Does Social Stigma Drive People To Bariatric Surgery?

As regular readers are well aware, bariatric surgery has considerable health benefits in people with severe obesity, who also have health problems (EOSS 2+).

However, it is also widely known, that health concerns alone are not the only factors that drive patients to consider surgical options.

A study by Christina Wee and colleagues from the Harvard Medical School, published in the the Journal of General Internal Medicine, suggests that a key driver of individuals opting for bariatric surgery may be related to social stigma and reduced quality of life rather than worry about their co-morbid conditions.

The study looked at data from a telephone survey of 575 patients with obesity (mean BMI 46) seeking weight loss surgery, using several standardised measures of quality of life and risk tolerance.

While highly variable, mean health utility was significantly reduced, much of which was attributable to public distress, work life and physical functioning. In fact, after adjustment for sociodemographic factors, only public distress and work life subscales on the IWQOL-lite remained significantly associated with patients’ utility. Similar findings were also apparent on the SF-36 assessment.

Overall, despair was great enough that patients were ready to accept a risk of death as high as 13% to achieve their desired health/weight state – a remarkably high number, which, if anything, clearly demonstrates the enormous burden that social and functional distress has on the respondents.

This high level of distress and willingness to accept even just a 1 in 10 chance of surviving the operation (fortunately, the actual risk of surgery is far lower), is perhaps not that surprising, given that these folks were identified based on their interest in surgery.

Thus, a random population sample of folks with a comparable BMI may well prove to be less distressed.

Nevertheless, the fact that a substantial number of people, willing to undergo and accept the risk of surgery are largely driven to this decision based on social stigma and functional distress rather than health concerns, should give pause to anyone interested in the health impact of weight-bias and discrimination.

While I fully support the use of bariatric surgery to address the many otherwise intractable health concerns of individuals with severe obesity, no one should be driven to consider surgery (no matter how low the risk) simply to appease social pressures and arbitrary social norms.

AMS
Edmonton, Alberta

Wee CC, Davis RB, Huskey KW, Jones DB, & Hamel MB (2012). Quality of Life Among Obese Patients Seeking Weight Loss Surgery: The Importance of Obesity-Related Social Stigma and Functional Status. Journal of general internal medicine PMID: 22956443