Better Patient-Provider Relationships Linked to Obesity Treatment Access

Those with a better patient-provider relationship are more likely to receive treatment for severe obesity, a trend researchers said in a study that should highlight the importance of good communication, care access, and shared decision-making.

The study, published in JAMA Network Open, particularly found that patient satisfaction scores were higher for patients who have obesity and who received Metabolic and bariatric surgery (MBS).

MBS is a surgery that can address obesity and its comorbidities, including type 2 diabetes, dyslipidemia, and hypertension. But although MBS is safe and effective, and obesity is growing at an alarming rate, the surgery is not often utilized. The researchers said only about half of the patients eligible for MBS are referred for the treatment, with White people being more likely to undergo MBS than Black or Hispanic people.

“The personal rationale for the low utilization rate of MBS is largely unknown, and even less is known about why these rates vary so much by ethnicity,” the researchers said. “Lack of insurance coverage for MBS, perceived invasiveness and irreversibility, concerns about surgical complications, nutritional deficiencies, and the lack of physicians who speak the patient’s native language, primarily Spanish, are reasons cited to date for this attrition.”

The researchers zeroed in on the impacts of the patient-provider relationship. Patients take provider testimony and recommendations seriously, the team reasoned, plus research completed internationally has indicated that miscommunication about MBS has stood in the way of patient access.

Using a seven-domain patient satisfaction scale, the researchers found a link between patient satisfaction with the provider relationship and MBS access. Patients reporting higher satisfaction with the patient-provider relationship were more likely to have completed MBS.

The most influential provider relationship factors were perceived technical quality, communication, and convenience of care, the researchers said.

Notably, this was true of all racial groups, indicating that improving the patient-provider relationship among all groups will be important to driving health equity.

“Given that members of racial and ethnic minority groups, such as non-Hispanic Black individuals, disproportionally experience chronic obesity and related conditions, racial and ethnic disparities in MBS completion rates cannot be neglected,” the team wrote in the study’s discussion section. “Our results suggest that enhancing patient-physician relationships for all racial and ethnic groups may help improve the MBS utilization rate.”

The researchers recommended that healthcare providers work to practice stronger shared decision-making with patients, helping them to understand their conditions and treatment options and then empowering patients to make informed choices. Forging longitudinal relationships with patients will also be effective for building the trust necessary to help patients access safe and effective obesity care.

The researchers added that clinicians must be culturally responsive in order to help build trust with Black and Hispanic groups, who have been historically marginalized and therefore who have less trust in healthcare.

Improving the patient-provider relationship is not a panacea, the researchers pointed out.

“Enhancing communication will not only improve patient satisfaction but also improve health care outcomes,” they wrote. “On the other hand, being unable to access health care and lack of convenience is associated with poor adherence, unsatisfied patient experiences, and lower levels of health care services used.”

Improving the patient-provider relationship is only one piece of the puzzle, the team asserted, and broad policymaking is necessary to help patients and providers address the other barriers to receiving MBS and other obesity treatments.