Consumer behavior Decision Making in Bariatric Surgery

December 15

2012
[Type the document subtitle]

Bariatric surgery Decision making in Indraprastha Apollo Hospitals

Introduction
Indraprastha Apollo is one of the largest corporate hospitals in the world. It is the third super specialty tertiary care hospital set by the Apollo Hospitals Group, jointly with the Government of New Delhi, India's capital. It is a 695 bedded hospital, with the provision for expansion to 1000 beds in future. The hospital is at the forefront of medical technology and expertise. It provides a complete range of latest diagnostic, medical and surgical facilities for the care of its patients. The hospital started functioning from July 1996, its mission being, Medical Excellence with a Human Touch." Dr. Prathap C Reddy, Chairman, Apollo Hospitals Group says, "Our mission is to bring healthcare of international standards within the reach of every individual. We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity. Our mission is also to transcend the realm of curative care. With a new focus on preventive care, Apollo is going beyond medicine. And as the 21st century approaches, we stand committed to building an infrastructure that will create an environment that protects and nurtures our future generations

BARIATRIC SURGERY
Bariatric surgery (weight-loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). The U.S. National 0049 nstitutes of Health recommends bariatric surgery for obese people with a body mass index (BMI) of at least 40, and for people with BMI 35 and serious coexisting medical conditions such as diabetes.[1] However, research is emerging that suggests bariatric surgery could be appropriate for those with a BMI of 35 to 40 with no comorbidities or a BMI of 30 to 35 with significant comorbidities

INDICATIONS

"Surgery should be considered as a treatment option for patients with a BMI of 35 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. A doctorpatient discussion of surgical options should include the long-term side effects, such as possible need for reoperation, gallbladder disease, and malabsorption."

"Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery."

Recently the International Diabetes Federation issued a position statement in which "Under some circumstances people with a BMI 3035 should be eligible for surgery" International Diabetes Federation position statement on Bariatric Surgical and Procedural Interventions in the Treatment of Obese Patients with Type 2 Diabetes When determining eligibility for bariatric surgery for extremely obese patients, psychiatric screening is critical; it is also critical for determining postoperative success. In patients with a body mass index of 40 kg/m2 or greater,

Diabetes

More than 80% of individuals with Type 2 diabetes are obese or overweight because obesity reduces insulins ability to regulate blood sugar levels. Over time, this inability may lead to

diabetes. Unfortunately, drug treatment is less effective for obese people because obesity increases insulin resistance and glucose intolerance. (The Endocrine Society, 2009)

Heart Disease Obese people have an increased incidence of heart disease. The excessive body fat increases triglyceride levels and decreases high-density lipoprotein (HDL), i.e., good cholesterol. Thus, an obese person is more likely to suffer from heart attacks, congestive heart failure, sudden cardiac death, angina, and abnormal heart rhythm than a healthy BMI individual. (The Endocrine Society, 2009)

Hypertension

Metabolic Syndrome-Obesity impacts existing endocrine and metabolic disorders, a condition that affects one of every five overweight people, approximately 22% of the American population. This condition is characterized by a cluster of health problems including obesity, hypertension, abnormal lipid levels, and high blood sugar. Again the problems associated with diabetes, heart disease, or stroke Treatment Option 1: Medication Prescription drug therapy may be incorporated into a patients weight loss program when he or she has a BMI of more than 30 with no obesity-related conditions; or when the BMI is above 27 with two or more obesity related conditions. Medication may be effective for weight-loss when

combined with lifestyle, behavioral, and dietary modifications. Long-term treatments include sympathomimetic drugs which inhibit ones appetite and lipase inhibitors which prevent enzymes from breaking down fat. Short-term treatments are for weight loss but are not used for patients with heart disease, high blood pressure, and thyroid conditions. Many over-the-counter pills are available for weight loss, although their efficacy has not been supported in any research studies

Treatment Option 2: Bariatric Surgery Bariatric surgery, also known as weight loss surgery, is the last option for weight loss when all other treatment regimes have failed. Obesity surgery is recommended only for patients with either a BMI of 40 or a BMI of 35 to 39.9 when coupled with other obesity-related medical conditions. Persons considering this surgery need to fully understand the risks, benefits, and lifestyle changes that accompany obesity surgery. A cadre of health care providers, e.g., general practitioners, endocrinologists, OB/GYNs, nutritionists, and psychologists, are made available to offer their expertise and guidance. Table 1 highlights characteristics exhibited by the more than 14,500 patients as compiled by the International Bariatric Surgery Registry. RELATED LITERAURE-. The study is also important because, although more and more people turn to bariatric surgery for weight loss, there are a few studies that consider the use of the Internet to inform the public about bariatric services lofferd in hospit. In Salant and Santry (2006) the authors argue that economic and professional motivations confuse patients. The study reported here differs in that it incorporates two possible motivations for weight loss. Specifically, the desire for enhanced relationships with loved ones and improvement in mental health are used to create a conceptual model that maps a prospective patients decision-making process.

