Teens with severe obesity face a number of barriers to metabolic and bariatric surgery, a qualitative study suggests.

These data suggest that a lack of understanding about metabolic and bariatric surgery along with social stigma and access challenges associated with financial difficulties contribute to limited or decreased access to metabolic and bariatric surgery, report Eric G. Campbell, PhD, a professor of medicine at University of Colorado School of Medicine in Aurora, and colleagues.

Most current research has used large federal datasets, involving secondary analysis. There hasn’t been a lot of work done in understanding what the people who underwent the surgery perceived as their barriers, noted Campbell. For this study, researchers analyzed the characteristics of the people who have had these surgeries as adolescents and made inferences from the data.

“Bariatric surgery is well within the standard of care for adolescents with severe obesity. Physicians have a moral and an ethical duty to make sure that patients who are potential candidates are at least informed of that treatment option,” Campbell told Medscape Medical News.

An in-press report of the findings were recently published online in the journal Surgery for Obesity and Related Diseases.

Patients Unaware Metabolic and Bariatric Surgery an Option

The researchers collected information from 14 individuals through qualitative interviews. Participants were between 19 and 25 years of age and had undergone metabolic and bariatric surgery in the last 5 years. Interviews also focused on the barriers to metabolic and bariatric surgery they faced as teens.

The researchers used continual comparative approaches of grounded theory, as directed by Andersen’s Behavioral Model of Health Service Use, to conduct a two-site qualitative study.

The qualitative interview results suggest that many patients did not know that metabolic and bariatric surgery was an option for managing severe obesity.

Campbell said many patients shared that the information they did have about the operation often came from a family member or friend, and many participants said their doctor never brought it up with them.

The data also highlight patients’ concerns regarding social stigma.

Campbell noted that the study cohort cited concerns that people perceived the procedure as an “easy way out” or that it was simply done for cosmetic purposes.

The findings also show cost is another primary barrier.

Campbell said many people reported being denied surgery because their insurance would not cover it. Several people also reported issues around access as patients described “chaotic” lives that made the idea of undergoing bariatric surgery challenging.

Study limitations include that the participants who had surgery in the last 5 years were interviewed as an adult, and clinicians and participants may have varying opinions on these barriers. Roughly half of the participants interviewed probably did not qualify for the surgery as teens, the researchers note.

Another limitation was that the study team interviewed 14 adults who had undergone surgery as adults, so they were unable to differentiate how barriers differed among participants who received the surgery as teens.

“Further research should be conducted to explore these issues. In the end, gaining a more complete empirical understanding of these barriers will assist in developing interventions to increase access to metabolic and bariatric surgery in adolescents for whom this surgical intervention is appropriate,” the authors concluded.

Campbell has reported no relevant financial relationships.

Surg Obes Relat Dis. Published online March 22, 2022. Abstract

Ashley Lyles is an award-winning medical journalist. She is a graduate of New York University’s Science, Health, and Environmental Reporting Program. Previously, she studied professional writing at Michigan State University, where she also took premedical classes. Her work has taken her to Honduras, Cambodia, France, and Ghana and has appeared in outlets like The New York Times Daily 360, PBS NewsHour, The Huffington Post, Undark, The Root, Psychology Today, TCTMD, Insider, and Tonic (Health by Vice), among other publications.

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