Skip to main content
SpringerLink
Log in

Zuweisungsverhalten der Hausärzte bei Patienten mit Adipositas

Referral behavior of general physicians for patients with obesity

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Prävalenz von Adipositas und Übergewicht nimmt stetig zu. So wird Adipositas derzeit als eines der wichtigsten Probleme des deutschen Gesundheitssystems angesehen. Chirurgische Eingriffe sind für Patienten mit morbider Adipositas oftmals die einzige Möglichkeit, eine nachhaltige Gewichtsreduktion und Verbesserung der adipositasassoziierten Begleiterkrankungen zu erreichen. Im Hinblick auf die im Verhältnis zur Prävalenz geringe Anzahl von in Deutschland durchgeführten Adipositasoperationen werden derzeit mehrere Gründe diskutiert. Allgemeinmediziner spielen eine sehr wichtige Rolle, wenn es um Entscheidungen für oder gegen eine Behandlung geht. Bisherige Forschungsergebnisse weisen darauf hin, dass Wissen und Stigma eine Rolle spielen, wenn Behandlungspfade für Patienten mit Adipositas definiert werden. Interventionen sind erforderlich, um Behandlungsentscheidungen von Ärzten oder Patienten unabhängig von sozialem Druck aufgrund von Stigmatisierung oder Wissenslücken zu gestalten.

Abstract

The prevalence of obesity and overweight is constantly rising. Thus, obesity is increasingly considered as one of the most important healthcare problems in Germany. Surgical interventions have been proven to be the only treatment option to achieve sustained weight loss along with a reduction of obesity-related comorbidities in the vast majority of morbidly obese patients. With respect to the small numbers of weight loss surgeries conducted in Germany, several reasons are currently discussed. General practitioners play a very important role in gatekeeping when it comes to decisions about treatment. Research has shown that knowledge and stigma play a role when treatment pathways for patients with obesity are defined. Interventions are required to make treatment decisions by physicians or patients independent of social pressure due to stigma or gaps in expertise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C (2013) Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(5-6):786–794

    Article  PubMed  CAS  Google Scholar 

  2. Pappachan JM, Babu S, Krishnan B, Ravindran NC (2017) Non-alcoholic fatty liver disease: a clinical update. J Clin Transl Hepatol 5(4):384–393

    PubMed  PubMed Central  Google Scholar 

  3. Goodwin PJ, Stambolic V (2015) Impact of the obesity epidemic on cancer. Annu Rev Med 66:281–296

    Article  PubMed  CAS  Google Scholar 

  4. Preiss K, Brennan L, Clarke D (2013) A systematic review of variables associated with the relationship between obesity and depression. Obes Rev 14(11):906–918

    Article  PubMed  CAS  Google Scholar 

  5. Stroh C (2016) Bariatrische Chirurgie: Magenbypass bevorzugte Operation. Dtsch Arztebl 113(20):A980–A983 (Available from: URL: https://www.aerzteblatt.de/archiv/179375/Bariatrische-Chirurgie-Magenbypass-bevorzugte-Operation, cited 2017 Dec 15)

    Google Scholar 

  6. Stolberg CR, Hepp N, Juhl AJA, Deepti BC, Juhl CB (2017) Primary care physician decision making regarding referral for bariatric surgery: a national survey. Surg Obes Relat Dis 13(5):807–813

    Article  PubMed  Google Scholar 

  7. Chirurgische Arbeitsgemeinschaft für Adipositastherapie, Deutsche Adipositas Gesellschaft, Deutsche Gesellschaft für psychosomatische Medizin und Psychotherapie, Deutsche Gesellschaft für Ernährungsmedizin (2017) S3-Leitlinie:Chirurgie der Adipositas. http://www.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/ADIP-6-2010.pdf. Zugegriffen: 18. Dez. 2017

    Google Scholar 

  8. Herpertz S, Kielmann R, Wolf AM, Hebebrand J, Senf W (2004) Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. Obes Res 12(10):1554–1569

    Article  PubMed  CAS  Google Scholar 

  9. McMahon MM, Sarr MG, Clark MM, Gall MM, Knoetgen J, Service FJ et al (2006) Clinical management after bariatric surgery: value of a multidisciplinary approach. Mayo Clin Proc 81(10 Suppl):S34–S45