Decision Making process of consumers-. Customers pass through various stages before making a purchase. Five-stage decision-making process in any purchase is summarized in the diagram below:

RESEARCH QUESTION DEVELOPMENT The current study examines the different traits and conditions that influence a person to consider weight loss surgery. The information gathered from this study will aid in the understanding of the dynamics among the motivations and barriers to weight loss along with the underlying desire for a better quality of life. Unfortunately, the most formidable obstruction is a persons own psychology, e.g., he or she may find false comfort in resigning oneself to always being overweight or obese. Also, in a society that emphasizes unattainable standards of beauty, a person might be swayed by the paradoxes and criticisms presented by Hollywood. (Weightlossforall, 2009)

According to Thuan and Avignon (2005), the two biggest frustrations faced by health practitioners when assisting patients in weight loss treatments are poor compliance with the recommended program and lack of motivation tied to the setting of unrealistic goals. The most powerful factor to behavioral change to overcome such psychosocial barriers lies in the utilization of motivations for weight loss. The data collected will be useful to prospective bariatric surgery patients seeking a better quality of life for themselves and their loved ones. The survey has 7 questions/items developed from 13 using the 1-to5 Likert response scale that is anchored with 1 = strongly disagree, and 5 = strongly agree.

The questionnaire was distributed to patients outside obesity clinic in

I ndraprastha Apollo

hospital once they had met the surgeons. The various options for weight loss were explained to the patient along with information about bariatric surgery (lapararoscopic,robotic and open options). The cost associated with each were also explained.

RESULTS

Sample Characteristics Criteria Age characteristics Average Number of Children Gender (female) Male Married Single Divorced graduates Post graduates High school

Statistic (Average age) 40.667 0.8 Percentage 53% 43% 77% 20% 3% 73% 23% 4%

Distribution of gender Distribution of gender

MALE MALE FEMALE FEMALE

43% 43%

57% 57%

DISTRIBUTION OF GENDER

Scales Means Scale Self Blame Depression Partner Criticism Quality of Life Professional life affected Low on confidence Scales Means Scale Ratings of bariatric surgery

Mean 2.4 4.10 4 3.4744 1.53 1.43 Mean 3.22

Standard Deviation 1.607 0.711 0.718 0.33916 0.57 0.77 Standard Deviation 1.2195

Frequency

Percent

Cumulative Percent

Word of mouth Internet search Active search

4 19 6

12.5 59.4 18.8

12.5 71.9 90.6

Preference in case of surgery open laparoscopic robotic

Frequency

Percent 0 77 23

19 6

Cumulative Percent 0 77 100

Further one sample t test was done, From this we can figure out that depression is the most important characteristic for people who are undergoing barriatic surgery.As the depression has the highest mean out of other variables studied.

Null hypothesis is that all emotional variables considerd in the study are simply random samples And equally affect the consumer decision for bariatric surgery

Rejecting the null hypothesis implies that different variables have different impact oon decision making process

we rejected null hypothesis. Therefore means for all the 7 variables are different and hence Depression is the most important variable to be targeted for convincing for surgery

DiscussionAverage age was 40.66 years,53% being women. 77% of those surveyed were married.73% were graduates. As an aid to assess decision making process for bariatric surgery, Motivation for bariatric surgery cannot be explained by self blame.(mean 2.4),affect on professional life or low confidence. However marketers can target depression among prospective customers and Partner criticism by customers as an aid in decision making process.

Internet search(59.4%) is predominant form of search. Therefore marketers can add information on internet about bariatric surgery. The most preferred option for surgery is laparoscopic . however robotics is the upcoming method for surgery and therefore inorder to change consumer perception marketers would have to consider alternative options to increase its popularity(not considered in the study)

Distribution of samples based on Annual Income

>20 Lakhs 17%

Dependant 16%

4-10 Lakhs 17% 10-20 Lakhs 50%

Distribution based on marital status

Divorcee 3%

Single 20%

Married 77%

DISTRIBUTION ACCORDING TO EDUCATIONAL STATUS

POSTGRAD 23%

HIGH SCHOOL 4%

GRADUATE 73%

Conclusion-A surgeon should concentrate on depression as the most important emotional factor for convincing patients for Bariatric Surgery.Furger internet is an important vehicle for promoting bariatric surgery. Therefore a surgeon should consider putting videos of the procedure on you tube.
Positioning Statement As written in the highly revered book Crossing the Chasm (Copyright 1991, by Geoffrey Moore, HarperCollins Publishers), the position statement is a phrase so formulated: For (target customer) who (statement of the need or opportunity), the (product name) is a (product category) that (statement of key benefit that is, compelling reason to buy). Unlike (primary competitive alternative), our product (statement of primary differentiation). Therefore target customer women Reduce weight

Baratric surgery Indraprastha apollo hospital Statament- time to give up depression