Primary care and subspecialty management of morbid obesity: Referral patterns for bariatric surgery

Background: The global rise in morbid obesity and associated comorbid diseases concerns a wide range of specialists. Although bariatric surgery has been proven to be an effective, enduring treatment available for morbid obesity, the rates of referral for surgery are not consistent with the number of individuals affected. Methods: A survey of 478 experienced physicians from 6 specialty areas was conducted to ascertain the attitudes and practices regarding the treatment of morbidly obese patients. Results: Approximately 21% (12% family practitioners and 34% internists) of patients seen by respondents were morbidly obese. Bariatric surgery was perceived as, by far, the most effective morbid obesity treatment available (judged to be effective for 49% of patients). Medical treatments were perceived as effective for <20% of patients (15% drugs and 23% exercise). Despite the respondents' perception that most surgery recipients achieve good to excellent long-term results, only 15.4% of patients were referred for consultation with a surgeon (8.0% for cardiologists and 26.1% for bariatricians). Most physicians were not knowledgeable regarding the National Institutes of Health morbid obesity management guidelines. Few could identify a local bariatric surgeon. The volume of referrals across all 6 specialty groups was low, at an average of 6 patients annually (3 patients for cardiologists and 19 patients for bariatricians). Conclusions: The results of our study have demonstrated that primary care physicians and subspecialists see a high proportion of morbidly obese patients; however, many are unfamiliar with morbid obesity management and surgical referral guidelines. Even though the perception of surgical effectiveness was quite high, the referrals for surgery were relatively low.