More than half of obese patients opt out of the bariatric surgical procedure process

Researchers from the University Health Network in Toronto are hoping to improve the operational efficiency of bariatric surgery programs to increase access to care. Studies have shown that bariatric operations can alleviate chronic health issues like diabetes and arthritis for extremely obese people. Now the University Health Network researchers are trying to determine why many patients who are referred for a bariatric operation do not ultimately have the procedure performed, despite being in a publicly funded health care program. Findings from their single-site study are published in the November issue of the Journal of the American College of Surgeons.

For people who are severely obese, bariatric operations can provide a “treatment modality for obesity,” the study authors noted. Severe obesity means the person has a basal metabolic index (BMI) of 40 or greater. That’s about 240 lbs for a 5-foot, 5-inch person, according to the U.S. Center’s for Disease Control BMI calculator.

“We often see patients who are older in life come to us with a spectrum of co-morbidities, like diabetes and osteoarthritis, as a result of their obesity,” said Fayez Quereshy, MD, MBA, FRCSC, staff surgeon at the University Health Network in Toronto and a senior author on the study. Osteoarthritis, in particular, can make exercise-induced weight loss difficult because patients are often in too much pain to exercise,. People with a BMI of 35 or higher may also be candidates if they also have one or more chronic conditions. The person’s primary care physician may refer him or her for a bariatric surgical procedure for those reasons.

At the University Health Network’s program, patients then go through several assessments, including an orientation followed by a nursing consultation, a nutrition class and dietician assessment, and an evaluation by a social worker. They are then evaluated by a psychologist and have a final consultation with the surgeon before actually undergoing the procedure. At each of these steps in the process, clinical experts evaluate whether the patient is a candidate for the procedure.

However, many patients don’t make it through the orientation process. Dr. Quereshy and his colleagues collaborated with University of Toronto’s Rotman School of Management to identify which patients were more likely to quit the program and when.

The researchers analyzed data on 1,644 patients who were referred to the university’s bariatric surgery program between June 2008 and July 2011. Among them, only 45 percent actually became bariatric surgical patients. Among those who didn’t, 30 percent didn’t even make it to the patient orientation session, the first step after getting the physician referral.

But it’s not because patients are being turned away. “…The majority of attrition appears to be the result of patient self-removal,” the authors wrote.

Least Likely Candidates

The patients who were least likely to have the operation included: