Americans with severe obesity receive fewer surgeries despite rising need

A study led Pennington Biomedical researchers highlights growing disparities in standard surgical care access for individuals with extreme obesity and Americans with the highest levels of obesity are undergoing fewer surgical procedures overall. These procedures include common operations like knee or hip replacement, hernia surgery, and surgery of the breast, prostate and colon – operations that are frequently done to treat cancer.

“Understanding and addressing these disparities is increasingly urgent,” said Dr Philip Schauer, director of the Metamor Institute and United Companies Life Insurance Co/Mary Kay and Terrell Brown Chair at Pennington Biomedical. “As obesity prevalence continues to rise, healthcare systems must ensure equitable access to surgical evaluation, treatment and supportive infrastructure for patients across all BMI categories. Having severe obesity should not exclude someone from getting the surgical care they need whether it’s gallbladder surgery, hernia surgery or haemorrhoid surgery, for example.”

The study authors say these trends are concerning because rising obesity nationally should lead to more, not fewer, surgeries for common obesity-related diseases and ailments.

“This study reveals a concerning disconnect between the growing prevalence of severe obesity and access to surgical care for a variety of common operations,” said senior author, Dr Vance Albaugh of Pennington Biomedical and the Metamor Institute. “Individuals at the highest BMI levels carry the greatest burden of obesity-related disease, yet they appear to be receiving proportionally fewer surgical interventions each year.”

The study analysed more than 11.6 million surgical cases from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2005 and 2022. Investigators found that patients having a higher body mass index (BMI) or extreme obesity experienced progressively lower representation in surgical care over time. Despite the increased prevalence of extreme obesity, these individuals appear to be undergoing fewer operations year after year.

Relative change in surgical case prevalence stratified by BMI, 2005–2022. Credit: Obesity (2026). DOI: 10.1002/oby.70240

Since it is known that obesity is associated with increased risks for a number of conditions that are treated by surgical intervention, there is a critical need to identify the mechanisms underlying these disparities to enable equitable healthcare access to higher BMI populations.

The research team used multinomial logistic regression models adjusted for demographics, health status and comorbidities to evaluate surgical trends across BMI categories. Results showed that the higher the BMI category, the greater the decline in operative representation over time.

Regression models demonstrated decreased odds of patients with BMI≥50kg/m2 undergoing surgery over consecutive years, with increasingly higher BMI groups representing greater declines. Patients with BMI 30.0–39.9 kg/m2 demonstrated increased proportional operative volume.

Researchers suggest the findings may reflect multiple barriers to care, including:

• Increased surgical complexity and perioperative risk

• Limited access to specialized equipment and infrastructure

• Reduced eligibility for elective procedures

• Delayed diagnosis and preventive care access

  
  

The authors warn that reduced access to surgical intervention could contribute to worsening health outcomes and more advanced disease presentation among patients with severe obesity.

The study also examined trends across surgical specialties, including general surgery, gynaecology, cardiac surgery and thoracic surgery. Declines in surgical representation among higher BMI groups were most pronounced in general surgery and abdominal procedures.

Collaborators on the study included researchers from Pennington Biomedical, LSU Health New Orleans, University of South Florida and other affiliated institutions. The study was supported in part by the Louisiana Clinical and Translational Science Institute (LA CaTS) and the Louisiana Optical Network Infrastructure (LONI). Dr. Albaugh is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant DK138261.

The findings were reported in the paper, 'Increasing Obesity Severity Is Associated With Less Surgical Care in the United States', published in Obesity. To access this paper, please click here