According to current estimates, approximately 41.9% of adults in the United States have obesity, and future projections suggest that one-half of adults will be classified as obese by 2030. Importantly, racial and ethnic disparities continue to be prevalent in the obesity epidemic. Based on 2020 data, 45.6% of Hispanic/Latinx adults and 49.9% of non-Hispanic Black adults in the US had obesity.
“Metabolic and bariatric surgery (MBS) is an effective and safe treatment for obesity and its related comorbidities, but less than one-half of those who are eligible and referred for MBS actually complete the procedure,” says Luyu Xie, PharmD, PhD. Prior research has shown that 57.8% of non-Hispanic Whites complete MBS, but this rate drops to 17.3% for non-Hispanic Blacks and 9.4% for Hispanics. “The rationale for not completing MBS has not been well studied in an ethnically diverse patient population,” Dr. Xie says.
Assessing the Role of the Patient–Physician Relationship
Previous studies have suggested that the patient–physician relationship can influence patients’ decisions on seeking healthcare. For a study published in JAMA Network Open, Dr. Xie, Sarah E. Messiah, PhD, MPH, FTOS, and colleagues examined associations between the patient–physician relationship and the decision to complete MBS among a racially and ethnically diverse group of patients. “We hypothesized that higher patient satisfaction with the patient–physician relationship would increase the likelihood of completing MBS,” says Dr. Messiah.
For the Bariatric Health Study, the study team included 408 patients who were referred to a bariatric surgeon or obesity medicine program, 363 of whom had data available on race and ethnicity. Using the Patient Satisfaction Questionnaire Short Form (PSQ-18), they evaluated patient satisfaction with their physician by measuring seven dimensions: general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with physician, and accessibility and convenience. Of note, a total of 124 patients in the analysis (30.4%) completed MBS.
Better Satisfaction Raises Likelihood of MBS Completion
“The most important finding from our study was that MBS candidates with better patient satisfaction were more likely to complete MBS, regardless of racial and ethnic identity,” says Dr. Xie. Overall, mean patient satisfaction scores using the PSQ-18 were significantly greater for MBS completers than for those who did not complete the surgery (3.86 vs 3.61, respectively). A multivariable logistic regression analysis showed that technical quality was the most significant factor for MBS completion, followed by communication, accessibility, and convenience.
The study group also performed an interaction analysis to further assess race and ethnicity as a potential moderating factor (Figure). Among MBS completers, the mean PSQ-18 score was 3.95 among Hispanic/Latinx patients, 3.94 for non-Hispanic Black patients, 3.77 among non-Hispanic White patients, and 3.74 for patients of other races or ethnic groups. Among non-completers, satisfaction was lower for each patient group, with PSQ-18 scores of 3.49 for Hispanic/Latinx patients, 3.68 among non-Hispanic Black patients, 3.65 for non-Hispanic White patients, and 3.17 among patients of other races or ethnicity.
Efforts Needed to Improve MBS Completion
“Our findings have important implications for strategies to improve the proportion of qualified patients who complete MBS to achieve better health outcomes,” says Dr. Xie. “The fact that technical quality was one of the most significant factors for MBS completion indicates that more efforts may be needed to build trust with patients. The foundation of a good patient–physician relationship relies on the ability of physicians to gain trust. It may be necessary to train physicians on how to build trust with patients from different ethnic backgrounds to improve healthcare outcomes among diverse populations.”
Other targeted strategies may further increase the number of eligible patients completing MBS, including improvements in communication, accessibility, and convenience. “The Bariatric Health Study is an ongoing analysis that has collected rich data to identify various socioecological characteristics that may be associated with patient-directed completion or noncompletion of MBS,” Dr. Xie says. “Our next step will be to comprehensively examine those aspects and find the most decisive factors for MBS completion among an ethnically diverse patient population.”
