Walls of Cain

The Daunting Barriers to Bariatric Surgery for Teens

New data keeps documenting the safety, health, and quality of life benefits from bariatric surgery for teens who need it. But only a tiny number of the 4.5 million young people with severe obesity receive this procedure. So what are the daunting barriers that stand in the way?

A new qualitative study in SOARD offers fresh insight.

An Information Vacuum, Social Stigma, and Cost Barriers

Researchers led by Eric Campbell conducted structured interviews with young adults who had received bariatric surgery. The focus of those interviews was the barriers to the surgery that prevented them from getting it until adulthood. They used an analytical framework developed by Ronald Andersen and Pamela Davis to provide structure to their findings.

What emerged were three primary factors. First, it was hard to get good objective information. “It was never offered to me under the age of 18, I never would have known it was an option for me,” said one respondent. In fact, these young people typically learned about it from family and friends – not healthcare professionals. Furthermore, they reported that their health providers never really discussed anything related to obesity with them. For the most part, they just avoided the subject.

The next issue was stigma related to the procedure itself. The common belief is that opting for surgery is an act of desperation. A last ditch option. Even then, the perception is that it’s an easy way out. Something that should not have been necessary. Said one respondent, “I decided to keep it a secret, nobody but my mother knows how I lost the weight.”

Then finally, they encountered stalling and barriers from insurance. “To get to the point where we are ready to schedule surgery and then just not have insurance cover it. It’s kind of devastating.”

Systemic Barriers to Safe and Effective Care

This state of affairs is an embarrassment. For a young person who needs it, bariatric surgery can be life saving and life changing. A new systematic review tells us that it is generally even safer in young persons than it is in adults. The only explanation for these barriers that prevent teens from the benefits of bariatric surgery is stigma that devalues their lives and health payers who see an opportunity to avoid an expense, even though it is for a high value therapy.

This is wrong.

Click here for the new paper from Campbell et al, here for the systematic review of safety, and here for further perspective on the barriers to access.

Walls of Cain, illustration by Ivan Bilibin / WikiArt

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April 18, 2022

One Response to “The Daunting Barriers to Bariatric Surgery for Teens”

  1. April 18, 2022 at 8:14 am, Allen Browne said:

    Very interesting paper.

    One more explanation for the barriers is lack of education about obesity as a disease – education for patients, families, providers, payors, policy makers, and the public. Obesity should be treated just like any other disease.