Role of weight bias and patient–physician communication in the underutilization of bariatric surgery

• Published in: Surgery for obesity and related diseases Vol. 17; no. 11; pp. 1926 - 1932
• Main Authors: Sarwer, David B., Gasoyan, Hamlet, Bauerle Bass, Sarah, Spitzer, Jacqueline C., Soans, Rohit, Rubin, Daniel J.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2021
• Subjects: Bariatric surgery; Obesity; Shared decision-making; Weight bias; Weight stigma; Obesity; Weight bias; Weight stigma; Bariatric surgery; Shared decision-making
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2021.07.013

A growing body of evidence supports the efficacy and safety of bariatric surgery for clinically severe obesity. Despite this empirical support, bariatric surgery remains profoundly underutilized. The reasons for underutilization are likely multifactorial, including health insurance coverage and benefits design, lack of awareness about bariatric surgery by patients, and anecdotal concerns about safety. We believe that there are two other factors—the occurrence of weight stigma and bias and suboptimal communication between patients and providers—that also serve as barriers to greater utilization. The article reviews the existing literature related to these two factors. The review also highlights the science of shared medical decision-making as a potential strategy to promote appropriate conversations between patients and providers, both surgical and nonsurgical, about the efficacy and safety of bariatric surgery. Shared medical decision-making is used in other areas where complex medical decisions are required. We believe that it has great potential to contribute to the increased utilization for the millions of individuals who could benefit from bariatric surgery. •The underutilization of bariatric surgery is likely multifactorial.•Weight stigma and bias, as well as suboptimal communication between patients and providers, are likely barriers to greater usage.•Shared decision making between patients and providers has potential to contribute to increased utilization of bariatric surgery.