Mindset and Communication Barriers in the Diffusion of Bariatric Surgery

Cumulating evidence is available to demonstrate the efficacy of bariatric surgery (BS) in achieving weight loss and optimizing comorbidities. However, currently, only a minority of eligible patients approaches bariatric centers. The underuse of BS can no longer be explained by the lack of evidence supporting its beneficial outcomes along with its favorable safety-profile, rather, by the supporting infrastructure, insurance coverage, and mindset of society, including potential patients and allied healthcare professionals. As a framework to approach mindset barriers in the diffusion of BS, we used the Rogers' levels of the innovation adoption process: (1) knowledge, (2) persuasion, (3) decision, (4) implementation, and (5) confirmation.

Knowledge: people tend to believe that obesity is a result of lack of willpower and they have difficulties in differentiating BS from cosmetic surgery. Eligible patients often do not assess themselves as being morbidly obese and are unaware that they would qualify for BS. Persuasion: majority of BS candidates search health information online, with the aim of getting information about surgical techniques and other patients' experiences. Decision: metabolically more compromised patients are more likely to opt for BS.

general practitioners who already referred patients for BS seem to be more confident to refer again, to tackle obesity and manage postoperative follow-up. Confirmation: postbariatric patients seem to be more self-confident and more productive at work; however, their stigmatization might prevail related to the way they have achieved weight loss. Dissemination of balanced and corroborative information seems to be the main instrument to combat mindset barriers. The integration of general practitioners under the umbrella of bariatric centers has a great potential to increase referrals. Social media may represent a helpful tool to be used by medical professionals and patient-role models to improve confident decision-making of bariatric candidates.