Abstract
Background
It is estimated that 4.5 million youth in the United States have severe obesity (SO).
Metabolic and bariatric surgery (MBS) is the most effective and longitudinally durable
treatment for adolescents with SO, but only an estimated 1600 adolescents undergo
the procedure annually.
Objective
To understand patients’ perceptions and experiences with the barriers to MBS as an
adolescent.
Setting
This research was conducted at Children’s Hospital Colorado, an urban academic medical
center, and the University of Colorado Anschutz School of Medicine and Sanford Research,
a rural medical center.
Methods
We conducted 14 qualitative interviews with individuals who received MBS between the
ages of 19 and 25 years in the last 5 years regarding the barriers to MBS they experienced
as an adolescent. A formal qualitative analysis was conducted using the constant comparative
techniques of grounded theory generally guided by Anderson’s behavioral model of health
service use.
Results
We identified 3 principal groups of barriers related to (1) a lack of information
that MBS was an option and the absence of discussions about MBS with medical providers
while an adolescent, (2) a lack of access to MBS primarily related to insurance coverage,
costs, and family-related issues, and (3) a general stigma around MBS as a treatment
for obesity.
Conclusion
This study suggests that the primary barriers to MBS for adolescents with SO are related
to a general lack of information about MBS, social stigma, and access issues related
to costs that decrease or limit access.
Key words
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References
- Section on Obesity, Section on Surgery. Pediatric metabolic and bariatric surgery: evidence, barriers, and best practices.Pediatrics. 2019; 144e20193223
- Pediatric severe obesity: time to establish serious treatments for a serious disease.Child Obes Print. 2014; 10: 283-284
- Body mass index in adolescence and cardiovascular death in adulthood.N Engl J Med. 2016; 375: 1300-1301
- Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association.Circulation. 2013; 128: 1689-1712
- Obesity stigma and bias.J Nurse Pract. 2016; 12: 425-432
- Short- and long-term safety and efficacy of bariatric surgery for severely obese adolescents: a narrative review.Pediatr Res. 2020; 87: 202-209
- Should bariatric surgery be performed in adolescents?.Eur J Endocrinol. 2017; 176: D1-D15
- The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study.Pediatrics. 2005; 115: 22-27
- Long-term outcomes of bariatric surgery in adolescents with severe obesity (FABS-5+): a prospective follow-up analysis.Lancet Diabetes Endocrinol. 2017; 5: 165-173
- Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and meta-analysis.PLoS Med. 2020; 17e1003206
- Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality.JAMA Surg. 2016; 151: 631-637
- ASMBS pediatric metabolic and bariatric surgery guidelines, 2018.Surg Obes Relat Dis. 2018; 14: 882-901
- American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016.Surg Obes Relat Dis. 2018; 14: 259-263
- Referral and utilization of paediatric bariatric surgery in an academic freestanding children’s hospital with dedicated paediatric bariatric programme.Pediatr Obes. 2021; 16e12830
- Bariatric surgery barriers: a review using Andersen’s model of health services use.Surg Obes Relat Dis. 2018; 14: 404-412
- Mindset and communication barriers in the diffusion of bariatric surgery.Curr Atheroscler Rep. 2018; 20: 38
- Hurdles to take for adequate treatment of morbidly obese children and adolescents: attitudes of general practitioners towards conservative and surgical treatment of paediatric morbid obesity.World J Surg. 2019; 43: 1173-1181
- Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation.Surg Obes Relat Dis. 2021; 17: 425-433
- Bariatric surgery for obese children and adolescents: a review of the moral challenges.BMC Med Ethics. 2013; 14: 18
- Basics of qualitative research: techniques and procedures for developing grounded theory.SAGE Publications, Thousand Oaks, CA1998
- Improving access to care in America: individual and contextual indicators.in: Changing the U.S. health care system: key issues in health services policy and management. 3rd ed. Jossey-Bass, San Francisco, CA2007: 3-31
- Best practice updates for pediatric/adolescent weight loss surgery.Obesity. 2009; 17: 901-910
- Adolescent bariatric surgery: a qualitative exploratory study of US patient perspectives.Clin Obes. 2018; 8: 345-354
- Obesity stigma: important considerations for public health.Am J Public Health. 2010; 100: 1019-1028
- Barriers to accessing weight-loss interventions for patients with class II or III obesity in primary care: a qualitative study.CMAJ Open. 2019; 7: e738-e744
- Insurance coverage criteria for bariatric surgery: a survey of policies.Obes Surg. 2020; 30: 707-713
- Access to care for adolescents seeking weight loss surgery.Obesity. 2014; 22: 2593-2597
- Outcomes of adolescents compared with young adults after bariatric surgery: an analysis of 227,671 patients using the MBSAQIP data registry.Surg Obes Relat Dis. 2020; 16: 1463-1473
- How adolescents decide on bariatric surgery: an interpretative phenomenological analysis.Clin Obes. 2018; 8: 114-121
Article Info
Publication History
Published online: March 22, 2022
Accepted:
March 13,
2022
Received:
December 16,
2021
Identification
Copyright
© 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
