Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity

J Gen Intern Med. 2014 Jan;29(1):68-75. doi: 10.1007/s11606-013-2603-1. Epub 2013 Sep 19.


Background: Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery.

Objective: To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation.

Design, setting, and patients: Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston.

Measurements: Patients' consideration of bariatric surgery.

Results: Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited.

Limitations: Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery.

Conclusion: African Americans and men were less likely to have considered bariatric surgery and were less likely to have been recommended surgery by their doctors. Differences in how obesity affects QOL appear to account for some of these variations. High perceived risk rather than financial barrier was the major deterrent for patients.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / psychology
  • African Americans / statistics & numerical data
  • Anthropometry / methods
  • Attitude to Health / ethnology*
  • Bariatric Surgery / psychology*
  • Body Mass Index
  • Comorbidity
  • European Continental Ancestry Group / psychology
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Hispanic Americans / psychology
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Male
  • Massachusetts
  • Middle Aged
  • Obesity / ethnology*
  • Obesity / surgery*
  • Patient Acceptance of Health Care / ethnology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Physician-Patient Relations
  • Primary Health Care
  • Quality of Life
  • Sex Factors
  • Socioeconomic Factors