Attitudes of primary care physicians toward bariatric surgery: a free word association networks analysis

Background: Primary care physicians (PCPs) hold major responsibility in referring patients with obesity eligible for bariatric surgery (BS).Objective: The aim was to explore PCPs' mental representation of BS in order to identify barriers and catalysts of BS referral practices. Setting: Switzerland.Methods: A total of 3526 PCPs were invited to participate in an online survey. PCPs were asked to write the first 5 words that came to their mind about the term "bariatric surgery." Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity related referral patterns were collected. Mental representation network was constructed based on co occurrence of associations, using validated data-driven methodology.Results: In all, 216 PCPs completed the study (response rate: 6.13%). Respondents were aged 55 +/- 9.8 years, had an equal sex distribution, and practiced mainly in urban settings. Three mental representations of BS emerged: indication-focused (most frequent associations: "obesity," "diabetes"), treatment-focused ("gastric bypass," "weight loss"), and outcome-focused ("complications," "challenging follow-up"). The emotional label "interested" was used significantly more frequently in the treatment-focused group. Comparison of PCPs among mental modules showed that those with a treatment-focused mindset referred patients for BS most frequently and were significantly more willing to follow up with postbariatric patients (chi(2 )= 17.8, P = .022).Conclusions: PCPs think about BS along 3 mental representations, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confidence in performing postbariatric follow-up was identified as catalyst of BS referral. Access to optimal care for patients with obesity may be improved accordingly.