EXPLORING THE PERCEPTIONS AND UNDERSTANDING OF DIFFERENT BARIATRIC PROCEDURES AMONG OBESE INDIVIDUALS IN THE NORTHERN BORDER REGION, SAUDI ARABIA

Yasir Mehmood¹, Pakeeza Shafiq², Abdullah Shafi Alanazi^3*, Feras Hamad Alanazi³, Khalid Majed Almutlaq³, Omar Mosab Alenazi³, Abdulaziz Mohammed Almalki³ and Hussam Mohammed Alanazi^3
*Correspondence: Abdullah Shafi Alanazi, Medical students, Faculty of Medicine, Northern Border University, Saudi Arabia, Email:

Keywords

awareness, perception, obesity, bariatric procedures, Saudi Arabia.

Introduction

Obesity is an alarming health concern on both national and global levels that has significant ramifications for individuals and healthcare systems. Obesity- Defined by WHO as having a body mass index (BMI) greater than or equal to 30, has been spreading like fire from around the world. As of 2016, more than 1.9 billion adults were overweight and obese globally with over 650 million fitting into those categories. [1]. The rise in obesity prevalence is not only a matter of surplus poundage but also associated with numerous non-communicable diseases such as type 2 diabetes, cardiovascular disease, musculoskeletal disorders, and various cancers. [2].

Saudi Arabia has a particularly high rate of obesity which is reaching epidemic dimensions. Recent studies found that almost 35% of the adult population is obese, and there are huge disparities between the region and the country. These differences depend on the environment, lifestyle, and population in this multiethnic County [3]. The situation in the Northern Border Region is characterized by uniqueness in demographics and lifestyle. It is also witnessing an important rise in obesity factors because of their dietary habits, low levels of physical activity, and predispositions to genetic factors [4].

Bariatric surgery forms part of the optimal solution to obesity and has proven to be the most successful means of treatment for severe obesity and its comorbidities. [5].Bariatric surgery is a collective term for a group of operations that cause weight loss by specific anatomical changes to the digestive system. These types of surgery include gastric bypass, sleeve gastrectomy, adjustable gastric banding, and biliopancreatic diversion with a duodenal switch, which are the most performed.

Gastric bypass surgery dramatically limits food intake and nutrient absorption by bypassing most of the stomach and duodenum. It accomplishes these goals by creating a tiny pouch at the top of the stomach and connecting it straight to the small intestine. Sleeve gastrectomy, the second common operation in the US, involves resection of 75-90 percent of the stomach, leaving a tubular remnant. Weight loss is encouraged by reducing the stomach’s physical capacity and limiting the production of the hunger hormone ghrelin. Finally, with adjustable gastric banding, a small pouch that limits food intake is created via an inflatable band encircling the upper end of the stomach. Other variations, such as biliopancreatic diversion with duodenal switch, include major rearrangement of the intestines and removal of an upper part of the stomach, thereby maximizing nutrient malabsorption.

The acceptance and the use of bariatric surgery in the treatment of obesity patients, though this clinical solution is efficient, depends on the awareness and knowledge of obese patients of these procedures [11]. In this sense, awareness is the ability to identify and accept that bariatric surgery can be used to treat obesity. In knowledge, however, the applicant is expected to provide thorough information about the surgery including the techniques, benefits, and possible dangers. Evidence suggests, that awareness and knowledge of patients strongly influence their decision-making process on treatment options available and their readiness for such interventions [12].

In Saudi Arabia, the level of awareness and knowledge about bariatric surgery among obese individuals is not well-documented. For example, a study showed that the bariatric surgery awareness level was low, and even more, there were misunderstandings of the procedures and expected outcomes of the Saudi citizens [13]. Likewise, a study conducted by Alfadhel et al., also proved that most subjects did not know the risks and benefits of the different techniques of bariatric surgery [14]. Such findings highlight the urgency of developing strategies aimed at educating people on effectiveness as well as possible complications.

The impact of age, sex, income, and education, among other parameters of the population, is strong and influences the level of awareness and comprehension of individuals [15]. Furthermore, there are other factors, including previous healthcare experiences, healthcare provider information, media, and social networks that contribute to patients' knowledge in addition to the barriers identified [16]. The North Region of Saudi Arabia therefore forms an interesting basis on which to conduct an analysis of awareness and understanding regarding bariatric procedures among obese patients.

