1. Identifying patients that drop out of bariatric surgery programs David Mahony, Ph.D., Henry Alder, M.S., M.B.A. & Jeff Eha
Introduction
Bariatric surgery is a clinically and cost-effective procedure for moderate to severe obesity1. In spite of this, the American Society for Metabolic and Bariatric Surgery estimates that less than 1% of the obese individuals in the U.S. who are medically eligible for bariatric surgery, receive the procedure2. Even amongst patients that enroll in bariatric surgery programs, only 43% to 51% complete the procedure3. Although some patients drop out due to inadequate health insurance, researchers have speculated that the majority drop out due to psychological factors such as anxiety about surgical risks and the patient’s belief that they can lose weight without surgery4.
The current study was designed to identify the psychological barriers to bariatric surgery. Once these barriers are identified, interventions to manage them can be developed and implemented so that a greater number of patients can receive the benefits of bariatric surgery.
For the current study we hypothesized that; 1) Patients with higher levels of surgical anxiety will be more likely to drop out ; 2) Patients with higher levels of confidence in their ability to lose weight without surgery will be more likely to drop out; 3) Patients with a lower number of previous weight loss attempts, and less weight regain after weight loss, will be less likely to complete surgery; and 4) Medical and psychological co-morbidities that are generally considered to be primary surgical motivators (e.g., diabetes) will not be sufficient motivation for surgical completion.
Materials and Methods
Participants
This study had access to a database of 23,917 patients that were enrolled in a bariatric surgery program and had verified health insurance coverage for bariatric surgery. They were all medically and psychological eligible for surgery. 123 patients were randomly contacted by telephone including 105 females (85.4%) and 18 males (14.6%). 90 identified themselves as Caucasian (73.2%), 7 as Latino (5.7%), 24 as African-American (19.5%) and 2 as “other” race (1.6%). The patients had a mean BMI of 47.7 (±7.31) and a mean age of (±11.45).
Instruments
A structured clinical telephone interview that assessed psychological, medical and demographic factors, considered to be relevant to surgical motivation was created. Patients were asked about surgical anxiety, confidence in their ability to lose weight without surgery, history of weight loss attempts, history of weight regain after previous weight loss, and the presence of obesity related medical and psychological co-morbidities.
Results
Out of 123 patients, 71 (57.7%) completed bariatric surgery and 52 (42.3%) dropped out (Chart 1). Results of chi square and Mann-Whitney U tests are as follows; surgical drop outs were less comfortable with surgical risks, U(121) = , p =.014; felt more able to control their weight, U(121) = , p =.006; were less likely to believe that bariatric surgery was the only way for them to lose weight, U(121) = , p =.003; had more confidence in their ability to lose weight without surgery, U(121) = , p =.022 (Chart 2); had less experience dieting, X2(1) = 6.767, p = .009 (Chart 3); and were less likely to have experienced weight regain, after weight loss, in the past, X2(1) = , p <.000 (Chart 4). No significant differences were found for surgical drop outs vs. completers for medical or psychological co-morbidities (Chart 5).
Discussion
The present study found that only 57.7% of the patients that enrolled in a bariatric surgery program completed surgery, while 42.3% dropped out. All of our hypotheses were supported indicating that although some patients may drop out of the surgical process due to inadequate health insurance, the majority are dropping out due to psychological factors. These findings provide direction for the development of psychological interventions that can decrease the amount of patients that drop out of the surgical process.
References
1. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess 2009;13: 1-190, , iii-iv.
2. American Society for Metabolic and Bariatric Surgery. New study finds social and economic factors play major role in determining who gets bariatric surgery. Retrieved October 5, 2009, from
3. Tsuda S, Barrios L, Schneider B & Jones DB. Factors affecting rejection of bariatric patients from an academic weight loss program Surg Obese Relat Dis: 5;
4. Munoz DJ, Lal M, Chen EY, et al. Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation. Obes Surg 2007: 17; DOI: /s
Poster presented at the Cleveland Clinic’s 7th Annual Obesity Summit and supported by Ethicon-Endo Surgery.