Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study

Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. Adults with severe obesity and obesity care providers described their experiences with the bariatric surgery care process in semi-structured interviews. Using conventional content analysis, individual-level barriers were identified within Andersen's Behavioral Model of Health Services Use. Of the 73 individuals interviewed, 36 (49%) were female, and 15 (21%) were non-white. Six individual-level barriers were identified: fear of surgery, fear of lifestyle change, perception that weight had not reached its “tipping point,” concerns about dietary changes, lack of social support, and patient characteristics influencing referral. Patient and provider education should address patient fears of surgery and the belief that surgery is a “last resort.” Bariatric surgery programs should strengthen social support networks for patients. •Patients and providers identified 6 individual-level barriers to bariatric surgery.•Surgery was feared and felt to be an extreme measure to address obesity.•Patients feared change and committing to a new diet for rest of life.•Fear of judgement & unstable support networks influenced decision to pursue surgery.•Education and longitudinal support are needed to address the barriers.