Study: Racial, gender disparities persist in bariatric surgery

Editor's Note

Despite a rise in discussions about bariatric surgery, a retrospective study spanning two decades revealed persistent racial and gender disparities in which patients undergo the procedure. MedPage Today reported the news January 16.

The analysis, involving 122,487 patients, showed that only 9.1% with class II obesity or higher (BMI ≥35) discussed bariatric surgery with their healthcare provider, the outlet reports. Of those, 12.2% underwent surgery. Although a comparable proportion of Black and non-Black patients discussed surgical weight loss (9.5% vs. 9%, P=0.09), Black patients were significantly less likely to proceed to surgery (8.4% vs. 12.6%, P<0.001), with a 44% lower likelihood compared to non-Black patients (OR 0.56, 95% CI 0.45-0.70).

According to the article, these disparities align with prior findings showing lower rates of metabolic surgery among Black individuals despite higher obesity prevalence and comorbidities, such as type 2 diabetes. Black patients in this study also exhibited higher diabetes rates (10% vs. 7.1%, P<0.001) and higher average BMIs (39.4 vs. 39.1, P<0.001). Researchers attributed these disparities to factors such as implicit provider bias, medical mistrust, and lower health literacy, notin that the gap between Black and non-Black patients’ progression to surgery narrowed over time.

Gender disparities also persisted, MedPage reports, with men being less likely than women to discuss (8.1% vs. 9.6%, P<0.001) or undergo surgery (7.6% vs. 14.6%, P<0.001). Moreover, this gap widened, with the difference in progression rates increasing by 2.7% per year (P=0.037).

The study emphasized the role of primary care physicians as pivotal in initiating discussions about bariatric surgery, which the researchers linked to higher uptake of the procedure. However, the shift toward anti-obesity pharmacotherapy, such as GLP-1 receptor agonists, may influence future trends in surgical discussions.

The study, which reviewed electronic health records from patients affiliated with Mass General Brigham between 2000 and 2022, had limitations, including the lack of data on whether non-surgical weight-loss options were discussed. The researchers recommended further exploration into patient barriers following surgical recommendations.