One Racial Group Is Less Likely to Go Through With Bariatric Surgery

After patients with obesity discuss bariatric surgery with a clinician, racial disparities appeared to affect who moves forward with the procedure, according to 20 years of retrospective data.

Among 122,487 patients with class II obesity or higher (BMI ≥35), 9.1% discussed metabolic and bariatric surgery with their healthcare provider and 12.2% of these progressed to surgery from 2000 through 2020, reported Alexander Turchin, MD, MS, of Brigham and Women’s Hospital in Boston, and colleagues.

Although a comparable proportion of Black and non-Black patients discussed surgical weight loss with their provider (9.5% vs 9%, P=0.09), Black patients were significantly less likely to subsequently undergo metabolic surgery (8.4% vs 12.6%, PAnnals of Surgery Open.

This translated to a 44% lower odds of Black patients proceeding to surgery compared with other racial and ethnic groups (OR 0.56, 95% CI 0.45-0.70).

“Our findings indicate that we need to improve these conversations and identify barriers to undergoing surgery once it has been discussed,” Turchin said in a statement. “Providers need to ensure that patients have all the available information to make decisions about obesity treatments.”

American Society for Metabolic and Bariatric Surgery guidelines recommend metabolic and bariatric surgery when BMI is 35 or higher, regardless of whether it has led to health conditions or their level of severity.

“As a clinician, I often see patients who could potentially benefit from metabolic and bariatric surgery but who aren’t aware of this treatment option. Patients who discuss metabolic and bariatric surgery are much more likely to undertake it and lose weight,” Turchin added.

Turchin and co-authors said the majority of patients first discussed surgery with their primary care physicians, “indicating that these physicians should be the primary target of interventions meant to increase metabolic and bariatric surgery uptake.”

The current findings are congruent with prior research that reported Black people were less likely to undergo metabolic surgery despite higher rates of obesity and comorbidities such as type 2 diabetes.

From 2017 to 2020, obesity rates in the U.S. reached almost 42% overall but nearly 50% among the age-adjusted Black population. In this study, Black patients had higher rates of diabetes (10% vs 7.1%, PP

“Prior research has shown that Black patients are less likely to accept recommendations for surgical procedures. Possible reasons for this observation include implicit provider bias, higher rates of medical mistrust, and lower levels of health literacy,” the researchers explained.

One silver lining was that these discussions became more common over the past two decades, rising from 3.2% to 10% (PP=0.044).

“This increase in discussion rates mirrors the increased safety of metabolic and bariatric surgery procedures over the past 20 years,” the researchers added. Although more conversations are being had, Turchin’s group said that the shift towards anti-obesity pharmacotherapy like GLP-1 receptor agonists may change the landscape of future providers’ discussions of metabolic surgery.

Beyond racial disparities, the expected gender differences also emerged, as bariatric surgery has historically been more popular among women. Men were significantly less likely than women to both discuss (8.1% vs 9.6%, PPP=0.037).

Also, patients with higher BMIs were significantly, albeit modestly, more likely to progress to surgery than those with lower BMIs (OR 1.081, 95% CI 1.011-1.026, P

Data for the analysis came from a review of electronic health records of adult patients with class II obesity or higher and under the age of 65, who were followed in primary care practices affiliated with Mass General Brigham from 2000 through 2022. Grounds for exclusion included prior metabolic surgery and significant comorbidities that would be a contraindication to surgery like health failure or drug use disorder.

Median age among the overall cohort was 45, and median BMI was 37.3. About 62% were women, 75.1% were white, 10.2% were Black, 5.1% were Hispanic, and 1.4% were Asian.

One limitation of the study was a lack of information on whether or not the clinician discussed nonsurgical weight-loss modalities with the patient, like medication or lifestyle interventions.

Turchin’s group suggested future studies should assess patient barriers to receiving metabolic surgery once surgery has been recommended by a healthcare provider.

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