Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey

Emre Erdoğan; Berk Koncalıoğlu; Furkan Türkoğlu; Elif Nur Gencer; Rabia Küçükarslan Güler; Soner Sarı; Özgür Doğan

doi:10.32322/jhsm.1993584

Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey

Abstract

Aims: This study evaluated healthcare professionals’ perceptions, clinical practices, and referral patterns regarding bariatric surgery in overweight or obese patients with musculoskeletal pain, and identified factors associated with referral decision-making. Methods: A cross-sectional survey was completed by 603 healthcare professionals from multiple specialties. The questionnaire assessed clinical exposure to obese patients with musculoskeletal pain, body-mass index (BMI) assessment practices, weight-loss recommendations, attitudes toward bariatric surgery, referral criteria, and factors influencing referral decisions and referral center selection. Results: Overall, 405 participants (67.2%) reported that at least one-quarter of their patients with musculoskeletal pain were overweight or obese. Although 422 (70.0%) consistently recommended weight loss and 463 (76.8%) considered weight reduction highly effective for symptom relief, only 68 (11.3%) routinely assessed BMI. Bariatric surgery was regarded as moderately or highly effective by 515 participants (85.4%), and 572 (94.9%) believed it could reduce the need for orthopaedic surgery. The most common indication for bariatric surgery referral was obesity refractory to conservative treatment (67.4%). Referral criteria differed significantly according to age (p=0.034), specialty (p<0.001), and institution (p<0.001). Referral center selection was primarily influenced by familiarity with and trust in a specific physician (70.8%) and varied by age, gender, specialty, and institution (all p<0.001). Conclusion: Despite recognizing the importance of weight reduction and the benefits of bariatric surgery, healthcare professionals infrequently assess BMI and inconsistently refer eligible patients. This awareness-referral gap highlights the need for clearer multidisciplinary referral pathways for obese patients with musculoskeletal pain.

Keywords

Supporting Institution

None

Ethical Statement

The study protocol was reviewed and approved by the Institutional Ethics Committee of [T.C. SAĞLIK BAKANLIĞI İL SAĞLIK MÜDÜRLÜĞÜ ANKARA BİLKENT ŞEHİR HASTANESİ 2 NOLU TIBBİ ARAŞTIRMALAR BİLİMSEL VE ETİK DEĞERLENDİRME KURULU (TABED) BAŞKANLIĞI] (Approval No: TABED 2-26-2344], Date: 10/06/2026). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Participation was voluntary and anonymous, and informed consent was obtained electronically from all participants prior to completion of the survey.

References

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet. 2024;403(10431):1027-1050. doi:10.1016/S0140-6736 (23)02750-2
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-154. doi:10.1093/aje/kwp356
Peltonen M, Lindroos AK, Torgerson JS. Musculoskeletal pain in the obese: a comparison with a general population and long-term changes after conventional and surgical obesity treatment. Pain. 2003;104(3):549-557. doi:10.1016/S0304-3959(03)00091-5
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007;66(4):433-439. doi:10.1136/ard.2006.065904
Cooper L, Ryan CG, Ells LJ, et al. Weight loss interventions for adults with overweight/obesity and chronic musculoskeletal pain: a mixed methods systematic review. Obes Rev. 2018;19(7):989-1007. doi:10.1111/obr.12686
Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022;18(12): 1345-1356. doi:10.1016/j.soard.2022.08.013
King WC, Chen JY, Belle SH, et al. Change in pain and physical function following bariatric surgery for severe obesity. JAMA. 2016;315(13):1362-1371. doi:10.1001/jama.2016.3010
Premkumar A, Samaan JS, Samakar K. Factors associated with bariatric surgery referral patterns: a systematic review. J Surg Res. 2022;276:54-75. doi:10.1016/j.jss.2022.01.023

Atlantis E, Chimoriya R, Seifu CN, et al. Enablers and barriers to implementing obesity assessments in clinical practice: a rapid mixed-methods systematic review. BMJ Open. 2022;12(11). doi:10.1136/bmjopen-2022-063659
Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA. 2021;325(6):568-578. doi:10.1001/jama. 2020.22171
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149-162. doi:10.1002/acr.24131
Lim YZ, Wong J, Hussain SM, et al. Recommendations for weight management in osteoarthritis: a systematic review of clinical practice guidelines. Osteoarthr Cartil Open. 2022;4(4):100298. doi:10.1016/j.ocarto.2022.100298
Garcia MM, Corrales P, Huerta MÁ, et al. Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024;15:1340465. doi:10.3389/fendo.2024. 1340465
King WC, Hinerman AS, White GE. A 7-year study of the durability of improvements in pain, physical function, and work productivity after Roux-en-Y gastric bypass and sleeve gastrectomy. JAMA Netw Open. 2022;5(9):e2231593. doi:10.1001/jamanetworkopen.2022.31593
Stenberg E, Dos Reis Falcão LF, O’Kane M, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: a 2021 update. World J Surg. 2022;46(4):729-751. doi:10.1007/s00268-021-06394-9
Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures-2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247. doi:10.1016/j.soard.2019.10.025
Rajeev ND, Samaan JS, Premkumar A, Yu E, Srinivasan N, Samakar K. Providers’ knowledge and perceptions of bariatric surgery: a systematic review. Obes Surg. 2023;33(11):3571-3601. doi:10.1007/s11695-023-06827-5
Conaty EA, Denham W, Haggerty SP, Linn JG, Joehl RJ, Ujiki MB. Primary care physicians’ perceptions of bariatric surgery and major barriers to referral. Obes Surg. 2020;30(2):521-526. doi:10.1007/s11695-019-04204-9
Zevin B, Sivapalan N, Chan L, Cofie N, Dalgarno N, Barber D. Factors influencing primary care provider referral for bariatric surgery: systematic review. Can Fam Physician. 2022;68(3). doi:10.46747/cfp. 6803e107
Elliott AF, Deepti BC, Stolberg CR, et al. Attitudes and knowledge regarding referrals for bariatric surgery among Danish secondary healthcare providers: a national survey. Clin Obes. 2020;10(4). doi:10. 1111/cob.12369
Zoabi E, Elran-Barak R, Sakran N, Sandler NK, Hatoum OA, Kaplan U. Factors influencing referral for bariatric surgery by primary care physicians in Northern Israel. Obes Surg. 2024;34(7):2431-2437. doi:10. 1007/s11695-024-07253-x
Gasoyan H, Tajeu G, Halpern MT, Sarwer DB. Reasons for underutilization of bariatric surgery: the role of insurance benefit design. Surg Obes Relat Dis. 2019;15(1):146-151. doi:10.1016/j.soard.2018.10.005

