Perceived Barriers in the Decision for Bariatric and Metabolic Surgery: Results from a Representative Study in Germany

Narrative and obesity: Managing weight stigma associated with bariatric surgery

The present study examined how individuals who have been clinically diagnosed as obese explain their decision to undergo bariatric surgery and how they deal with the stigmatization that such a decision may entail. A total of 23 participants (15 women and 8 men) who were awaiting bariatric surgery within the Spanish healthcare system, were interviewed about their weight trajectory and their decision to undergo this surgery. In order to examine the participants' stories, a narrative analysis of the interviews was conducted, with attention to both content (what they told) and structure (how they told) and examining the stories in line with the socially and culturally available narratives that they had access to, and the context in which the stories were produced. The participants explained their weight trajectory through the origin of their weight, the failure to control it, and their decision to have surgery to solve the weight problem. The narrative of a sick body that needs to be restored appeared to function as a schema or script through which participants attempted to defend themselves from anti-fat narratives that assume personal failure while at the same time presenting themselves as deserving to be operated on. Through their narratives, they positioned themselves as undeserving of stigma but did not challenge the stigma itself.

Survey of Information Acquisition and Satisfaction after Bariatric Surgery at a Tertiary Hospital in Korea

Background

To determine how patients who underwent bariatric surgery at a tertiary hospital in Korea first considered and then decided to get the surgery and identify information gaps among patients and healthcare professionals.

Methods

This study included 21 patients who underwent bariatric surgery to treat morbid obesity (body mass index [BMI] ≥35 or ≥30 kg/m2 together with obesity-related comorbidities) between August 2020 and February 2022. A telephone interview was conducted with the patients after at least 6 months had elapsed since the surgery. We asked how the patients decided to undergo bariatric surgery. We also inquired about their satisfaction with and concerns about the surgery.

Results

Seventy-one percent of the patients were introduced to bariatric surgery following a recommendation from healthcare professionals, acquaintances, or social media. Most of the patients (52%) decided to undergo bariatric surgery based on recommendations from healthcare professionals in non-surgical departments. Satisfaction with the information provided differed among the patients. Post-surgical concerns were related to postoperative symptoms, weight regain, and psychological illness.

Conclusion

Efforts are needed to raise awareness about bariatric surgery among healthcare professionals and the public. Tailored pre- and postoperative consultation may improve quality of life after bariatric surgery.

Psychometric Properties of the WBIS/M in a Representative Prebariatric Sample: Evidence for an Improved 10-Item Version

INTRODUCTION

The Weight Bias Internalization Scale and the Modified Weight Bias Internalization Scale are well-established self-report questionnaires for assessing weight bias internalization, which is widespread among bariatric patients. However, among this group, psychometric properties of the Weight Bias Internalization Scale have only been examined in small samples showing unsatisfactory model fit and have not been explored for the modified questionnaire.

METHODS

This study psychometrically evaluated and compared the Weight Bias Internalization Scale and Modified Weight Bias Internalization Scale in a large sample of prebariatric patients (N = 825, mean age = 46.75 years, SD = 11.55) regarding item characteristics, model fit to unidimensionality, reliability, construct validity, and measurement invariance.

RESULTS

Item 4 of both questionnaires showed low corrected item-total correlations (<0.40) and was therefore removed from the scales. The new 10-item versions showed improved item characteristics, internal consistency, model fit to unidimensionality, and convergent and divergent validity when compared to the 11-item versions. The best psychometric properties were found for the 10-item version of the Modified Weight Bias Internalization Scale.

CONCLUSION

The 10-item version of the Modified Weight Bias Internalization Scale surpasses the other versions studied in all psychometric properties. Therefore, it should be used in prebariatric patients to detect weight bias internalization and provide them with psychological interventions that could improve bariatric surgery outcomes.

Depression and Anxiety as Predictors of Metabolic and Bariatric Surgery Completion Among Ethnically Diverse Patients

BACKGROUND

Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients.

METHODS

This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity.

RESULTS

The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30-0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64-19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39-6.79, p = 0.005) compared to men.

CONCLUSIONS

Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion.

Cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity: a systematic review of economic evaluations

AIM

To systematically identify and appraise the international literature on the cost-effectiveness of metabolic surgery for the treatment of comorbid type 2 diabetes (T2D) and obesity.

METHODS

A systematic search was conducted in electronic databases and grey literature sources up to 20 January 2021. Economic evaluations in a T2D population or a subpopulation with T2D were eligible for inclusion. Screening, data extraction, critical appraisal of methodological quality (Consensus Health Economic Criteria list) and assessment of transferability (International Society for Pharmacoeconomics and Outcomes Research questionnaire) were undertaken in duplicate. The incremental cost-effectiveness ratio (ICER) was the main outcome. Costs were reported in 2020 Irish Euro. Cost-effectiveness was interpreted using willingness-to-pay (WTP) thresholds of €20,000 and €45,000/quality-adjusted life year (QALY). Due to heterogeneity arising from various sources, a narrative synthesis was undertaken.

RESULTS

Thirty studies across seventeen jurisdictions met the inclusion criteria; 16 specifically in a T2D population and 14 in a subpopulation with T2D. Overall, metabolic surgery was found to be cost-effective or cost-saving. Where undertaken, the results were robust to sensitivity and scenario analyses. Of the 30 studies included, 15 were considered high quality. Identified limitations included limited long-term follow-up data and uncertainty regarding the utility associated with T2D remission.

CONCLUSION

Published high-quality studies suggest metabolic surgery is a cost-effective or cost-saving intervention. As the prevalence of obesity and obesity-related diseases increases worldwide, significant investment and careful consideration of the resource requirements needed for metabolic surgery programmes will be necessary to ensure that service provision is adequate to meet demand.