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Bariatric surgery less commonly used in states with highest rates of obesity

Residents in several states with the highest obesity rates in the US are among the least likely to undergo bariatric surgery, according to a study presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2021 Annual Meeting.

Researchers from Rush University Medical Center in Chicago conducted a state-by-state analysis of nearly 100,000 patients who had bariatric surgery (either sleeve gastrectomy or gastric bypass) between 2010 to 2019 from a pool of 1,789,457 patients who were deemed eligible for surgery but did not get it. Patient data was obtained from the PearlDiver Mariner insurance claims database.

According to the study, the overall utilisation of bariatric surgery was highest in New Jersey (10.4%), Rhode Island (9.6%) and Delaware (9.2%) and lowest in Vermont (2.1%), Arkansas (2.6%), Alabama (2.8%) and West Virginia (2.8%) – a four to five-fold difference in utilisation rates between states. The US Centers for Disease Control and Prevention (CDC) reports Midwestern (33.9%) and Southern (33.3%) states have the highest prevalence of obesity, followed by states in the Northeast (29.0%) and the West (27.4%).

“The best treatment for severe obesity is also unfortunately the most underutilised by many of the very people who can most benefit,” said study co-author, Dr Scott Schimpke, Assistant Professor, Division of Minimally Invasive and Bariatric surgery, Rush Medical College. “These state disparities in utilization, and the factors contributing to it, need to be better understood and addressed to ensure equitable access to bariatric surgery and to reduce the burden of obesity in America.”

The study authors note that multiple factors may contribute to state variation in bariatric surgery utilisation, including physician beliefs, the number of bariatric surgeons, financial incentives, insurance coverage, policy differences, and patient characteristics. Only about 256,000 bariatric surgeries were performed in the US in 2019, which represents less than 1% of the country’s currently eligible surgical population.

“Bariatric surgery remains one of the most underutilized treatments in all of medicine,” said Dr Matthew M Hutter, MPH, President of the ASMBS and Professor of Surgery at Harvard Medical School, who was not involved in the study. “Access to this life-saving and transformational treatment should not be determined by zip code but rather by medical need."


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