A recent study of 20 years of retrospective data highlights a troubling racial disparity in the uptake of bariatric surgery among patients with obesity. The study, which analyzed over 120,000 patients with class II obesity or higher (BMI ≥35), found that although Black and non-Black patients were equally likely to discuss bariatric surgery with their healthcare providers, Black patients were significantly less likely to proceed with the procedure.
The research, led by Dr. Alexander Turchin and colleagues from Brigham and Women’s Hospital in Boston, revealed that 9.1% of patients discussed bariatric surgery, and 12.2% of those went on to have the surgery between 2000 and 2020. However, Black patients were found to have a 44% lower chance of moving forward with the procedure compared to other racial groups. Specifically, only 8.4% of Black patients underwent surgery after discussion, compared to 12.6% of non-Black patients.
Dr. Turchin explained that improving conversations around bariatric surgery and addressing the barriers that prevent patients from proceeding with the surgery are essential for better health outcomes. According to him, healthcare providers should ensure that patients are well-informed about all available treatment options for obesity.
The findings are consistent with previous research showing that Black patients are less likely to pursue metabolic surgery despite having higher rates of obesity and associated comorbidities, such as type 2 diabetes. From 2017 to 2020, obesity rates in the U.S. reached nearly 42%, with the rate for Black Americans approaching 50%. In the study, Black patients also had higher rates of diabetes and a slightly higher average BMI compared to non-Black patients.
While the reasons for these racial disparities are not fully understood, Dr. Turchin’s team pointed to possible factors such as implicit provider bias, greater medical mistrust, and lower levels of health literacy among Black patients. Additionally, they noted that Black patients may be less likely to accept surgical recommendations.
However, the study did show some progress over time. The percentage of patients discussing bariatric surgery rose from 3.2% in 2000 to 10% in 2020. Furthermore, the gap between Black and non-Black patients’ progression to surgery has gradually narrowed by 4.4% annually. This increase in discussion rates parallels the growing safety of metabolic and bariatric surgery over the past two decades.
Dr. Turchin also highlighted the shift towards pharmacotherapy, such as GLP-1 receptor agonists, which may change the landscape of future discussions around obesity treatment. This could potentially reduce the emphasis on bariatric surgery as a primary intervention for obesity.
In addition to racial disparities, gender differences were also evident. Women were significantly more likely than men to discuss and undergo bariatric surgery, with the gender gap widening over time. Men were 2.7% less likely each year to progress to surgery compared to women.
Interestingly, patients with higher BMIs were more likely to proceed with surgery, though the effect was modest.
The study, which included data from electronic health records of adult patients followed at Mass General Brigham, examined patients under 65 years of age with class II obesity or higher. The cohort had a median age of 45 and a median BMI of 37.3. Most patients were women (62%), and the racial breakdown was predominantly white (75.1%), with Black patients comprising 10.2%, Hispanic patients 5.1%, and Asian patients 1.4%.
One limitation of the study was the lack of data regarding whether healthcare providers discussed nonsurgical weight-loss interventions, such as medication or lifestyle changes, with their patients. Dr. Turchin’s team recommended that future studies explore the barriers that prevent patients from receiving metabolic surgery, even after it has been recommended by a healthcare provider.
This study underscores the need for targeted interventions that address racial and gender disparities in bariatric surgery, as well as the need to ensure that all patients are informed about and have access to a range of treatment options for obesity.
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