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The 3 most important considerations for patients deciding on bariatric surgery

June 27, 2019

    Latent demand in weight-loss surgery as a treatment for obesity exists in many markets, but obesity prevalence is not a driving factor of bariatric surgery utilization. According to a recent study by the American Society for Metabolic & Bariatric Surgery, the states with the highest prevalence of obesity are also the states with poorly performing state economies—and also have low rates of weight-loss surgery per capita, as most of them do not list surgery as an essential health benefit (EHB) under the Affordable Care Act, which means payers are not required to cover the surgeries.

    99% of eligible patients don't get bariatric surgery—here's what you can do about it

    See how your state compares in the obesity crisis, here.

    To grow bariatric surgery volumes and capture latent demand, providers need to appeal to patients' interests. Specifically, a recent JAMA Surgery study found that surgery candidates value three factors above all others when deciding on bariatric surgery: total weight loss, resolving medical conditions, and cost .

    1. Total weight loss

    According to the study, the majority of surveyed candidates said they would like to receive gastric bypass surgery because it usually results in the most weight loss. In reality, however, the sleeve gastrectomy, which results in slightly less weight loss than bypass, is the most commonly performed bariatric surgery—likely because the sleeve may result in fewer long-term complications than bypass.

    This discrepancy in what patients say they want and what they do isn't surprising, given that surveyed candidates also said adverse effects were another important factor in deciding on bariatric surgery. Based on the study findings, physicians should consider using a hierarchy of procedure characteristics with their patients to help them select their preferred weight-loss option.

    2. Resolving medical conditions

    As many bariatric surgery candidates usually have other medical conditions, they can benefit from learning what conditions, beyond weight loss, bariatric surgery  can resolve—and this information may help encourage them to opt for the procedure. Beyond patient education, providers should also understand not just the medical conditions of each patient, but also what the patient wants from his or her weight-loss journey in order to better help him or her choose the surgery that will be the best fit.

    3. Out-of-pocket cost

    Patients care about out-of-pocket costs of surgery, but many providers aren't well trained on how to discuss costs of procedures with patients. This leads to a gap in the conversation providers should be having with patients ahead of bariatric surgery. Open conversations about cost, especially patients and providers in states where bariatric surgery isn't listed as an EHB, is important in a patient's education on surgery.. If patients in your market are price sensitive, consider offering financial counseling, payment plans, and even price bundles so they know upfront the cost of their care episode.

    Considering only 1% of eligible patients actually receive surgery, working with local PCPs to educate patients on the benefits of bariatric surgery can help capture latent demand for these services. As obesity and access barriers to treatment persist, this education on the benefits of surgery as a treatment option will be imperative in improving the overall health of whole communities, regardless of a patient's ZIP code.


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