Wee Christina C, Huskey Karen W, Bolcic-Jankovic Dragana, Colten Mary Ellen, Davis Roger B, Hamel Marybeth
Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA,
J Gen Intern Med. 2014 Jan;29(1):68-75. doi: 10.1007/s11606-013-2603-1. Epub 2013 Sep 19.
Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery.
To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation.
DESIGN, SETTING, AND PATIENTS: Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston.
Patients' consideration of bariatric surgery.
Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited.
Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery.
African Americans and men were less likely to have considered bariatric surgery and were less likely to have been recommended surgery by their doctors. Differences in how obesity affects QOL appear to account for some of these variations. High perceived risk rather than financial barrier was the major deterrent for patients.
减肥手术是少数几种能显著减轻体重的肥胖治疗方法之一，但只有一小部分符合医学条件的患者，尤其是男性和少数族裔，会接受减肥手术。
描述初级保健患者对减肥手术的考虑情况、性别和种族的潜在差异以及造成任何差异的因素。
设计、地点和患者：对大波士顿地区四家不同初级保健机构中337名体重指数（BMI）>35 kg/m²的患者进行电话访谈。
患者对减肥手术的考虑情况。
在325名听说过减肥手术的患者中，34%曾认真考虑过手术。在对社会人口统计学和BMI进行调整后，男性比女性、非裔美国人比白人患者考虑手术的可能性更小。合并症并不能解释性别和种族差异，但在对生活质量（QOL）进行调整后，种族差异消失了，非裔美国患者的生活质量往往高于白人患者。医生对减肥手术的推荐与认真考虑手术独立相关[比值比（OR）4.95（95%置信区间2.81-8.70）]，但并不能解释不同性别和种族在考虑手术方面的差异。然而，在调整后，如果医生推荐，男性同样愿意考虑减肥手术，非裔美国人和西班牙裔患者比各自的对照组更愿意考虑减肥手术。尽管如此，只有20%的患者报告称医生推荐他们进行减肥手术，非裔美国人和男性获得这种推荐的可能性较小；手术推荐方面的种族差异也很大程度上由生活质量差异所解释。对减肥手术的高感知风险是最常被提及的障碍；很少有人提及经济方面的担忧。
单一地理区域；研究的是考虑情况而非最终接受减肥手术的人。
非裔美国人和男性考虑减肥手术的可能性较小，且被医生推荐手术的可能性也较小。肥胖对生活质量影响的差异似乎可以解释其中一些差异。高感知风险而非经济障碍是患者的主要阻碍因素。
