The Reluctant Bride

Bariatric Surgery Saves Lives, So Why Do People Balk?

To folks who care for people receiving bariatric surgery, it seems like the world’s best kept secret. But it shouldn’t be. This surgery puts diabetes into remission and reduces the burden of many other diseases that result from obesity. It gives people a better quality of life. And it lets people live longer. So why do people who could benefit from bariatric surgery balk at having it?

Why do less than one percent of candidates for bariatric surgery receive it?

It’s Hard

Anyone working in this field has a long list of factors that get in the way. But the bottom line is really quite simple. It’s hard. Four decades of healthcare marketing experience tells us that people in the real world don’t bother doing stuff for their health that’s hard.

Ask people to take a pill four times a day and more than half of them won’t do it. In fact, even asking people to take more than one pill at a time causes effective use of a treatment to plummet. For example, when the first drug to treat shingles came along, it was the same drug that worked for herpes at a much lower dose. So to effectively treat shingles, doctors had to prescribe four pills instead of one. Most doctors didn’t. And even when they did, many patients balked at taking so many pills – although shingles can be terribly painful without effective treatment. But when a higher dose tablet came out, effective use soared overnight.

Bariatric surgery is hard. Not just because of all the bias about obesity and this treatment in particular. But because it’s surgery. People don’t like needles, but they’ll take a shot before they’ll go for a surgery. They’ll take a pill before they take a shot. And if you really want them to take a pill, the regimen had better be simple – impossible to screw up. Otherwise, you lose people.

If you have any doubt, look at how hard it will be to get the other half of the U.S. population to take a vaccine that could save their lives. The COVID-19 vaccine is free and yet doses are going unused.

Making It Harder

So it’s little wonder that so many people balk at bariatric surgery. Especially when you consider how health systems make it even harder. Health plans look for excuses to deny access to care. Doctors who are ignorant about its benefits ask patients if they want to do something so extreme. Friends and family too often cluck with disapproval.

Some of this is necessary. People need to go into this with eyes wide open. But they don’t need hurdles that only serve to make it harder. They need support and encouragement to make it easier to get a good clinical outcome.

Right now, bariatric surgery is the most effective treatment we have for obesity – a disease that cuts lives short and makes them unpleasant. Instead of complaining that too few people are getting the surgery they need, we would do well to put all our energy into finding sound ways to make it easier.

Click here and here for further perspective on utilization of bariatric surgery. For perspective on meeting people where they are for obesity care, click here.

The Reluctant Bride, painting by Auguste Toulmouche / WikiArt

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April 25, 2021

2 Responses to “Bariatric Surgery Saves Lives, So Why Do People Balk?”

  1. April 27, 2021 at 7:43 am, Sam said:

    I think the problem is that it is permanent and irreversible. What if you have bariatric surgery, and then a better, less invasive treatment comes along? Too late, you’ve already had your guts rearranged.

    • April 27, 2021 at 10:30 am, Ted said:

      Likewise, one might opt out of heart surgery in the hopes that less invasive treatments will come along. Good strategy if you live to see the day. But I’ve seen loved ones die from complications while they defer treatment.