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Gender disparity

Major gender disparity among bariatric patients

80% percent of patients who undergo bariatric surgery are female, despite equal rates of obesity among American men and women

Researchers at the University of California, San Diego School of Medicine, have identified demographic, socioeconomic and cultural factors that contribute to a major gender disparity among US men and women undergoing bariatric surgery. The study, Benefits of Bariatric Surgery Do Not Reach Obese Men', published in the Journal of Laparoendoscopic & Advanced Surgical Techniques, reports that 80% percent of patients who undergo bariatric surgery are female, despite equal rates of obesity among American men and women.

"The results of this study should raise awareness in men about the complications that obesity brings to their health," said senior author Dr Santiago Horgan, chief of the Division of Minimally Invasive Surgery at UC San Diego Health System. "Even though we have a 50-50 percent split in obesity rates among US men and women, women get 80 percent of the bariatric surgeries and men only 20 percent. That's a very uneven distribution."

The investigators carried out a retrospective analysis of the Nationwide Inpatient Sample of patients who underwent open or laparoscopic gastric bypass or sleeve gastrectomy and who were identified using International Classification of Diseases, 9th edition codes. Female gender was used as a dependent variable to determine factors that influence gender distribution. Multivariate analyses adjusted for age, race, state within the US, Charlson Comorbidity Index, income level, and insurance status.

They found that from 1998 to 2010, 190,705 patients underwent bariatric surgery (93% gastric bypass, 7% sleeve gastrectomy) and females made up 81.36% of the surgical population. An 80% to 20% female to male distribution was maintained for every year (1998–2010) and was unchanged within individual states. Patients were more likely to be female if from a lower-income neighbourhood or if African American or Hispanic (p<0.05). Patients were less likely to be female with increasing age, more comorbidities, or private insurance (p<0.05).

Horgan said the study explored non-biological factors that may be causing fewer men to seek weight reduction surgery. "We think some of it is cultural. Women seem to be more aware of the problems obesity brings to health. They are much more willing to look at surgical weight loss earlier in life, whereas men tend to wait until they have more co-morbidities."

Santiago Horgan

He pointed to a 2014 study from Kansas State University showing differences in health satisfaction between obese men and women. That study found that 72.8 percent-94.0 percent of overweight and obese men were satisfied with their health as compared to 56.7 percent-85.0 percent of overweight and obese women.

"This skewed male body perception hinders the likelihood of seeking healthcare advice," he said. "This is something we hope to change by educating men about the need to treat obesity earlier, so they don't develop complications in the future. Bariatric surgery contributes to improving medical conditions associated with obesity, such as diabetes, high blood pressure, high cholesterol, sleep apnoea, and arthritis. Men need to wake-up to the need to control their obesity."

Age also plays a pivotal role in the gender differences, said co-author Dr Cristina Harnsberger of the UC San Diego Department of Surgery's Division of Minimally Invasive Surgery, noting more men seek bariatric surgery as they age. "There are still more women than men, but when people get into their 70s, the split narrows to about 70 percent women to 30 percent men," she said. "Once they get sicker and older, men begin to seek bariatric surgery in greater numbers."

Another possible explanation for the higher rate of females undergoing bariatric surgery is greater eligibility, said the researchers. A recent analysis of racial trends in US bariatric surgery by Medical University of South Carolina researchers found an overall larger proportion of females were eligible for the surgery from 1999-2010. According to the National Hospital Discharge Survey and National Health and Nutrition Examination Survey databases, the proportion held true across ethnic groups.

The scientists did note that race and income appeared to affect male to female surgery ratios within certain populations.

"A significantly higher female percentage was observed in counties with lower median income as well as in some ethnic groups," said Dr Hans Fuchs, co-first author with Dr Ryan Broderick, both of the UC San Diego Division of Minimally Invasive Surgery."This suggests that cultural differences and racial differences may accentuate the gender disparity," said Broderick.

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