Background

Metabolic and bariatric surgery (MBS) is an effective treatment for obesity, which continues to be a highly stigmatized medical condition. High reported rates of attrition after MBS may have significant impact on patient outcomes. We aimed to explore the impact of weight stigma, among other factors, on patient follow-up after MBS.

Methods

A survey assessing barriers to follow-up after MBS was distributed to patients at three centers of bariatric surgery in Los Angeles, California. Questions from the Body Acceptance subscale (BAS) of the validated Fat Attitudes Assessment Toolkit were included, where higher scores reflect more positive self-evaluations that do not focus on weight.

Results

A total of 208 patients completed the survey, 147(70.7%) were female and a majority (177[85.9%]) reported overall health improvement after MBS. Postoperatively, 96(46.2%) respondents reported not having achieved their goal weight and 92(44.2%) reported weight regain. Of these, 18/96(18.8%) and 21/92(22.8%) avoided utilizing support services due to not achieving goal weight and weight regain, respectively. These patients also scored lower on the BAS (9.2 +-3.9 vs 13.0+-3.4, p<0.001). Other barriers to post-MBS follow-up appointments, indicated by 124(59.6%) participants, included limited time/scheduling issues (19.2%), transportation/parking/distance (10.6%), and concern that the provider would judge them (4.3%). Patients who were worried that their provider would judge them scored lower on the BAS (7.8+-3.6 vs 12.7+-3.6, p<0.001).

Conclusions

Internal stigma towards weight may play a significant role in post-MBS patient attrition. Further studies are required to elucidate this complex relationship to help improve follow-up and optimize long-term outcomes.