Of the 750 physicians in this national sample, 78 were excluded because the mailing materials were returned as undeliverable. Of the remaining sample, 451 completed surveys were returned, resulting in an overall response rate of 67% (pediatricians 76%, family physicians 58%). Seventy of these respondents were determined to be ineligible for the study because they reported that they did not provide care for adolescents. Thus, 381 surveys remained for final analysis giving an eligible response rate of 63%. There were no significant differences between non-respondents and respondents based on demographic characteristics (gender, years since graduation, and board certification) from the AMAMasterfile.
The characteristics of eligible respondents are presented in . Pediatricians and family physicians in this sample did not differ significantly in years since graduation or percentage with board certification. However, a higher percentage of pediatricians than family physicians were female.
Regarding physicians’ perceptions about referrals for bariatric surgery, nearly one-half of physicians (48%) surveyed stated they would not ever refer an obese adolescent for bariatric surgery. Results were not significantly different by specialty (pediatricians 47% vs. family physicians 50%; p=0.53), physicians’ gender (female 45% vs. male 52%; p=0.18), history of board certification (certified 47% vs. not certified 60%; p=0.1), or years in practice (≤10 years 48%, 11–19 years 52%, and ≥20 years 49%; p=0.42).
With regard to the minimum age at which physicians believe bariatric surgery should be considered for adolescents, the mean and median age for boys and girls combined was 18 years old (). Few physicians felt that bariatric surgery should be considered for adolescents younger than 15 years. The mean minimum age varied by whether physicians indicated they themselves would vs. would not refer adolescents for bariatric surgery (16.9 vs. 19.6 years; p<0.01).
Physicians’ opinions regarding the minimum age at which bariatric surgery should be considered in boys and girls
Of note, only 17% of physicians indicated different minimum ages for boys vs. girls. In this subgroup, the average age at which physicians would consider bariatric surgery for girls was 1.5 years younger than for boys (16.3 vs. 17.8 years; p<0.01). These physicians were more likely to state that they would refer adolescents for bariatric surgery, compared to those that indicated the same minimum age for boys and girls (69% vs. 50%; p<0.01).
Among those providers who indicated a level of obesity severity at which bariatric surgery should be considered for adolescents, the most common minimum levels suggested were a BMI of 40 (45% FPs vs. 16% PDs), a BMI of 35 (25% FPs vs. 17% PDs), and a minimum BMI percentile of 95 (6% FPs vs. 16% PDs).
Almost all respondents endorsed participation in a monitored weight loss program as a prerequisite to bariatric surgery (99%). However, physicians’ preferences for the minimum duration of treatment in such weight loss programs prior to bariatric surgery varied from 3 months to over 5 years, with 96% recommending a duration between 6 and 24 months (). Overall, the mean recommended minimum treatment duration was 13.4 months. On average, pediatricians, compared to family physicians, recommended a minimum treatment duration that was 2.4 months longer (pediatricians 14.4 months vs. family physicians 12.0 months, p<0.05). Findings did not differ by physician gender, board certification, or years in practice.
Physicians’ opinions regarding the length of time adolescents should participate in a monitored weight management program prior to undergoing bariatric surgery
Beyond a monitored weight loss program, physicians were asked to state other prerequisites for surgery. The most frequent responses indicated that patients should have: passed a psychological evaluation (n=65), co-morbid conditions (n=43), demonstrated commitment/compliance with lifestyle changes (n=42), individual/family counseling (n=23), and family support (n=23).