The Role of Weight Bias and Patient-Physician Communication in the Underutilization of Bariatric Surgery

A growing body of evidence supports the efficacy and safety of bariatric surgery for clinically severe obesity. Despite this empirical support, bariatric surgery remains profoundly underutilized. The reasons for underutilization are likely multifactorial, including health insurance coverage and benefits design, lack of awareness about bariatric surgery by patients, and anecdotal concerns about safety. We believe there are two other factors – the occurrence of weight stigma and bias as well as suboptimal communication between patients and providers – which also serve as barriers to greater utilization. The paper reviews the existing literature related to these two factors. The paper also highlights the science of shared medical decision making (SDM) as a potential strategy to promote appropriate conversation between patients and providers, both surgical and non-surgical, about the efficacy and safety of bariatric surgery. SDM is used in other areas where complex medical decisions are required. We believe it has great potential to contribute to the increased utilization for the millions of individuals who could benefit from bariatric surgery.