Most obese patients who qualify for weight loss surgery don’t seek it out, and that may be due at least partly to stigma, a U.S. survey suggests.

Nearly half of randomly-chosen survey participants said they believe the procedure is usually done for cosmetic rather than health reasons, and about 40 percent thought people who choose the surgery have taken “the easy way out,” researchers report in JAMA Surgery.

“Across the United States, there are adults who have obesity, and the health problems that come with obesity, who are not getting or even seeking the care they need because of the social stigma with being obese and having obesity surgery,” said senior author Dr. Heather Yeo of NewYork-Presbyterian/Weill Cornell Medicine in New York City. “This is actually a problem with physicians, too. Often they give patients advice to lose weight, but they don’t refer the patient to a weight loss specialist.”

Weight loss surgery involves one of several techniques for making the stomach smaller, to accommodate less food and curb appetite, sometimes also rerouting part of the digestive tract to bypass part of the intestines. Patients with a body mass index (BMI) in the obese and severely obese ranges are considered good candidates for the procedure.

These procedures, called bariatric surgery, can improve a host of conditions, including diabetes, hypertension and joint pain, Yeo said.

To assess how the public views bariatric surgery, Yeo and colleagues got three questions added to The Cornell National Social Survey, an annual survey that uses random-digit dial telephone sampling of English-speaking U.S. adults.

The questions were: Do you think people mostly have weight loss surgery for cosmetic or for health reasons?; Do you think weight loss surgery is usually an “easy way out?”; and Should health insurance cover medical procedures to help people lose weight?

Of the 948 people who answered these questions, 49.4 percent thought people had weight loss surgery for cosmetic reasons, 39.1 percent said people usually chose surgery as “the easy way out” and just 19.2 percent thought insurance should always pay for it.

Women were 34 percent more likely than men to say the surgery was for health reasons, 54 percent less likely to say it’s “the easy way out,” and 48 percent less likely to say insurance shouldn’t cover it. Non-Hispanic blacks were 61 percent more likely than others to call surgery “the easy way out.”

The findings align with other researchers’ findings, Yeo said.

“There have been smaller studies looking at who gets the surgery,” she explained. “And the results parallel what we saw about social stigma. The majority of people who get weight loss surgery are Caucasian, more educated and more likely to have higher household incomes.”

“This just confirmed what a lot of people in this field know,” said Dr. Yijun Chen of the University of California, Los Angeles, who wasn’t involved in the study. “It’s a big problem. And it continues even as more and more data accumulates supporting surgery in the treatment of patients with obesity.”

Chen said he hears consistent responses from patients who’ve had bariatric surgery: “About 90 percent felt it was one of the best decisions they’d made in their lives. About 60 to 70 percent said they had one regret: they didn’t do it sooner. And the reason why was stigma. The biggest issue in the field right now is, how do you change that bias.”