Socioecological factors associated with ethnic disparities in metabolic and bariatric surgery utilization: a qualitative study.

backgroundMetabolic and bariatric surgery (MBS) is a safe and effective treatment choice for severe obesity. Yet only approximately 50% of those referred to MBS complete the procedure. Studies show that racial minority groups are less likely than non-Hispanic whites to complete MBS despite having higher rates of severe obesity and co-morbidities.

objectivesTo conduct a qualitative study to determine facilitators and challenges to racially diverse patients completing MBS based on the 4 socioecological model domains (intrapersonal, interpersonal, organization/clinical interaction, and societal/environmental).

settingOne university-based surgery practice serving a racially diverse patient population.

methodsFocus groups and in-depth interviews were conducted (Spring 2019) among patients (n = 24, 70% female, 50% non-Hispanic black, 4% Hispanic) who completed MBS over the past year. Social support members were also included (n = 7). Grand tour questions were organized by the 4 socioecological model domains and within the context of MBS completion. Data were audio-recorded, transcribed, and coded. A thematic analysis combining a deductive and inductive approach was conducted. Codes were analyzed using Dedoose to identify themes/subthemes.

resultsTen themes and 15 subthemes were identified. Key intra- and interpersonal facilitators to MBS completion included social support systems, primary care physician support of MBS, co-morbidity resolution, discrimination experiences, and mobility improvements. Key community and environment themes associated with post-MBS sustained weight loss included community support groups and access to healthy foods and exercise facilities. No themes or subthemes varied by race.

conclusionsEducating primary care physicians and social support networks about the benefits of MBS could improve utilization rates. MBS patients have a desire to have their communities provide resources to support their postoperative success.