Patient Perceptions and Barriers to Metabolic Bariatric Surgery Among Adults with Obesity in the West Bank, Palestine: A Cross-Sectional Study.

BACKGROUND

Metabolic bariatric surgery (MBS) is the most effective intervention for improving associated medical problems. However, patient misconceptions, knowledge gaps, and attitudinal barriers may influence acceptance, even among eligible individuals. In Palestine, where obesity exceeds one-third of adults, evidence regarding patient perceptions of MBS remains limited. This study assessed perceptions and barriers to MBS among adults with obesity in the West Bank.

METHODS

A cross-sectional study was conducted among adults (N = 424) with BMI ≥ 30 kg/m² across eleven West Bank governorates (February-March 2026). Participants completed a validated Arabic questionnaire assessing sociodemographics, obesity history, knowledge (14 items), and attitudes (11 items, 5-point Likert). Regression analyses identified factors associated with knowledge and attitudes (p < 0.05).

RESULTS

Mean age was 32.8 ± 12.9 years and mean BMI was 35.6 ± 5.2 kg/m². Overall, 76.9% demonstrated adequate knowledge (mean score 10.5 ± 2.5/14); attitudes were moderately positive (35.1 ± 8.1/55). Misconceptions persisted regarding diabetes remission (63.4%) and long-term weight-loss durability (66.7%). Fear of complications (63.2%), cost (60.1%), and social stigma (49.5%) were the principal barriers. Postgraduate education independently associated with adequate knowledge (AOR = 3.49, 95% CI 1.03-11.82); greater knowledge and previous non-surgical attempts associated with favorable attitudes. The model explained minimal attitude variance (adjusted R²=0.018), indicating unmeasured psychosocial determinants.

CONCLUSIONS

Despite adequate knowledge and moderately positive attitudes, important misconceptions and barriers persisted regarding metabolic benefits, long-term outcomes, and financial/social concerns. These potentially modifiable barriers may impede MBS acceptance. Targeted education, multidisciplinary counseling, and strategies addressing financial/social barriers may improve informed decision-making and facilitate access to bariatric care in Palestine and similar settings. The predominance of female participants (72.9%) should be considered when generalizing findings to men.

KEY POINTS: • Most participants had adequate MBS knowledge, but some knowledge gaps remained. • Fear, financial burden, and social stigma were major barriers to MBS. • Knowledge showed only a weak correlation with attitudes toward MBS. • Targeted education and counseling may support informed MBS decision-making.