Conversations about Bariatric Surgery May Lead to Weight Loss, Even Without the Surgery

A new study found that patients with severe obesity who had even one discussion about bariatric surgery with a clinician were more likely to lose weight but that the discussions are infrequent.

Patients with obesity who discuss the option of bariatric surgery with a physician are more likely to lose weight, whether or not they undergo a bariatric procedure, according to new research from the Brigham and Women's Hospital and published online June 10, 2021, in the journal Obesity.

The study also revealed, however, that less than 10% of patients eligible for weight loss surgery had a conversation on the topic with their physician over the course of a year--an unfortunate finding given that patients with obesity are more likely to elect the surgery based on discussions with a primary care provider or a specialist from disciplines ranging from cardiology to urology and to lose more weight than those who do not have such discussions, according to a hospital statement.

To better understand the correlation between the frequency of discussions between patients and clinicians about weight loss surgery and subsequent weight loss and receipt of the surgery, investigators, led by Alexander Turchin, MD, MS, director of quality in diabetes in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women's tapped the Mass General Brigham healthcare network.

The researchers conducted a retrospective cohort study using data on adults with class 2 to 3 obesity treated in clinical practices associated with Mass General Brigham who received care between January 2000 and December 2015.

Patients fulfilling all the following criteria were eligible for study inclusion: age 18 to 65 years; BMI ≥35 and <60 kg/m2 on two consecutive visits; no prior bariatric surgery; and with follow up data for at least 24 months during the study.

READ MORE: Bariatric Surgery: Clinician and Patient Barriers to the First Conversation

The lower BMI cutoff, wrote Turchin et al, was chosen because many of these patients have comorbidities that make them eligible for bariatric surgery. The upper cut offs for age (65 years) and for BMI (<60) were set because patients in these populations frequently are not considered candidates for bariatric surgery.

Search of the Mass General Brigham database yielded 37 220 adults with class 2-3 obesity who had been followed for 24 months during the study period. After excluding those with insufficient data and those who had undergone bariatric surgery within 30 days of study entry, the final cohort for analysis numbered 30 560.

Median patient age was 45.0 years and 64.7% were women. Baseline median BMI was 37.3 and 71.6% of patients had a BMI of 35-40. In terms of comorbidities authors found 41.3% had a history of hypertension, and 16.9% a history of diabetes; 23.6% had a history of smoking.

To obtain information on frequency of discussion of bariatric surgery between clinician and patient, investigators used artificial intelligence to analyze 692 057 notes from clinic visits in which the conversation may have taken place.

Results

The investigators report that of the study’s 30 560 patients, only 8.7% (2659) discussed bariatric surgery with a clinician during the first year after study entry. Of that group, 4.8% (1462) had one discussion and 3.9% (1197) had at least 2 discussions. Patients who did have a conversation with a clinician about weight loss surgery were more likely to be younger, women, non-white, and have a higher baseline BMI compared to those who did not have a discussion.

READ MORE: Why Not Talk About Bariatric Surgery: What makes patients and healthcare professionals

Analysis of the nearly the 700 000 notes from clinical visits found that only 1.5% (10 347) documented discussion of bariatric surgery. Endocrinologists were the most likely specialists to have the discussion (3.47%), followed by cardiologists (2.72%), and obstetrician/gynecologists (2.28%).

While the greatest number of notes analyzed by far were from primary care visits (~550 000) only 1.36% of those notes (7463) revealed a discussion of bariatric surgery.

Correlation with BMI, surgery

Univariate analysis demonstrated a mean decrease in BMI of 2.18 among patients who had at least 1 conversation about bariatric surgery with a physician compared with a decrease in BMI of 0.21 in those who did not have one (p<.001). The authors also found that decrease in BMI was larger among those who had more frequent discussions.

Within 2 years of study entry, 4.1% (1257) of all study patients underwent bariatric surgery. Univariate analysis found that 24.4% of patients who discussed the surgery with a physician opted to have the procedure compared with 2.2% who never discussed it (p<.001) and, patients who had multiple discussions were more likely than those who had only one to complete the surgery. In multivariate analysis patients who discussed it had greater odds of undergoing the surgery (odds ratio, 10.2 [95% CI: 9.0-11.6; p < 0.001]).

"Even without surgery, such discussions emphasize the seriousness of obesity and may prompt patients to explore ways to lose weight," said Turchin. "It's important for clinicians to initiate these discussions but also support them when patients bring them up themselves."


Reference: Chang L-S, Malmasi S, Hosomura N, et al. Patient-provider discussions of bariatric surgery and subsequent weight changes and receipt of bariatric surgery. Obesity. Published online 10 June 2021