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Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists



Despite reported effectiveness, weight loss surgery (WLS) still remains one of the least preferred options for outpatient providers, especially in Germany. The aim of this study was to examine the effect of stigma and knowledge on recommendation of WLS and referral to a surgeon by general practitioners (GPs) and internists.


The sample consists of 201 GPs and internists from Germany. The questionnaire included questions on the perceived effectiveness of WLS, the frequency of recommendations of WLS, and the frequency of referral to WLS. Stigma, as well as knowledge was also assessed in this context. Linear and logistic regression models were conducted. A mediation analysis was carried out within post hoc analysis.


Knowledge (b = 0.258, p < 0.001) and stigma towards surgery (b = −0.129, p = 0.013) were related to the frequency of recommendation of WLS. Additionally, respondents, who were more likely to express negative attitudes towards WLS, were less likely to recommend WLS and thus refer patients to WLS (b = −0.107, p < 0.05). Furthermore, respondents with more expertise on WLS were more likely to recommend and thus refer patients to WLS (b = 0.026, p < 0.05).


This study showed that stigma plays a role when it comes to defining treatment pathways for patients with obesity. The question remains how this might influence the patients and their decision regarding their treatment selection. Interventions are required to make treatment decisions by physicians or patients independent of social pressure due to stigma.

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Corresponding author

Correspondence to Franziska U. C. E. Jung.

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Conflict of Interest

FUCEJ, CLS, HHK, SRH declare to have no conflict of interest. CLS has received speaker honoria from Johnson & Johnson Medical.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study. Participants were informed about the study on the first page of the questionnaire and they were instructed that upon returning the filled out questionnaire, their data would be used for scientific publications.

Statement of Human Rights

This study has been approved by the ethics committee of the University of Leipzig and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Jung, F.U.C.E., Luck-Sikorski, C., König, HH. et al. Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists. OBES SURG 26, 2393–2401 (2016).

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  • Stigma
  • Obesity
  • Weight loss surgery
  • General practitioners
  • Internists