J. Murtha5, E. Alagoz2, C. Breuer2, A. Finn6, S. D. Raffa3,4, C. Voils1,2, L. M. Funk1,2 1William S. Middleton VA Memorial Hospital,Madison, WI, USA 2University Of Wisconsin,Department Of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR),Madison, WI, USA 3National Center for Health Promotion and Disease Prevention,Department Of Veterans Affairs,Durham, NC, USA 4Duke University Medical Center,Department Of Psychiatry And Behavioral Sciences,Durham, NC, USA 5University Of Wisconsin,Department Of Surgery,Madison, WI, USA 6University Of Wisconsin,School Of Medicine,Madison, WI, USA
Introduction: Bariatric surgery is the most effective weight loss treatment for individuals with severe obesity but <1% of U.S. adults and <0.1% of U.S. Veterans who meet BMI criteria undergo it. We previously characterized 8 barriers to bariatric surgery care at the health system level. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery within the Veterans Health Administration (VHA) from the perspectives of Veterans with severe obesity, primary care providers (PCPs), registered dietitians (RDs), health psychologists and bariatric surgeons.
Methods: We conducted semi-structured interviews with Veterans with severe obesity and providers, including PCPs, RDs, health psychologists and bariatric surgeons. Veterans were from two Midwest VA medical centers (VAMCs) and had either been referred for bariatric surgery or were participating in the VHA’s behavioral weight management program (MOVE!). PCPs, RDs and health psychologists were recruited from three VAMCs in the Midwest region, and bariatric surgeons were recruited from all 21 VA bariatric surgery programs. Participants were asked to describe their experiences with obesity care treatment within VHA. Interviews were audio recorded and transcribed. Four coders developed a codebook, which was applied to all interviews. Conventional content analysis identified individual-level barriers within Anderson’s Behavioral Model of Health Services Use, which has two general determinants: individual and contextual (e.g. systems). This analysis focused on the individual determinants, which describe how service utilization is influenced by an individual’s need, health behaviors, and predisposing beliefs or social structure.
Results: Thirty-three veterans and 40 providers (15 PCPs, 13 bariatric surgeons, 6 RDs and 6 health psychologists) were interviewed. Nearly three-fourths of Veterans were male, whereas nearly three-fourths of providers were female. We identified six individual-level barriers to undergoing bariatric surgery (Figure 1): lack of social support, fear of surgery and its potential outcomes, fear of change, difficulty adhering to required dietary changes, the perception that weight had not reached its “tipping point,” and patient characteristics influencing provider referral.
Conclusion: Veterans and providers reported that fears of surgery and concerns regarding adherence to required behavioral and dietary changes were barriers to bariatric surgery. Patient and provider education is needed to address patient fears of surgery and the belief that surgery is a “last resort.” Furthermore, patients must be empowered to change their personal health practices.
