Bridging the Gap: Addressing Barriers in Bariatric Surgery Training in Pakistan

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Background Obesity is a growing public health crisis in Pakistan, with increasing numbers of individuals experiencing obesity related complications such as diabetes and cardiovascular disease. Metabolic and bariatric surgery (MBS) is a well-established, evidence-based intervention for managing severe obesity. However, its utilization remains suboptimal in many low- and middle-income countries, including Pakistan. Despite an increasing clinical need, MBS training and practice remain underdeveloped in Pakistan. This study aims to identify key barriers impeding MBS development and explore potential solutions through a nationwide survey of surgical professionals. Methods A survey was distributed among surgery residents, fellows, and consultants in major hospitals across Pakistan. Designed using Google Forms, the questionnaire included consent and biodata forms, along with eight questions each addressing barriers and solutions in MBS training and practice. Responses were evaluated using a 5-point Likert scale. Reliability analysis, descriptive statistics, and the Pearson chi-square test were utilized for data analysis. Results We received 55 responses from 25 hospitals nationwide between February and March 2024. Participants, with an average age of 37.7 ± 10.2 years and 21.8% female representation, included residents (38.2%), fellows (20%), and consultant surgeons (41.8%). Notably, 27.3% had formal MBS training, while 12.7% had over five years of experience. Key barriers identified encompassed limited public and surgeon awareness, financial limitations, unclear guidelines, faculty shortages, societal stigma, and policy gaps regarding MBS as a treatment for obesity. Proposed solutions included media campaigns, international collaborations, exchange programs, policy reforms, establishing a national MBS registry and center of excellence, mentorship programs, and tailored guidelines by the Pakistan Society of Metabolic and Bariatric Surgery (PSMBS). Conclusion There is an urgent need to address the multifactorial barriers hindering MBS expansion in Pakistan. Strengthening training infrastructure, enhancing public and professional awareness, and developing a robust policy framework are critical steps toward improving access to surgical care for obesity and reducing the national burden of related comorbidities.

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