    Article  PubMed  CAS  Google Scholar 

  10. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA et al (2017) Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med 376(7):641–651

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M et al (2013) Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369(2):145–154

    Article  PubMed  CAS  Google Scholar 

  12. Sjöström L (2008) Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond) 32(Suppl 7):S93–S97

    Article  Google Scholar 

  13. Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307(1):56–65

    Article  PubMed  Google Scholar 

  14. Wee CC, Huskey KW, Bolcic-Jankovic D, Colten ME, Davis RB, Hamel M (2014) Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med 29(1):68–75

    Article  PubMed  Google Scholar 

  15. Kim KK, Yeong L‑L, Caterson ID, Harris MF (2015) Analysis of factors influencing general practitioners’ decision to refer obese patients in Australia: a qualitative study. Bmc Fam Pract 16:45

    Article  PubMed  PubMed Central  Google Scholar 

  16. Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB et al (2003) Primary care physicians’ attitudes about obesity and its treatment. Obes Res 11(10):1168–1177

    Article  PubMed  Google Scholar 

  17. Avidor Y, Still CD, Brunner M, Buchwald JN, Buchwald H (2007) Primary care and subspecialty management of morbid obesity: referral patterns for bariatric surgery. Surg Obes Relat Dis 3(3):392–407

    Article  PubMed  Google Scholar 

  18. Balduf LM, Farrell TM (2008) Attitudes, beliefs, and referral patterns of PCPs to bariatric surgeons. J Surg Res 144(1):49–58

    Article  PubMed  Google Scholar 

  19. Primomo JA, Kajese T, Davis G, Davis R, Shah S, Orsak M et al (2016) Decreased access to bariatric care: an analysis of referral practices to bariatric specialists. Surg Obes Relat Dis 12(9):1725–1730

    Article  PubMed  Google Scholar 

  20. Puhl R, Suh Y (2015) Health consequences of weight stigma: implications for obesity prevention and treatment. Curr Obes Rep 4(2):182–190

    Article  PubMed  Google Scholar 

  21. Puhl RM, King KM (2013) Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab 27(2):117–127

    Article  PubMed  Google Scholar 

  22. Puhl RM, Heuer CA (2009) The stigma of obesity: a review and update. Obesity (Silver Spring) 17(5):941–964

    Article  Google Scholar 

  23. Wu Y‑K, Berry DC (2017) Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. J Adv Nurs. https://doi.org/10.1111/jan.13511

    Article  PubMed  Google Scholar 

  24. Tomiyama AJ, Finch LE, Belsky ACI, Buss J, Finley C, Schwartz MB et al (2015) Weight bias in 2001 versus 2013: contradictory attitudes among obesity researchers and health professionals. Obesity (Silver Spring) 23(1):46–53

    Article  Google Scholar 

  25. Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M (2015) Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 16(4):319–326

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Anderson DA, Wadden TA (2004) Bariatric surgery patients’ views of their physicians’ weight-related attitudes and practices. Obes Res 12(10):1587–1595

    Article  PubMed  Google Scholar 

  27. Mattingly BA, Stambush MA, Hill AE (2009) Shedding the pounds but not the stigma: negative attributions as a function of a target’s method of weight loss. J Appl Biobehav Res 14(3):128–144

    Article  Google Scholar 

  28. Vartanian LR, Fardouly J (2013) The stigma of obesity surgery: negative evaluations based on weight loss history. Obes Surg 23(10):1545–1550

    Article  PubMed  Google Scholar 

  29. Fardouly J, Vartanian LR (2012) Changes in weight bias following weight loss: the impact of weight-loss method. Int J Obes (Lond) 36(2):314–319

    Article  CAS  Google Scholar 

  30. Carels RA, Rossi J, Borushok J, Taylor MB, Kiefner-Burmeister A, Cross N et al (2015) Changes in weight bias and perceived employability following weight loss and gain. Obes Surg 25(3):568–570

