The knowledge of Polish primary care physicians about bariatric surgery

Providers' Knowledge and Perceptions of Bariatric Surgery: a Systematic Review

Bariatric surgery remains underutilized despite its proven efficacy in the management of obesity. Provider perceptions of bariatric surgery are important to consider when discussing utilization rates. PubMed, SCOPUS, and OVID databases were searched in April 2023, and 40 published studies discussing providers' knowledge and perceptions of bariatric surgery were included. There were generally positive perceptions of the efficacy of bariatric surgery, although overestimations of surgical risks and postoperative complications were common. Providers' previous training was associated with knowledge and perceptions of bariatric surgery and familiarity with perioperative management across studies. These perceptions were also associated with referral rates, suggesting that inadequate provider knowledge may contribute to bariatric surgery underutilization. We advocate for increased bariatric surgery-related education throughout all stages of medical training and across specialties.

Ten Years of Change in Bariatric/Metabolic Surgery in the Asia-Pacific Region with COVID-19 Pandemic: IFSO-APC National Reports 2021

BACKGROUND

On November 25, 2021, the IFSO-Asia-Pacific Chapter (IFSO-APC) Virtual Meeting 2021 was held online, and the representatives from the Asia-Pacific region presented 10 years of change in bariatric/metabolic surgery and the influence of COVID-19 in the special session of "IFSO-APC National Reports 2010-2020". We herein report the summarized data.

METHODS

National bariatric/metabolic surgery data, which included the data of 2010 and 2020, were collected from the representatives using a questionnaire that consisted of 10 general questions. At the congress, the data were calculated and summarized.

RESULTS

Thirteen of the 14 national societies responded to the survey. From 2010 to recent years, the populations of individuals with obesity (BMI ≥ 30 kg/m2) and individuals with diabetes both significantly increased. Eight countries and regions expanded the lower limit of criteria for bariatric surgery by 2-5 kg/m2 (BMI), and 5 countries newly established criteria for metabolic surgery in the last ten years. Sixty-nine percent of the countries currently run public health insurance systems, which doubled from 2010. The number of bariatric surgeons and institutions increased more than threefold from 2010. In 2010, 2019, and 2020, surgeons in IFSO-APC societies performed 18,280, 66,010, and 49,553 bariatric/metabolic surgeries, respectively. Due to the COVID pandemic, restriction policies significantly reduced access to surgery in South and Southeast Asian countries. The biggest changes included increased numbers of bariatric surgeons and institutions, operation numbers, public insurance coverage, raising awareness, and national registry systems.

CONCLUSION

For the last 10 years, bariatric/metabolic surgery has rapidly grown in the Asia-Pacific region.

Factors influencing primary care provider referral for bariatric surgery: Systematic review

OBJECTIVE

To identify barriers to and facilitators of primary care provider (PCP) referral for bariatric surgery in patients with obesity.

DATA SOURCES

MEDLINE, EMBASE, and PsycINFO databases were searched and reference lists of included articles were screened to identify additional relevant articles. Two reviewers independently reviewed citations and full-text articles, and appraised the quality of the included articles using the Critical Appraisal Skills Programme Tool Qualitative Checklist and the Appraisal Tool for Cross-Sectional Studies. They extracted data on the study characteristics and the barriers to and facilitators of PCP referral for bariatric surgery. Appraisal discrepancies were resolved through consensus among authors.

STUDY SELECTION

Overall, 882 citations were identified and 18 articles were then selected for this review.

SYNTHESIS

Barriers included fear of surgery complications and side effects, cost, lack of availability, perception that surgery is a quick fix or a last resort, and prior negative experiences. Facilitators included direct requests from patients, patient motivation, previously failed weight-loss interventions, and obesity-related comorbidities. Those PCPs who were knowledgeable about the risks and benefits of bariatric surgery were more likely to refer their patients.

CONCLUSION

Education and continuing professional development programs regarding bariatric surgery are needed to improve PCP knowledge and capacity to manage patients with obesity. Also, educating the general public on obesity, weight management, and available treatment options can empower patients and families to manage their weight and pursue evidence-informed treatments.

Challenges associated with bariatric surgery - a multi-center report

Introduction

Due to the constantly growing demand for surgical treatment of obesity, it is necessary to create new bariatric centers and further improve presently active ones.

Aim

To identify which stages of conducting peri-operative care and organizing a modern bariatric center currently pose the greatest challenge.

Material and methods

An anonymous survey was designed and distributed to bariatric surgeons. Our questionnaire was divided into three parts: demographic characteristics, difficulties associated with peri-operative care for bariatric patients (assessed on a scale of 1-5) and difficulties associated with organization or running of bariatric centers in which participants are currently working (assessed on a scale of 1-5).

Results

Overall, 70 surgeons and surgical residents from 17 surgical centers participated in our survey. The most difficult element of the pre-operative care was compliance with the recommendation to cease smoking (3.47 ±1.28). The most difficult obstacle during the postoperative care period was implementation of the enhanced recovery after surgery (ERAS) protocol (2.27 ±1.31). Funding for the bariatric treatment was obtained exclusively from the National Health Fund by 60 (85.7%) respondents working in 15 different bariatric centers (88.2%). Among elements of bariatric infrastructure access to operating theater equipment sized for morbidly obese patients was reported to be the most difficult (3.8 ±1.68).

Conclusions

Pre-operative recommendations including smoking, physical activity or weight loss, as well as introducing ERAS protocol based peri-operative care, are difficult to execute in bariatric departments. Future specialized bariatric centers should be included in the centralized register and equipped with specialized infrastructure for morbidly obese patients.

Telemedical assessment of the level of energy expenditure in overweight and obese individuals

Introduction

Increasing the energy expenditure above the elementary level of metabolism by undertaking regular physical activity causes body mass reduction and its maintenance at a healthy level.

Aim

To remote assessment of the level of physical activity in a group of overweight and obese individuals.

Material and methods

The research was conducted in the Department of Rehabilitation at the Institute of Rural Health, Lublin, Poland, and included a group of 514 volunteers of both genders (38 ±12 years). The examined group was divided into three subgroups depending on the body mass index (BMI) level (I – normal, II – overweight, III – obese). The level of physical activity at home was assessed based of the short version of the International Physical Activity Questionnaire (IPAQ), conducted by means of a mobile application, and was compared with data registered by the accelerometer of a smartphone.

Results

The IPAQ-assessed level of the physical activity expressed in MET-min/week amounted to the following values: group I: 5190.38 ±6629.84, group II: 5099.53 ±6380.97, group III: 3939.31 ±4000.73; and the caloric cost (cal × week^–1) amounted to: group I: 5825.47 ±7512.99, group II: 7204.09 ±9187.96), and group III: 7002.10 ±7296.22. Registered levels of physical activity (MET-min/week) were lower than IPAQ-assessed: in group I (3741.24 ±3958.29), in group II (2447.72 ±2156.44) and in group III (1927.42 ±1790.85) (p < 0.05).

Conclusions

The average values of energy expenditure showed a declining tendency, together with an increase in the BMI. On the other hand, the total weekly caloric cost showed the lowest average values in the group with normal body mass.