title: Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.
abstract: BACKGROUND
  Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization.
  
  
  OBJECTIVE
  To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral.
  
  
  METHODS
  Focus groups with PCPs practicing in small, medium, and large cities in Wisconsin.
  
  
  METHODS
  PCPs were asked to discuss prioritization of treatment for a severely obese patient with multiple co-morbidities and considerations regarding bariatric surgery referral. Focus group sessions were analyzed by using a directed approach to content analysis. A taxonomy of consensus codes was developed. Code summaries were created and representative quotes identified.
  
  
  RESULTS
  Sixteen PCPs participated in 3 focus groups. Four treatment prioritization approaches were identified: (1) treat the disease that is easiest to address; (2) treat the disease that is perceived as the most dangerous; (3) let the patient set the agenda; and (4) address obesity first because it is the common denominator underlying other co-morbid conditions. Only the latter approach placed emphasis on obesity treatment. Five factors made PCPs hesitate to refer patients for bariatric surgery: (1) wanting to "do no harm"; (2) questioning the long-term effectiveness of bariatric surgery; (3) limited knowledge about bariatric surgery; (4) not wanting to recommend bariatric surgery too early; and (5) not knowing if insurance would cover bariatric surgery.
  
  
  CONCLUSIONS
  Decision making by PCPs for severely obese patients seems to underprioritize obesity treatment and overestimate bariatric surgery risks. This could be addressed with PCP education and improvements in communication between PCPs and bariatric surgeons.
authors.affiliation: Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin. Electronic address: funk@surgery.wisc.edu.
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.affiliation: Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin; William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Jolles
authors.affiliation: Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Caprice C
authors.initials: CC
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Schwarze
authors.affiliation: William S. Middleton Veterans Memorial Hospital, Madison, Wisconsin; Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.affiliation: Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina; Durham VA Medical Center, Health Services Research & Development, Durham, North Carolina.
authors.forename: Megan A
authors.initials: MA
authors.lastname: McVay
authors.affiliation: Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Whittle
authors.affiliation: Durham VA Medical Center, Health Services Research & Development, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: Durham VA Medical Center, Health Services Research & Development, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
mesh_terms: D001291:Attitude of Health Personnel; D050110:Bariatric Surgery; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010342:Patient Acceptance of Health Care; D010347:Patient Care Planning; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000592:standards; D014481:United States
keywords: Bariatric surgery; Obesity treatment attitudes; Primary care physicians