Details

Primary Language

English

Subjects

General Surgery

Journal Section

Research Article

Authors

Emre Erdoğan
0000-0001-9963-0480
Türkiye

Berk Koncalıoğlu
0000-0001-6805-2745
Türkiye

Furkan Türkoğlu ^*
0000-0002-5942-1518
Türkiye

Elif Nur Gencer
0000-0002-8623-593X
Türkiye

Rabia Küçükarslan Güler
0009-0006-9584-6448
Türkiye

Soner Sarı
0000-0001-8863-9332
Türkiye

Özgür Doğan
0000-0002-5913-0411
Türkiye

Publication Date

September 19, 2026

Submission Date

July 13, 2026

Acceptance Date

August 30, 2026

Published in Issue

Year 2026 Volume: 9 Number: 5

DOI

https://doi.org/10.32322/jhsm.1993584

IZ

https://izlik.org/JA84PH92UY

Cite

RIS / Bibtex

APA

Erdoğan, E., Koncalıoğlu, B., Türkoğlu, F., Gencer, E. N., Küçükarslan Güler, R., Sarı, S., & Doğan, Ö. (2026). Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey. Journal of Health Sciences and Medicine, 9(5), 1509-1518. https://doi.org/10.32322/jhsm.1993584

AMA

1.Erdoğan E, Koncalıoğlu B, Türkoğlu F, et al. Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey. J Health Sci Med / JHSM. 2026;9(5):1509-1518. doi:10.32322/jhsm.1993584

Chicago

Erdoğan, Emre, Berk Koncalıoğlu, Furkan Türkoğlu, et al. 2026. “Physicians’ Perceptions and Referral Patterns Regarding Bariatric Surgery in Overweight and Obese Patients With Musculoskeletal Pain: A Multidisciplinary Cross-Sectional Survey”. Journal of Health Sciences and Medicine 9 (5): 1509-18. https://doi.org/10.32322/jhsm.1993584.

EndNote

Erdoğan E, Koncalıoğlu B, Türkoğlu F, Gencer EN, Küçükarslan Güler R, Sarı S, Doğan Ö (September 1, 2026) Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey. Journal of Health Sciences and Medicine 9 5 1509–1518.

IEEE

[1]E. Erdoğan et al., “Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey”, J Health Sci Med / JHSM, vol. 9, no. 5, pp. 1509–1518, Sept. 2026, doi: 10.32322/jhsm.1993584.

ISNAD

Erdoğan, Emre - Koncalıoğlu, Berk - Türkoğlu, Furkan - Gencer, Elif Nur - Küçükarslan Güler, Rabia - Sarı, Soner - Doğan, Özgür. “Physicians’ Perceptions and Referral Patterns Regarding Bariatric Surgery in Overweight and Obese Patients With Musculoskeletal Pain: A Multidisciplinary Cross-Sectional Survey”. Journal of Health Sciences and Medicine 9/5 (September 1, 2026): 1509-1518. https://doi.org/10.32322/jhsm.1993584.

JAMA

1.Erdoğan E, Koncalıoğlu B, Türkoğlu F, Gencer EN, Küçükarslan Güler R, Sarı S, Doğan Ö. Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey. J Health Sci Med / JHSM. 2026;9:1509–1518.

MLA

Erdoğan, Emre, et al. “Physicians’ Perceptions and Referral Patterns Regarding Bariatric Surgery in Overweight and Obese Patients With Musculoskeletal Pain: A Multidisciplinary Cross-Sectional Survey”. Journal of Health Sciences and Medicine, vol. 9, no. 5, Sept. 2026, pp. 1509-18, doi:10.32322/jhsm.1993584.

Vancouver

1.Emre Erdoğan, Berk Koncalıoğlu, Furkan Türkoğlu, Elif Nur Gencer, Rabia Küçükarslan Güler, Soner Sarı, Özgür Doğan. Physicians’ perceptions and referral patterns regarding bariatric surgery in overweight and obese patients with musculoskeletal pain: a multidisciplinary cross-sectional survey. J Health Sci Med / JHSM. 2026 Sep. 1;9(5):1509-18. doi:10.32322/jhsm.1993584