Serious, Thoughtful, and Rare Conversations About Obesity

How rare is it to have serious and thoughtful conversations with primary care providers about obesity? Here’s a clue that it’s rare. Less than one in ten patients who might benefit from bariatric surgery discuss it with their doctor. Yet when this happens, things get better. Not everyone who discusses the surgery goes on to have it. Three fourths of them don’t. But regardless, just having the conversation predicts better odds for an improved weight status.

So the truism holds up. Dealing with a problem is easier if you can talk about.

A Cohort of 30,560 Patients

A new study in Obesity of patient records of a large integrated healthcare network in Massachusetts provides this insight. It included 30,560 patients with a BMI of 35 or more receiving care between 2000 and 2015. Through natural language processing, Lee-Shing Chang and colleagues analyzed electronic provider notes to find any mention of bariatric surgery. Over all those years, only 8.7 percent of these patients ever had serious conversations about surgery for obesity with their provider.

Of course, this is just one cohort in one part of the U.S. But it might well be a best case scenario. A great deal of variation in the rates of bariatric surgery can be found in different regions. A recent study presented at the ASMBS annual meeting tells us that the Northeast has the highest utilization of bariatric surgery compared to all other regions in the U.S.

Roughly a fourth (24.4%) of the patients who had this conversation went on to have surgery. Only two percent of the rest of these patients did. Nonetheless, patients who had this conversation had better weight outcomes over time. In a multivariate analysis, Chang et al found that the conversation predicted 43 percent improvement in BMI. Overall, the people who discussed surgery saw an average reduction in BMI of 2.18. Those who did not have the conversation had an average improvement of 0.21.

Like Finding “A Life Raft”

In an NPR interview, Kayla Northam said that finding a physician who would talk to her about bariatric surgery was a turning point. Describing her conversation with Fatima Cody Stanford, an obesity medicine physician, she said:

“I jumped onto her like a life raft; I had so much hope after meeting with her.”

So these serious and thoughtful conversations about obesity can indeed be the spark for a lot of progress. The only problem is that they are far too rare.

Click here for the study by Chang et al and here for further perspective. For more about getting these conversations started, click here and here.

Conversation, painting by Vanessa Bell / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


June 22, 2021