From the Desk of the President

Published in February Issue             

FEAR FACTOR: Our Patients Fear Bariatric Surgery
More than Obesity!

Despite the scientific evidence and the millions of patients who have benefitted from bariatric surgery over the years, outsized fears and anxieties exist today among many patients, and even some doctors, about the “dangers,” “lack of effectiveness” and “extreme risks” of what some still call a “drastic procedure” that should only be considered a “last resort.”

Do not underestimate the fear factor in healthcare decision-making. It could mean the difference between action and paralysis, and in some cases, between life and death. When it comes to obesity, we know there are consequences to doing nothing, yet the fear of doing nothing takes a back seat to doing something, particularly when it comes to
bariatric surgery.

The fears around weight-loss surgery include the fear of complications and death, the fear of failure and weight regain, and even the fear of change itself. These are not irrational fears. They are very real, and many patients who would otherwise live healthier and longer lives, are staying away in droves as a result. How do we help our patients overcome these fears?

It’s not easy. Fear may be one of the greatest barriers to bariatric surgery, even more so than lack of insurance coverage and limited patient access. Yet, while many bariatric operations have stood the test of time and proven themselves to be among the safest and most effective treatments for severe obesity, fear continues to trump science.

In 2014, research from the Cleveland Clinic Bariatric and Metabolic Institute showed laparoscopic gastric bypass surgery in patients with type 2 diabetes carries a complication and mortality rate comparable to some of the safest and most commonly performed surgeries in America, including gallbladder surgery, appendectomy, and total
knee replacement.

In the study, the 30-day complication rate associated with metabolic surgery, specifically gastric bypass, was 3.4 percent, about the same as gallbladder surgery and hysterectomy. Hospital stays and readmission rates were similar to laparoscopic appendectomy. The month-long mortality rate for metabolic or diabetes surgery was 0.30 percent, about that of total knee replacement, and about one-tenth the risk of death after cardiovascular surgery. Yet I have a feeling the fear of dying after bariatric surgery is far greater than that of total knee replacement!

But what may seem obvious to surgeons, scientists and other medical professionals is not, to those who in many cases, have fought and lost their lifelong struggle with obesity. Thousands of success stories about bariatric surgery may have less of an impact on a patient or even a referring doctor, who knew or knows someone who has had difficulties with the operation or “read something somewhere” that someone had problems or even died after surgery. Risks do exist and bariatric surgery is a serious operation. But unexplained risks or risks without context are a lot scarier than risks explained and fears addressed.

It is important that bariatric teams explore the baseline knowledge and experiences of their patients considering bariatric surgery. Patients may have formed views based on faulty information or atypical occurrences with friends, family or coworkers. Our job is not to downplay the risks or ignore the emotional and anecdotal aspects of decision making, but rather to address them in a real and individualized and evidence-based fashion.

Help take out some of the uncertainty by providing patients with details about what happens before, during and after surgery. Provide data on the risks and benefits and likely outcomes, while also providing an individualized assessment. But go beyond the clinical. Explore and understand the patient’s fears and anxieties and what led to them. Listen carefully, address misinformation where you can, offer discussion opportunities with other patients or counselors, and help patients recognize that fear and anxiety alone, should not guide their decisions.

Bariatric surgery is performed on less than 1 percent of the eligible population. Fear is definitely a factor for this low utilization rate. Let’s try to replace that fear with facts, understanding and support, and address the emotional side of choosing to have bariatric surgery as well as we address the clinical side. It could just make the difference.