An Interview with Shanu N. Kothari, MD, FACS, FASMBS

| May 1, 2023

by Omar M. Ghanem, MD, FACS; Tammy Kindel, MD, PhD, FACS, FASMBS; Shaina R. Eckhouse, MD, FACS, FASMBS; and Benjamin Clapp, MD, FACS, FASMBS

Dr. Ghanem is a bariatric surgeon at the Mayo Clinic in Rochester, Minnesota. Dr. Kindel is Associate Professor of Surgery at the Medical College of Wisconsin in Milwaukee, Wisconsin. Dr. Eckhouse is a bariatric surgeon at Washington University in St. Louis, Missouri. Dr. Clapp is Associate Clinical Professor of Surgery at Texas Tech School of Medicine at El Paso in El Paso, Texas.

Bariatric Times. 2023;20(5–6):8–9.

Professor Shanu Kothari, MD, the immediate past president of the American Society for Metabolic and Bariatric Surgery (ASMBS), received a grant from the Treatment, Research and Education to end Obesity (TREO) Foundation (previously the ASMBS Foundation) for his study, titled, “When the COVID-19 pandemic collides with the obesity epidemic in the United States: a national survey.” The grant amount was $72,000. Through this interview, we aimed to highlight the study and its implications. Moreover, we explored the pivotal role that the TREO Foundation grant played in executing this survey and study.

Five years ago, your team published on how Americans perceive obesity and its treatment and identified that over 80 percent of participants believed obesity to be a serious health problem. This year, you published a follow-up study in which a sample of the American population was surveyed by the ASMBS in partnership with the National Opinion Research Center (NORC) of the University of Chicago, and these results were published in Surgery for Obesity and Related Diseases (SOARD) in 2023. Can you please share what incited the conduction of the survey in 2022? 

Dr. Kothari: The survey five years ago published in SOARD was led by our then President, Raul Rosenthal, MD. It was titled, “Obesity in America.” It gave us a broad generalization of the public’s perceptions of the disease of obesity. The results were surprising in the fact that the public tended to overestimate the effectiveness of conventional means for weight loss and underestimate the effects of metabolic and bariatric surgery. Interestingly, they felt the disease of obesity was a public health crisis and was as serious a health problem facing the nation as cancer. During the COVID-19 pandemic, many of us in healthcare saw the increased chance of adverse outcomes occurring in patients who suffered from the disease of obesity. Anecdotally, many of us also saw patients considering metabolic and bariatric surgery for the first time after contracting COVID-19. This survey allowed us to revisit the perception of obesity in America and see what impact the COVID-19 pandemic had on decision-making. 

How was the survey designed and conducted, and what were the results? Did the views of the surveyed sample of the American population regarding obesity change compared to five years ago?

Dr. Kothari: The survey was conducted by the NORC at the University of Chicago. They are a highly reputable institution that conducted a probability-based national representation of Americans. Surveys were conducted via the internet, as well as by telephone. Quality assurance checks were conducted to ensure data quality. Straight-line responses to all questions were excluded. Also excluded were timed responses that took less than one-third of the median in interview time for the full sample. In total, 1,714 Americans were sampled, with a purposeful overrepresentation of Black and Hispanic individuals. Once again, obesity was the number one health problem facing the United States (US), with 82 percent of responses, tying with cancer once again, followed by heart disease and diabetes. Nearly 4 in 10 of all Americans view obesity as a larger health risk now than they did before the pandemic. Nearly two-thirds (64%) of respondents said they are paying more attention to their overall health because of COVID-19. Thirty-nine percent of respondents stated that COVID-19 was a motivating factor in their attempt to lose weight in the past year, and this was even higher among Black (43%) and Hispanic (51%) adults. Twenty percent of respondents, or roughly 28 million Americans, attempted to lose weight in the prior year through a means they had not tried prior to the pandemic. Approximately 47 percent of Americans felt obesity was a result of lifestyle choices, versus 53 percent who felt it resulted from genetic, environmental, or social factors. Eighteen percent of respondents said COVID-19 increased the chance that they would bring up the issue of their weight with their primary care provider. That number was even higher among Black (28%) and Hispanic (29%) Americans.  

How did the funds from the TREO Foundation help you execute this research?

Dr. Kothari: This study would not have been possible without the financial support of the TREO Foundation. Their financial support gave us an opportunity to provide a high quality, unbiased, nonindustry-supported research project, the results of which can allow the ASMBS to continue its efforts to overcome the stigma around the disease of obesity.

How do the results of this survey aid society, surgeons, endocrinologists, and researchers in approaching the disease of obesity and its treatment? 

Dr. Kothari: We must continue to educate payors, providers, and patients alike that obesity is a disease. We still have many misconceptions that we must overcome, as 61 percent of those polled perceived obesity to be a risk factor, rather than a disease. We also have to work to spread the message of the efficacy of weight loss surgery, as only 56 percent of respondents felt weight loss surgery was a “very effective” method of significant, long-term weight loss, and many respondents thought diet and exercise on their own (73%) or with help of a doctor (65%) were effective at providing significant, long-term weight loss. 

Are there limitations inherent in the methodology of a sample-based population survey that should be known when interpreting the study results? 

Dr. Kothari: One limitation of the study is that it is not a true longitudinal cohort study, in that the Americans interviewed five years later were not the same who were interviewed in the original cohort; there is the possibility that they are two different populations. However, we feel the cohort is representative of the US population. The overall margin of sampling error was ±3.3 percentage points at the 95-percent confidence level.  

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Category: Current Issue, Research Grant Report

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