Bariatric treatments for adult obesity - Institute of Health Economics

lack of formal training in nutrition, exercise, behavioural counseling, and counseling onobesity and related topics;perceived inability to change patient behavior;lack of known long-term effectiveness of bariatric treatments;negative attitudes toward obese patients;lack of recognition/acceptance of obesity as a disease;the belief that obese individuals are not interested in or ready for weight loss and bariatrictreatment and/or the belief that obesity is the responsibility of the affected individual;lack of time during patient visits; lack of knowledge about available bariatric treatment services. 1,5,8,14,18,31,48,67,79,90,145,147-150,153Most commonly cited system-level barriers include:the lack of resources to support multidisciplinary weight management programs for adultobesity within the current environment of cost containment;the lack of available teaching materials for individuals with obesity;the lack of infrastructure support/places to which to refer patients; limited insurance coverage (public and private) for weight managementinterventions. 1,31,48,79,90,145,147,150 In Canada, for example, counseling services offered bydietitians and physical-activity specialists are not considered medically necessary and are notcovered as part of provincial health plans. 31Considering the growing prevalence of obesity in Canada, it has been suggested that the majority ofindividuals with obesity should be managed by primary care providers. 8,31 Primary care physicianscan play a variety of roles, from treating individuals with obesity directly for weight loss orprevention of weight gain and providing care for obesity-related comorbidities, to referring patientsto appropriate weight management programs. 154 However, evidence suggests that obesity tends to beneglected in primary care and that many adults with obesity are not even getting lifestylemodification advice from a healthcare professional. 1,5,8,146-151,153,155 The various causes for this includethe time limitations of an office visit, attention paid to other immediate healthcare issues, lack ofreimbursement for providing treatment and additional counseling, inadequate skills and training,physicians’ skepticism about health promotion, and lack of resources for referral. Moreover,physicians may be unaware of the tools necessary to diagnose obesity. 5,146,150Management of adult obesity and ethicsEthical concerns raised by the increasing prevalence of obesity and the treatment of individuals withobesity include:the question of whose responsibility it is and of whether bariatric treatment is accuratelydescribed as therapy or as research, given its low percentage of long-term success;the need for standardized disclosure of the possibility of harm versus the low probability ofbenefit;Bariatric treatments for adult obesity 30