Bariatric surgeons' views on barriers and enablers to bariatric surgery in Australia and New Zealand: A qualitative content analysis

Problem and aims: Bariatric surgery can be an effective treatment for severe obesity, yet publicly-funded access is often limited. Bariatric surgeons contribute to decisions regarding consumer (non)progression to bariatric surgery. Still, little is known about their views on barriers and enablers to bariatric surgery in the Australian and New Zealand context. The current study addresses this knowledge gap.

Methods: A qualitative design was utilised. Sixteen bariatric surgeons and registrars from Australia and New Zealand were interviewed about their views on barriers and enablers to bariatric surgery. The data were analysed using qualitative content analysis.

Results: Five content categories were derived from the analysis: 1. patient-related factors; 2. healthcare experiences and clinician-related factors; 3. societal beliefs and attitudes towards obesity, bariatric surgery and bariatric surgeons; 4. economic, governmental and institutional factors; and 5. bariatric surgery in the context of other treatments. A perceived lack of focus on obesity and publicly-funded bariatric surgery was apparent throughout the data in the form of descriptions of stigma, clinicians' disillusionment, patients not being guided and supported, and inadequate regulation and organisation of the field. The role of patients in determining their surgical progression was emphasised.

Conclusions: Participants discussed numerous barriers but fewer facilitators to bariatric surgery in Australia and New Zealand. Some of their opinions merit exploration with other bariatric multi-disciplinary team members and patients to understand further how the pre-operative process might be enhanced to support patients' needs and improve equity.