ 26–50% of eligible patients: 23.1% ○ 51–75% of eligible patients: 17.3% ○ 76–100% of eligible patients: 26.9% |
• Descriptive Statistics | ||
| Conaty et al., 2020 | • Familiar with NIH eligibility criteria: 46.7% strongly agree/agree, 35.3% strongly disagree/disagree | • Comfortable informing patients about various BSY options: 51% PCPs strongly agree/agree |
• Descriptive statistics • 5-point Likert Scale |
|
| El-Beheiry et al., 2020 | • Use NIH criteria for referral: 26% agree, 74% deny | • Descriptive Statistics | ||
| Elliott et al., 2020 |
• “I have good knowledge of the criteria for referral” ○ Endocrinologists: 68% strongly agree/agree • 6–13% of otorhinolaryngologists, obstetricians/gynecologists, and orthopedic surgeons strongly agree/agree |
• Descriptive Statistics • 5-point Likert Scale |
||
| Lopez et al., 2020 | • Correctly identified mortality rate of RYGB: 53.7% | • Descriptive statistics | ||
| Egerer et al., 2021 |
• Calculate every patients BMI: 38% • Calculate BMI only if patient is noticeably overweight: 53% |
• Knowledge of eligibility criteria: 65.2% familiar • Mean knowledge of eligibility criteria (1 = unfamiliar, 5 = familiar): ○ Normal weight PCP (3.64 ± 1.3), overweight/obese PCP (3.85 ± 1.0) (p = 0.454) ○ Male PCP (3.76 ± 1.2), female PCP (3.65 ± 1.2) (p = 0.445) ○ Younger PCP (3.16 ± 1.3), older PCP (3.86 ± 1.1) (p = 0.005) |
• Knowledge of different procedure options: 86.3% familiar • Mean knowledge (1 = no knowledge, 5 = high knowledge): ○ Normal weight PCP (4.41 ± 0.8), overweight/obese PCP (4.59 ± 0.7) (p = 0.185) ○ Male PCP (4.58 ± 0.7), female PCP (4.33 ± 0.9) (p = 0.036) ○ Younger PCP (4.39 ± 0.8), older PCP (4.55 ± 0.7) (p = 0.305) |
• Descriptive Statistics • Two-sample t-test • Mann–Whitney U test |
| Memarian et al., 2021 |
• Have “good knowledge” of referral criteria: 73% strongly agree/agree • 2 items on BMI criteria correctly answered: 55% strongly agree/agree |
• Descriptive statistics • 5-point Likert Scale |
||
| Özgüc et al., 2021 |
• Never: 2.2% • Rarely: 19%; • Sometimes: 47.1% • Frequently: 28.2% • Always: 3.5% |
• Correctly identified obese BMI range: 25 < BMI < 29 (93.5%), BMI > 30 (82.8%) • Patients with BMI > 40 kg/m2 should be referred: 72.37% agree ○ 56.3% agree, 16.1% strongly agree • Patients with BMI 35–40 kg/m2 and comorbidities should be referred: 53.3% agree ○ 42.3% agree, 11% strongly agree • Patients with BMI 35–40 kg/m2 and uncontrolled diabetes should be referred: 35.9% agree ○ 30.1% agree, 5.7% strongly agree |
• Descriptive statistics • 5-point Likert Scale |
|
| Zevin et al., 2021 |
• Unfamiliar with eligibility guidelines for patients with class II/III obesity and T2D: 53.3% • Have “good” knowledge of the referral criteria: All PCPs (68.9%) ○ Male (63.3%), female (36.8%) (p = 0.018) |
• Descriptive statistics • Independent sample t-tests |
||
| Alenezi et al., 2022 | • Level of training and education level not significantly associated with higher reported knowledge | • Descriptive Statistics | ||
| Carrasco et al., 2022 | • Willing to refer patient with BMI 38 kg/m2, several obesity-related comorbidities, family history of cardiovascular mortality: 43% | • Descriptive statistics | ||
| Holmes et al., 2022 | • Correctly identified regional BMI cutoffs for BSY: 67.0% | • Descriptive statistics | ||
| Ouni et al., 2022 |
• Familiarity with NIH eligibility criteria: 31.5% familiar, 45.4% somewhat familiar, 23.1% unfamiliar • Knowledge of indications for EBTs: 75.4% unfamiliar, 6.2% familiar |
• Awareness of EBTs for weight loss: 52.3% unaware • Interest in further education regarding therapeutic options for patients with obesity: 84.6% PCPs |
• Descriptive statistics | |
| Zawadzka et al., 2022 |
• Correctly identify eligibility guidelines: 35.9% of all physicians, 32.4% of diabetologists, 40% of non-diabetologists • Correctly identify criteria that indicate postponing a scheduled BSY procedure: 45.3% diabetologists, 31.3% non-diabetologists (p = 0.02) |
• Have knowledge about perioperative mortality: 85.3% diabetologists, 56.6% non-diabetologists (p = 0.01) • Interest in broadening knowledge: 92.2% of physicians |
• Chi-squared test | |
| Mojkowska et al., 2023 |
• Percentage of correct answers to questions related to knowledge: ○ BMI reference values: 89% ○ Indications: 51% • HCPs self-assessment of knowledge of obesity was negatively correlated with actual level of knowledge |
• Percentage of correct answers to questions related to knowledge about obesity: ○ Goals of surgical treatment of obesity: 66% ○ Indications: 51% • Respondents with prior training related to obesity had a lower regard of their knowledge of diagnosis and treatment (p = 0.008) • Respondents with prior training on obesity answered more questions correctly (p = 0.026) • Providers who work in hospitals had higher knowledge than providers who work in outpatient centers (p = 0.009) • Low level of knowledge was more often present in respondents < 29 years old than respondents > 30 years old (p = 0.03) • Older respondents knew regulations on reimbursements more often (p = 0.04) |
• Pearson’s chi-squared test • Mann–Whitney U Test |
Abbreviations: AACE American Academy of Clinical Endocrinology, ASMBS American Society for Metabolic and Bariatric Surgery, BARI bariatric medicine, BS bariatric surgeon, BSY bariatric surgery, CARD cardiologists, ENDO endocrinologists, FP family practitioners, ICSI Institute for Clinical Systems Improvement, IM internal medicine, LAGB laparoscopic adjustable gastric banding, LRYGB laparoscopic RYGB, LSG laparoscopic sleeve gastrectomy, NHLBI National Heart, Lung, and Blood Institute, NIH National Institute of Health, OBGYN obstetrics/gynecology, PCP primary care physician, RYGB Roux-en-Y gastric bypass, TOS The Obesity Society, USPSTF U.S. Preventative Services Task Force