Table 4.
Representative patient and provider quotes regarding individual-level barriers to bariatric surgery
| Theme | PCP | Bariatric surgeon | Registered dietitian | Health psychologist | Patient |
|---|---|---|---|---|---|
| 1. Lack of social support | “If they don’t have stability in their life, mentally and socially…then it’s not going to be as successful.” | “The best candidates had a lot of social support from family and friends and people who wouldn’t look at bariatric surgery as somehow cheating or lazy.” | “I just didn’t have the support to help me out after surgery” | ||
| 2. Fear of surgery and its outcomes | “There is the terror of surgery …that they could have a complication of it. That they might have chronic diarrhea or something like that or chronic reflux.” | “On the patient side it’s a …lack of understanding of what the risks actually are, and maybe potential unfounded fear in having bariatric surgery. I think those are kind of the biggest boundaries to referral.” | “Often they say they want surgery and they don’t really know the long- term ramifications of that. So, we do some instruction up front about what are the different surgeries, what are the risks? Sometimes people are like, ‘oh, no, never mind, that’s not for me.’” | “I’m going to take a perfectly good organ and frickin’ mangle it…half the reason why I backed out of that surgery” | |
| 3. Fear of lifestyle change | “I think that there is a fear that they won’t be able to eat the way they eat now.” | “I’ll get some patients who start the process, and they’re just, when they learn more what the changes they have to adhere to, just know they couldn’t do it” | “Specifically with carbonated beverages, you’re going to have to give up for rest of your life. Is that something that you’re willing to do? ‘Cause I do have some patients that I ask that question to already, and I get the answer “no”. That’s a big deterrent for them having surgery” | “I know you have to change your lifestyle. But I just didn’t feel like I wanted to do it that way.” | |
| 4. Patient characteristics influencing provider referral | “I feel like they haven’t put in the effort to try… their diabetes is not controlled, they’re not using their CPAP machines… all those little issues which will provide you with lack of motivation, which will make them more like less motivated, so I try to discourage” | “… patients that have had previous substance abuse have learned a lot of coping mechanisms to help with sobriety. I never thought that they would be good candidates, but what I’m finding is that they’re actually really good candidates.” | “Sometimes patients are in a real rush to get the surgery but aren’t from a behavioral standpoint really ready” | ||
| 5. Perception that weight had not reached its “tipping point” | “Well most of them really don’t [get surgery] unless they have a life threatening…reason.” | “Everybody who canceled their surgery said, “You know what I think I can do this on my own.” | “I would say that they see it as kind of life or death at that point. They have such a poor quality of life being morbidly obese, they’ve tried everything under sun, that this surgery is their last option to try to take some control of their life back.” “People have surprised me and said “I don’t need it” |
“We often also see a number of patients…who have in their minds that the surgery is sort of last resort for them.” | “I wanted to do it on my own, because I really didn’t want to alter my body.” “I just felt like there should have been a bridge. Before you go through this diet and gastric bypass there should be something like, “okay try this medication or something and see if this helps”” |
| 6. Concerns about adhering to recommended dietary changes | “I know a lot of people do have a hard time maintaining the diet. Several of my patients just kind of graze all day.” | “We say three months of weight management needs to occur [before surgery], so not every patient can do that” | “Food is a source of comfort…but if they use it as a coping tool, their relationship with it has to change. And that can be challenging.” | “You know I don’t mind eating less food, but to tell me to not be able to eat certain things or drink certain things…it just seemed not worthwhile for me.” |