Its demographic and cultural background includes variations in the healthcare system across regions that might affect patients' attitudes and level of acceptance of bariatric surgery. The current level of awareness and knowledge about this population group is important for assessing gaps in knowledge and educational interventions aimed at overcoming these gaps, thereby improving the latency of acceptance and outcomes of bariatric surgery.

Study Aim

This study evaluated the awareness and knowledge of different bariatric procedures among obese patients in the Northern Border Region of Saudi Arabia.

Methodology

This study was cross-sectional to assess the relevant information and visual comprehension and understanding of different bariatric procedures by obese patients residing within the Northern Border Region of Saudi Arabia. A non-random sampling method was employed for the obese group of 18 years and above residing in the Northern Border Region of Saudi Arabia, BMI ≥ 30.

A questionnaire was given out to the participants, in the form of an online survey. This was developed after a systematic review and consultation of professionals from public health and bariatric surgery. The questionnaire was organized in three elements namely participant demographics, awareness of Bariatric Surgery, and knowledge of Bariatric Procedures. In the knowledge section, twenty items were in multiple-choice questions. One point was awarded for a correct response; all wrong and “don’t know” responses were awarded zero. The score ranged from 0 to 20 where the higher the score the greater the degree of knowledge on bariatric surgery concepts. A small focus group of demographically similar obese persons tested the survey for comprehensibility, relevance, and validity. A draft version of the questionnaire was prepared and tested, and then the results were used to modify the questionnaire when actual data collection was to be done.

This also included the use of social networking sites that were able to reach a wide number of people in the Northern Border Region by using the online questionnaire. Further dissemination of the survey link was carried out with the help of collaborations with local healthcare institutions and community centers. At the start of the online questionnaire, an informed consent form was included.

Data Analysis

The statistical software called SPSS version 26.0 was employed to interpret the data. Demographic data on the individuals was summarized using frequencies, percentages, means, and standard deviations. Similar statistical measures were used to elaborate on the awareness and knowledge of bariatric surgery. To examine the association between personal characteristics (including age, gender, and education level) and awareness levels, a t-test and chi-square were applied.

Ethical Approval

The Local Committee of Bioethics (HAP-09-A-043) at Northern Border University approved the study on 02/06/2024 with decision number (77/24/H).

Results

The demographics of the 373 participants are detailed in (Table 1). A considerable proportion of participants aged 36 to 50 years stood at 41.6%, younger cohorts at 37.3%, and elderly at 21.2%. Gender analysis indicated that more men at 51.7% participated in the survey than women who constituted 48.3%. The height data showed that 30.6% of the population categorized themselves as 167 cm or less, while 30.6% weighed between 86 to 95 kg. Less than two-fifths (53.9%) of respondents had attained the first degree higher than the few graduate holders and those without any formal education. Occupationally, the sample comprised of 42.4% employed and 36.2% non-employed individuals, indicative of varying socioeconomic dynamics.

(Table 2) shows that a significant majority, comprising 77.7%, have consulted a healthcare provider regarding their obesity, indicating a proactive attitude to addressing this health issue. Remarkably, awareness of bariatric surgery as a treatment option is substantially high, with 76.7% of participants reporting prior knowledge. The primary sources of this information reveal participants mostly rely on interpersonal networks like friends and family (43%), as well as media (44.1%).

*Results may overlap

(Table 3) depicts the level of knowledge and awareness regarding various bariatric procedures among 373 obese patients. Sleeve gastrectomy and adjustable gastric banding emerged as the most recognized procedures, with 37% and 41.3% awareness levels, respectively. In contrast, only 6.4% of participants reported awareness of the biliopancreatic diversion with duodenal switch, suggesting that it is a far less well-known procedure.

*Results may overlap

Also, while 90.6% of respondents acknowledged the need to adhere to a special post-operative diet, a large group of participants showed misconceptions about the reversibility of most bariatric surgeries and indication criteria, with 50.1% of those participants assuming that it was an issue of being overweight without health conditions.

Awareness and knowledge of different bariatric procedures amongst the obese patients varied markedly (Table. 4). A majority, 51.5%, were moderately aware, while a minority, 14.5%, were highly aware. In contrast, 34% of the patients had low knowledge of the procedures.

(Table 5) shows that knowledge and awareness level was related significantly to gender, weight, occupational status, whether participants consulted a healthcare provider about obesity, and whether participants considered bariatric surgery before. It shows an insignificant relation to age, height, and educational level.