    Article  PubMed  Google Scholar 

  31. Groven KS (2014) They think surgery is just a quick fix. Int J Qual Stud Health Well-being 9:24378

    Article  PubMed  Google Scholar 

  32. Trainer S, Brewis A, Wutich A (2017) Not ‘taking the easy way out’: reframing bariatric surgery from low-effort weight loss to hard work. Anthropol Med 24(1):96–110

    Article  PubMed  Google Scholar 

  33. Jung FUCE, Luck-Sikorski C, König H‑H, Riedel-Heller SG (2016) Stigma and knowledge as determinants of recommendation and referral behavior of general practitioners and internists. Obes Surg 26(10):2393–2401

    Article  PubMed  Google Scholar 

  34. Stanford FC, Johnson ED, Claridy MD, Earle RL, Kaplan LM (2015) The role of obesity training in medical school and residency on bariatric surgery knowledge in primary care physicians. Int J Family Med 2015:841249

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ferrante JM, Piasecki AK, Ohman-Strickland PA, Crabtree BF (2009) Family physicians’ practices and attitudes regarding care of extremely obese patients. Obesity (Silver Spring) 17(9):1710–1716

    Article  Google Scholar 

  36. Jung FUCE, Dietrich A, Stroh C, Riedel-Heller SG, Luck-Sikorski C (2017) Changes in attitudes towards bariatric surgery after 5 years in the German general public. Obes Surg 27(10):2754–2758

    Article  PubMed  Google Scholar 

  37. Sikorski C, Luppa M, Dame K, Brähler E, Schütz T, Shang E et al (2013) Attitudes towards bariatric surgery in the general public. Obes Surg 23(3):338–345

    Article  PubMed  Google Scholar 

  38. MacLean L, Edwards N, Garrard M, Sims-Jones N, Clinton K, Ashley L (2009) Obesity, stigma and public health planning. Health Promot Int 24(1):88–93

    Article  PubMed  Google Scholar 

  39. Bombak AE (2014) The contribution of applied social sciences to obesity stigma-related public health approaches. J Obes. https://doi.org/10.1155/2014/267286

    Article  PubMed  PubMed Central  Google Scholar 

  40. Vartanian LR, Fardouly J (2014) Reducing the stigma of bariatric surgery: benefits of providing information about necessary lifestyle changes. Obesity (Silver Spring) 22(5):1233–1237

    Article  Google Scholar 

Download references

Förderung

Diese Arbeit wurde vom Bundesministerium für Bildung und Forschung Research (BMBF), FKZ: 01EO1501 sowie durch das nutriCARD-Kompetenzcluster (01EA1411B) unterstützt.

Author information

Authors and Affiliations

  1. Integriertes Forschungs- und Behandlungszentrum (IFB) Adipositas Erkrankungen, Universität Leipzig, Leipzig, Deutschland

    F. U. Jung & C. Luck-Sikorski

  2. SRH Hochschule für Gesundheit Gera, Neue Straße 28–30, 07548, Gera, Deutschland

    F. U. Jung & C. Luck-Sikorski

  3. Allgemein‑, Visceral- und Kinderchirurgie, SRH Wald-Klinikum Gera, Gera, Deutschland

    C. Stroh

  4. Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Leipzig, Deutschland

    S. G. Riedel-Heller

Authors
  1. F. U. Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Luck-Sikorski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Stroh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. G. Riedel-Heller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. U. Jung.

Ethics declarations

Interessenkonflikt

C. Luck-Sikorski hat als Referentin und Beraterin für die Firma Ethicon (Johnson & Johnson) Honorare erhalten. Diese Tätigkeit steht in keinem Zusammenhang mit dem vorliegenden Artikel und beschränkte sich auf Inhalte der Versorgungsforschung und Stigmatisierung von Menschen mit Adipositas. F.U. Jung, C. Stroh und S.G. Riedel-Heller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jung, F.U., Luck-Sikorski, C., Stroh, C. et al. Zuweisungsverhalten der Hausärzte bei Patienten mit Adipositas. Chirurg 89, 577–582 (2018). https://doi.org/10.1007/s00104-018-0616-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-018-0616-3

Schlüsselwörter

Keywords

Search

Navigation