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Kapera O, Xie L, Marroquin E, Ngenge S, Francis J, Mathew MS, Almandoz JP, Schellinger JN, Kukreja S, Schneider BE, McAdams C, Messiah SE. Association of Social Support and Metabolic and Bariatric Surgery Completion Among Racially and Ethnically Diverse Patients. Obes Surg 2024:10.1007/s11695-024-07343-w. [PMID: 38918268 DOI: 10.1007/s11695-024-07343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Metabolic and bariatric surgery (MBS) is presently the most evidence-based, effective treatment of obesity. Nevertheless, only half of the eligible individuals who are referred for this procedure complete it. This study aims to investigate the association between social support and MBS completion, considering race and ethnicity. METHODS In this prospective cohort study, 413 participants were enrolled between 2019 and 2022. Using the 19-item Brief Family Relationship Scale, which comprises three subscales (eight-item Cohesion subscale, four-item Expressiveness subscale, and seven-item Conflict subscale), the quality of family relationship functioning was assessed. Multivariable logistic regression models were used to determine the association between MBS completion and social support status, adjusting for variables including race, ethnicity, age, gender, body mass index, and insurance. RESULTS The mean age of the sample was 47.55 years (SD 11.57), with 87% of the participants being female and 39% non-Hispanic White. Nearly 35% of participants (n = 145) completed MBS. Multivariable logistic regression analysis showed overall cohesion (adjusted odds ratio [aOR], 1.52 [95% CI, 1.15-2.00]; p = .003) and overall expressiveness (aOR, 1.58 [95% CI, 1.22-2.05]; p < .001) were associated with higher odds of pursuing MBS. There was no significant interaction between overall cohesion, expressiveness, conflict, and race/ethnicity (p = .61, p = .63, p = .25, respectively). CONCLUSION The findings indicated that there is a link between family-based social support and MBS completion, regardless of race and ethnicity. Future research should continue to explore the complex interplay between family dynamics and MBS outcomes, considering cultural variations to enhance the effectiveness of obesity interventions within diverse communities.
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Affiliation(s)
- Olivia Kapera
- UT Health School of Public Health, Center for Pediatric Population Health, 2777 N. Stemmons Freeway, Suite, Dallas, TX, 8400, USA.
- School of Public Health, University of Texas Health Science Center, Austin Campus, Austin, TX, USA.
| | - Luyu Xie
- UT Health School of Public Health, Center for Pediatric Population Health, 2777 N. Stemmons Freeway, Suite, Dallas, TX, 8400, USA
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
| | - Elisa Marroquin
- Department of Nutritional Sciences, Texas Christian University, Fort Worth, TX, USA
| | - Sophia Ngenge
- UT Health School of Public Health, Center for Pediatric Population Health, 2777 N. Stemmons Freeway, Suite, Dallas, TX, 8400, USA
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
| | - Jackson Francis
- UT Health School of Public Health, Center for Pediatric Population Health, 2777 N. Stemmons Freeway, Suite, Dallas, TX, 8400, USA
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
| | - M Sunil Mathew
- UT Health School of Public Health, Center for Pediatric Population Health, 2777 N. Stemmons Freeway, Suite, Dallas, TX, 8400, USA
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Bariatric and Foregut Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah E Messiah
- UT Health School of Public Health, Center for Pediatric Population Health, 2777 N. Stemmons Freeway, Suite, Dallas, TX, 8400, USA
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
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Xie L, Atem F, Mathew MS, Almandoz JP, Schellinger JN, Kapera O, Ngenge S, Francis J, Marroquin EM, McAdams C, Kukreja S, Schneider BE, Messiah SE. Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis. Obes Surg 2024; 34:1513-1522. [PMID: 38105283 DOI: 10.1007/s11695-023-06999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored. METHODS This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis. RESULTS A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4 years), higher patient satisfaction, and BMI (≥ 38.0 kg/m2). Hispanic participants prioritized age (< 55.4 years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3 years, BMI ≥ 35.8 kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6 years) and higher body appreciation. CONCLUSION These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS.
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Affiliation(s)
- Luyu Xie
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, Dallas, TX, USA.
| | - Folefac Atem
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- Center for Pediatric Population Health, Dallas, TX, USA
- University of Texas Health Science Center at Houston, School of Public Health, Austin, TX, USA
| | - Sophia Ngenge
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | | | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
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