Background:
General Practitioners are increasingly managing patients with class 2 and 3 obesity (BMI > 35kg/m2 and 40 kg/m2 respectively). GPs facilitate access to surgery through referral processes, but the nature of GP involvement in bariatric pre and post-surgery care is currently unclear.
Methods:
This qualitative study involved 10 in-depth interviews with general practitioners (GPs) and 20 interviews with adults who had all undergone laparoscopic adjustable gastric banding (LAGB) for weight management in Tasmania. Interviews were analysed thematically
Findings:
GPs and patients found discussing weight difficult in the absence of related health conditions. For many patients, the functional and social impacts of their weight were their greatest concern. Patients and GPs identified long-term weight loss as the greatest challenge. For patients, seeking a surgical weight loss intervention was driven by their restricted physical capacity as well as an inability to sustain long-term weight loss using lifestyle interventions. For GPs, referral patterns were influenced by previous case experience, accessibility of surgery and patients’ financial considerations. Referrals for bariatric surgery commonly occurred at the patient’s request or to manage co-morbidity. Post-surgery, there was a lack of clarity around the role of GPs with patients generally preferring the surgical team to manage the LAGB.
Conclusion:
Assessing and monitoring physical and social functioning in patients with severe obesity may enhance discussions and facilitate decision making about long-term weight management. Patient preference for surgery, access and comorbidity are key drivers for referral and post-surgical monitoring and support. Greater role clarity and enhanced collaboration between surgeons, GPs and patients following surgery is likely to enhance the experience and outcomes for patients.