Bariatric surgery likely to generate substantial economic benefits by increasing earnings and employment opportunities

Bariatric surgery results in a sustained increase in the probability of being a paid employee from four months after surgery over the five-year follow-up period, leading to increased earnings, according to a study by UK researchers.

The researchers noted that there is substantial evidence that living with obesity can affect an individual’s pay and employment however, there is little evidence on the impact of weight-management interventions, such as surgery, in improving labour market outcomes of individuals. Therefore, the researchers evaluated the impact of bariatric surgery on monthly earnings and employee status among working-age adults, and examine variations across sociodemographic characteristics.

The study identified 43,968 individuals who had bariatric surgery with a hospital obesity diagnosis during follow-up, with no prior history of bariatric surgery. After restricting to those aged 25–64 years at time of surgery, resident in England and who could link to census and PAYE datasets, 40,662 individuals (92.5%) remained for analysis. The researchers then included a cohort of 49,921 sex- and age-matched individuals in Census 2011 who had not had bariatric surgery.

Individuals who were living with obesity and had bariatric surgery had a mean age of 45 years, 80% were female and 85% were of White ethnicity. Compared with the cohort who had not had bariatric surgery, those who had a bariatric surgery procedure were broadly similar by ethnic group distribution, but were less likely of Asian and more likely of Black ethnicity. The largest differences between the two groups were observed for morbidity measured using the Charlson Comorbidity Score, disability, region of residence and area-level socioeconomic deprivation, with people who had bariatric surgery more likely to have a higher burden of morbidity, have a disability and live in more deprived areas.

The overall median follow-up was 88 months, with a maximum of 105 months for both those who had bariatric surgery and those who did not. In those with bariatric surgery, median follow-up time was 48 months pre-surgery and 57 months post-surgery. The most common bariatric procedures were Roux-en-Y bypass (20,427; 50.2%) and sleeve gastrectomy (15,329; 37.7%). The number of procedures performed each month remained consistent until the COVID-19 pandemic, where large decreases were seen in the number of operations performed.

Among individuals who underwent bariatric surgery, the employment rate was 56.2% in the pre-surgery and 52.9% in the post-surgery period. Unadjusted median monthly deflated earnings were £1,368 in the pre-surgery and £1,337 in the post-surgery period; corresponding figures when omitting months for which people were not in work were £2,437 and £2,528. Earnings and employment rate were higher among those who did not undergo bariatric surgery, with median monthly earnings of £1,828 overall and £2,901 among those in work only, and an overall employment rate of 64.7%. Employment rate and overall earnings were lower post- than pre-index date, as they were for those who underwent bariatric surgery.

Bariatric surgery was associated with a sustained increase in the probability of being a paid employee. Compared to pre-surgery level, the probability of being a paid employee decreased by 0.8 (95% Cl: 0.6–1.0) percentage points in the month after surgery, increasing to pre-surgery levels by the third month after the month of surgery. The employment probability then increased by 1.5 (95% Cl: 1.3–1.8) percentage points in months 6–12 after surgery and continued increasing, reaching a maximum of 4.3 (3.7–4.9) percentage points higher than pre-surgery levels in the months 54–60 after surgery. There was evidence of pre-surgery trends, with increased probabilities in the months before surgery compared to the 6 months immediately prior to surgery.

Bariatric surgery was also associated with a sustained average increase in employee pay, following a short decrease in pay in the first few months following surgery. Compared with the pre-surgery levels, employee earnings decreased in the month after surgery by an average of £117 (95% Cl: 110–124), before increasing to pre-surgery levels by the fourth month after surgery. Compared to the six months before surgery, employee pay then increased to £61 (95% Cl: 49–72) more than pre-surgery levels in months 18–24 after surgery, and continued to gradually increase compared to the six months before surgery to £84 (63–106) more than pre-surgery levels in months 54–60 after surgery. There were no pre-surgery trends for employee pay overall.

Conversely, bariatric surgery was not strongly associated with an increase in pay among those in work, where only the months in which individuals were in paid employment were included in the analysis. Pay among those in work initially decreased in the month after surgery, by an average of £206 (95% Cl: 194–218) compared with pre-surgery levels, before increasing to pre-surgery levels by the fifth month after surgery. However, employee pay among those in work remained only slightly above or the same as pre-surgery levels in the following months, with a maximum of £21 (95% Cl: 6–36) more than pre-surgery levels in months 18–24 after surgery.

There were no pre-surgery trends for employee pay overall and only a very small, possible downward trend in the pre-surgery trends for employee pay among those in work.

“To our knowledge, this is the largest population-wide study of labour market outcomes of bariatric surgery internationally, and the only such study outside of Scandinavia and Belgium. This investigation was made possible by a new national linked dataset comprising electronic health records, sociodemographic information and monthly pay records, which is the first linked dataset containing labour market and health data with near-complete coverage for individuals in England,” the researchers concluded. “This (study) suggests that living with obesity negatively impacts labour market outcomes and obesity care interventions are likely to generate substantial economic benefits by increasing earnings and employment of people living with obesity, mediated by intentional weight-loss maintenance due to having had bariatric surgery.”

The findings were reported in the paper, ‘Impact of bariatric surgery on monthly earnings and employment: a national linked data study in England, 2014–2022’, published in the International Journal of Obesity. To access this paper, please click here