*P value was considered significant if ≤ 0.05.

Discussion

According to estimates from the World Health Organization (WHO), the rates of overweight and obesity in the population of Saudi Arabia are 68.2% and 33.7%, respectively. Similarly, studies undertaken in 2014 in the Arab region indicated that 25-40% of the children and 66-75% of the adults were overweight or obese [17]. The high percentage of obesity among Saudi individuals would indicate that whatever preventive measures have been adopted are either inadequate or ineffective [18]. Management of obesity typically involves pharmacologic therapies, which primarily serve to alleviate symptoms rather than provide a cure. Other options include surgery, where bariatric surgery is considered the most effective and durable therapy. The three most common bariatric surgeries are the Roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The findings of our study on knowledge and awareness of bariatric procedures among obese patients revealed that obese patients indeed had a high level of awareness; 76.7% knew bariatric surgery was among the lines of treatment.

This starkly contrasts with the findings of Alqahtani et al., in which only 22.7% of participants were informed about such solutions in eastern Saudi Arabia, indicating a major difference in awareness between populations. In this respect, a similar study by Shoog F. Alfadhel et al. reported that as many as 22.7% of participants were unaware of bariatric surgery and 50% did not understand the appropriate indications for these procedures. By contrast, ours would tend to indicate that most respondents are not only knowledgeable of the existence of bariatric surgeries but also deem postoperative dietary concerns relevant. What is more, whereas 14.5% of all subjects in our study had a high level of knowledge, Gowanlock et al. [22] established that 41% and 64.8% of subjects knew the indications and complications of bariatric surgery, respectively. That means comprehensive awareness exists, but the specific knowledge about indications and complications may be deficient in our cohort. Also, the study of Abdullah A. Alamri et al. confirms the variability of awareness as only 64% were aware of the acute complications of bariatric surgeries compared to the misconceptions given by our participants about the eligibility and reversibility of the surgeries being 50.1% and 14.5%, respectively. Thus, while our findings indicate that the level of general awareness is higher compared to previously related works, the difference in knowledge about the details of bariatric surgeries suggests a continued need for educational interventions among people and health professionals to close the gap in knowledge related to bariatric care. Knowledge level comparisons revealed that only 14.5% possessed a high level of knowledge about the procedures behind bariatric surgery, while 34% had low knowledge.

On the other hand, research conducted by Bilal S Al-Mushaigah et.al, [24] highlights that out of the intention to undergo surgery, 43% were worried about societal attitudes and community treatment. Thus, the role of stigma in considerably impeding not only awareness but also decision-making in the candidate group considering surgery is important to note. Both studies also report that sources of information about bariatric procedures are mainly acquired from media and personal networks, which once more could present opportunities for public health campaigns to enhance educational efforts.

Regarding the relation between knowledge and the awareness level with sociodemographic characteristics, we have found that there is a statistically significant relation in gender, weight, occupational status, whether participants consulted with a healthcare provider regarding obesity, and whether participants considered bariatric surgery before. It also insignificantly shows statistical relations to age, height, and educational level. On the contrary, Aly et al., in their previous study on demographic and quality of life factors affecting patients' intent to consider bariatric surgery, reported that 40% more women considered weight loss surgery than men (22%) [25]. In addition, another study [26] demonstrated that the participants who held bachelor's degrees and were between the ages of 18 to 25 and had residences in either the Northern or Southern regions of Saudi Arabia had a high level of knowledge on indications of sleeve gastrectomy with P < 0.05, in contrast to the research by Alolayan on gender and educational attainment [27].

Conclusion

The current study depicts the critical yet uneven landscape of awareness and knowledge about bariatric surgery among obese patients in the Northern Border Region of Saudi Arabia. This means that while most participants identified the correct treatment method, there were still several incorrect assumptions about eligibility and the reversibility of the procedure. Although awareness is on the increase, the findings indicate a dire need for targeted educational interventions that could bridge knowledge gaps, especially concerning the type of bariatric procedures and the respective risks and benefits associated with them. Increasing knowledge through comprehensive campaigns in public health may eventually enable patients to make informed decisions on the choice of treatment, thus realizing better health outcomes in this obese epidemic-prone region.

Acknowledgements

The author extends their appreciation to the Deanship of Scientific Research at Northern Border University, Arar, Saudi Arabia for funding this research work through the project number “NBU-FFR-2024-1510-01”.

Conflict of interest

Nil

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