IFB survey shows: knowledge gaps and prejudices of physicians have an influence on the therapy of obesity

The more practitioners and internists know about obesity surgery, the more they refer severely overweight patients to respective clinics and hospitals. Currently only 17.8 percent of 201 physicians do this. They were interviewed in a Germany-wide study of the IFB AdiposityDiseases.

adipöse Patientin bei Hausarzt
Certified doctors rarely recommend bariatric surgery rather. (Photo: iStock/jamirae)

Recently the results were published in the scientific magazine “Obesity Surgery”. One third of the respondents perceive it as “too easy” if obese people lose weight through obesity or bariatric surgery. 58 percent are convinced that a lack of willpower causes overweight. Although 56 percent believe that an operation is a useful method for weight reduction, only 48 percent of the surveyed physicians recommend bariatric surgery sometimes, and 34 percent rarely or not at all. Just about 18 percent refer their patients to a surgeon. This last group of physicians has the largest knowledge about obesity surgery. The more physicians believe that adiposity is a self-inflicted illness, the less likely is their recommendation of bariatric surgery or their referral.

This behavior of physicians, based on personal knowledge and attitude, does not concur in the treatment guidelines for morbid obesity. According to these guidelines, for a patient with a Body-Mass-Index (BMI) above 40, who was not able to lose weight in conservative therapy, bariatric surgery can be indicated.  If a patient already suffers from sequelae, like diabetes or cardiovascular diseases, an operation can be considered at a BMI of 35.

In bariatric surgery the size of the stomach and the length of the digestive bowel system are reduced. For the patient this means a comprehensive preparation and postoperative care, as well as a lifelong change of diet. Until now health insurers decide in every individual case if the costs for the procedure will be covered. In the IFB adiposity outpatient clinic are many patients who tried different diets and therapies over many years to lose weight - without being successful in the long run. For them obesity surgery often is the last chance to alleviate the obesity as well as the secondary diseases.

Although bariatric surgery presently is the most successful treatment for morbid obesity there few surgical interventions in Germany compared to other European countries. In Sweden, with a population of approximately 9.6 billion there were 7437 operations in 2013, while in Austria with about 8.47 billion inhabitants 2354 bariatric interventions were carried out. In Germany, with a population of 80.6 billion, only 7126 surgeries were performed*. Psychologist Franziska Jung led the study and says, that “physicians in Germany need more knowledge concerning the diverse causes for adiposity and the different treatments. This is the only way to reduce the prevailing negative and stigmatizing attitude.”

In cooperation with the Institute of Social Medicine, Occupational and Public Health (ISAP) at the University of Leipzig Dr. Claudia Luck-Sikorski and her team of scientists carried out different studies concerning the stigmatizing behavior and attitude of the general population as well as medical professionals towards obese people. “It is disillusioning that patients with adiposity are also stigmatized by health care professionals. The latest study with practicioners shows for the first time, how these prejudices affect the medical care”, emphasizes Luck-Sikorski.

To promote a better understanding of adipose patients and a more adequate assessment of their need for treatment, the scientist and her team realized the manual “5A Adiposity Management” for certified doctors. (The brochure is in German and can be found as a download on this website.)

Scientific Publication:
Franziska U.C.E. Jung, Claudia Luck-Sikorski, Hans-Helmut König, Steffi G. Riedel Heller: Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists, Obesity Surgery, 17 Feb. 2016
doi: 10.1007/s11695-016-2104-5

* The numbers of bariatric interventions of different European countries in 2013 can be found in: L. Angrisani, et al. Bariatric Surgery Worldwide. Obesity Surgery (2015), Vol. 25, Issue 10, pp 1822-1832

Doris Gabel