Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

Barriers to Bariatric Surgery: A Mixed Methods Study Investigating Obstacles Between Clinic Contact and Surgery

Hlavin, Callie (2023) Barriers to Bariatric Surgery: A Mixed Methods Study Investigating Obstacles Between Clinic Contact and Surgery. Master Essay, University of Pittsburgh.

Download (636kB) | Preview


Morbid obesity has emerged as a major public health concern as rates have skyrocketed over the past few decades. Populations most affected by obesity are not reflected in the patients who seek evaluation for and undergo bariatric or weight loss surgery. This study aims to identify patient populations at risk for attrition during bariatric surgery assessment and determine modifiable barriers to combat access inequality to bariatric surgery. We conducted a single institution, retrospective, mixed methods study investigating the compositional differences between adult patients who achieved or withdrew from bariatric surgery. We collected demographic, socioeconomic, and medical data from the electronic medical record between 2012 and 2021. We then performed computer-assisted self-administered interviews of patients who withdrew from surgery, collecting information on patient knowledge, expectations, and barriers to bariatric surgery. Patients who attained bariatric surgery were more likely to be younger (mean age, 42.2 ± 11.9 vs. 43.8 ± 12.5, p<0.0001), female (82.3 vs. 76.5%, p<0.0001), White (81.2% vs. 75.6%, p=0.0002), married (48.5% vs. 44.1%, p=0.004), and employed full-time (48.2% vs. 43.8%, p=0.01). They were less likely to live in an area with a low-income tract (37.1% vs. 40.7%, p=0.01) or poverty (poverty rate 15.8 ± 15.3 vs. 17.4 ± 16.8, p=0.0002). The surgery group had lower frequency of type 2 diabetes (11.1% vs. 15.6%, p<0.0001), hypertension (29.0% vs. 33.7%, p=0.0003), and current everyday tobacco use (5.4% vs. 12.0%). We received 280 completed surveys for a response rate of 8.9%. Respondents were majority female sex (75.5%) with at least some college education (81.8%) and a household income of $50,000 or greater (61.7%). During their clinic visit, patients gained knowledge about bariatric surgery and the insurance process. Fear of complications, length of the insurance approval process, and wait time between initial evaluation and surgery were the most reported barriers. Clinic patients who undergo surgery are more likely to identify with characteristics of historically privileged communities, which do not reflect communities most affected by obesity. Our results suggest the insurance approval process is a major barrier to bariatric surgery for marginalized populations and should be a focus of future healthcare reform.


Social Networking:
Share |


Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hlavin, Calliecah267@pitt.educah2670000-0002-0825-1782
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairCourcoulas, Anitacourcoulasap@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberHershey, Tinatbh16@pitt.edutbh16UNSPECIFIED
Date: 5 January 2023
Date Type: Completion
Submission Date: 13 December 2022
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 52
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: bariatric surgery; barriers
Date Deposited: 05 Jan 2023 15:27
Last Modified: 05 Jan 2024 06:15


Monthly Views for the past 3 years

Plum Analytics

Actions (login required)

View Item View Item