Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Obesity prevalence is increasing globally. Bariatric surgery is an effective treatment for severe and complex obesity resulting in significant and sustained weight loss. In Sweden, most bariatric surgery patients are referred by primary care physicians. We aimed to explore barriers for physicians to refer patients with severe and complex obesity for bariatric surgery.

Methods

A questionnaire survey was in 2019 emailed to 1100 primary care physicians in the Skåne and Kronoberg regions in south Sweden. The survey focused on referral patterns, knowledge and attitudes towards bariatric surgery and concerns about postoperative complications. We created different statistical indices for referral patterns, knowledge, attitudes and concerns about bariatric surgery. To analyze the correlation between these indices, we did Spearman’s correlations and regression analyses.

Results

Of 1100 email respondents, we received 157 (14%) completed surveys. Among 157 physician respondents, 73% answered that they had good knowledge about the referral criteria for bariatric surgery, whereas 55 and 60% answered correctly to two items on criteria for bariatric surgery. A majority of respondents (84%) stated that their patients initiated referral to bariatric surgery. Half of the respondents had concerns about postoperative medical and surgical complications, but another half had a positive attitude to bariatric surgery as a treatment for obesity comorbidities. Almost half of the respondents (44%) answered that they needed to learn more about bariatric surgery.

We found significant positive correlations between high knowledge and referral patterns (r = 0.292, p < 0.001) and positive attitudes (r = 0.235, p < 0.001) respectively. We found significant reverse correlations between concerns and referral patterns (r = − 0.355, p < 0.001) and between positive attitudes and concerns (r = − 0.294, p < 0.001). In logistic regression high levels of concerns explained low willingness to refer for bariatric surgery (Odds Ratio 0.2, 95% confidence interval 0.1–0.7).

Conclusion

According to this Swedish survey among primary care physicians, high levels of concerns about bariatric surgery among physicians seemed to be a barrier to refer patients with severe and complex obesity for bariatric surgery. Since high knowledge about obesity and bariatric surgery correlated negatively to concerns and positively to favorable attitudes to bariatric surgery, more knowledge about obesity and bariatric surgery is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12902-021-00723-8.

Related collections

Most cited references 36

Record: found
Abstract: found
Article: not found

Bariatric surgery: a systematic review and meta-analysis.

Henry Buchwald, Yoav Avidor, Eugene Braunwald … (2004)

About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.

0 comments Cited 358 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Effects of bariatric surgery on mortality in Swedish obese subjects.

Lars Sjöström, Kristina Narbro, C David Sjöström … (2007)

Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). The average weight change in control subjects was less than +/-2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjusted overall hazard ratio was 0.76 in the surgery group (P=0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P=0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29). Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality. Copyright 2007 Massachusetts Medical Society.

0 comments Cited 335 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.

L Sjöström (2013)

Obesity is a risk factor for diabetes, cardiovascular disease events, cancer and overall mortality. Weight loss may protect against these conditions, but robust evidence for this has been lacking. The Swedish Obese Subjects (SOS) study is the first long-term, prospective, controlled trial to provide information on the effects of bariatric surgery on the incidence of these objective endpoints. The SOS study involved 2010 obese subjects who underwent bariatric surgery [gastric bypass (13%), banding (19%) and vertical banded gastroplasty (68%)] and 2037 contemporaneously matched obese control subjects receiving usual care. The age of participants was 37-60 years and body mass index (BMI) was ≥34 kg m(-2) in men and ≥38 kg m(-2) in women. Here, we review the key SOS study results published between 2004 and 2012. Follow-up periods varied from 10 to 20 years in different reports. The mean changes in body weight after 2, 10, 15 and 20 years were -23%, -17%, -16% and -18% in the surgery group and 0%, 1%, -1% and -1% in the control group respectively. Compared with usual care, bariatric surgery was associated with a long-term reduction in overall mortality (primary endpoint) [adjusted hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.54-0.92; P = 0.01] and decreased incidences of diabetes (adjusted HR=0.17; P < 0.001), myocardial infarction (adjusted HR = 0.71; P = 0.02), stroke (adjusted HR=0.66; P = 0.008) and cancer (women: adjusted HR = 0.58; P = 0.0008; men: n.s.]. The diabetes remission rate was increased severalfold at 2 years [adjusted odds ratio (OR) = 8.42; P < 0.001] and 10 years (adjusted OR = 3.45; P < 0.001). Whereas high insulin and/or high glucose at baseline predicted favourable treatment effects, high baseline BMI did not, indicating that current selection criteria for bariatric surgery need to be revised. © 2012 The Association for the Publication of the Journal of Internal Medicine.

0 comments Cited 292 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Ensieh Memarian:

ORCID: http://orcid.org/0000-0002-8214-917X

ensieh.memarian@med.lu.se , ensieh@hotmail.com

Journal

Journal ID (nlm-ta): BMC Endocr Disord

Journal ID (iso-abbrev): BMC Endocr Disord

Title: BMC Endocrine Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6823

Publication date (Electronic): 8 April 2021

Publication date PMC-release: 8 April 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 62

Affiliations

[1 ]GRID grid.4514.4, ISNI 0000 0001 0930 2361, Department of Clinical Sciences in Malmö, , Lund University, Internal Medicine Research Group, ; Jan Waldenströms gata 15, 5th floor, Skane University Hospital, S-20502 Malmö, Sweden

[2 ]GRID grid.4514.4, ISNI 0000 0001 0930 2361, Center for Primary Health Care Research Region Skåne and Department of Clinical Sciences in Malmö, , Lund University, ; Lund, Sweden

[3 ]GRID grid.8148.5, ISNI 0000 0001 2174 3522, Linnaeus University, ; Kalmar, Sweden

Author information

Ensieh Memarian http://orcid.org/0000-0002-8214-917X

Article

Publisher ID: 723

DOI: 10.1186/s12902-021-00723-8

PMC ID: 8030650

PubMed ID: 33832469

SO-VID: 996f3235-6562-429f-a660-54141731c62d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 30 November 2020

Date accepted : 21 March 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100009748, Ernhold Lundström Stiftelse;

Funded by: ALF funding from Region Skåne

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: obesity,bariatric surgery,survey study,primary care physician,knowledge,referral,attitudes

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: obesity, bariatric surgery, survey study, primary care physician, knowledge, referral, attitudes

Primary care physicians’ knowledge, attitudes and concerns about bariatric surgery and the association with referral patterns: a Swedish survey study

Read this article at

Abstract

Background

Methods

Results

Conclusion

Supplementary Information

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 36

Bariatric surgery: a systematic review and meta-analysis.

Effects of bariatric surgery on mortality in Swedish obese subjects.

Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery.

Author and article information

Contributors

Journal

Affiliations

Author information

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 194

Cited by 9

Most referenced authors 735