Male patients undergoing bariatric surgery present later in the process of obesity, are older, exhibit more obesity associated medical problems (OAMPs) in a more advanced stage and show more modifiable risk factors such as smoking, compared to female bariatric patients.
The paper’s authors from The Netherlands noted that the IFSO Global registry reported that between 2016 and 2020, 72.7–82.8% of patients undergoing bariatric surgery were female. Previous studies have suggested that the motivation for surgery for women is due to the social stigma and the emotional burden of obesity, whereas men mostly seek surgery for health reasons. Moreover, research has also suggested that primary care physicians are less inclined to recommend surgery to men that could lead to males presenting later in the process of severe obesity, with a higher BMI and more frequent and more advanced OAMPs.
Therefore, the researchers investigated the differences between males and females undergoing surgery concerning pre-operative patient characteristics and OAMPs. They used two bariatric cohorts from 2013 and 2019, in order to evaluate a possible trend over time in sex differences in OAMPs. Participants with severe obesity from the HELIUS study were used as a control group to inquire if trends in surgical patients were also present in a cohort with obesity in the general population.
In total, 3,244 patients were included in the analysis with all the cohorts comprised of more females than males, 667 (85.6%), 545 (78.4%) and 1,445 (81.6%) in BS2013, BS2019 and HELIUS, respectively. In the BS2013 and BS2019 cohorts males were significantly older at the time of surgery than females (p<0.001). Median (IQR) age in males versus females was 47.0 (41.0-53.8) vs 43.0 (36.0-51.0) years in BS2013, and 52.0 (39.8-57.0) vs 45.0 (35.0-53.0) years in BS2019 (p<0.001). During intake at the bariatric outpatient clinic BMI was higher in females (p=0.001), median (IQR) BMI in males versus females was 41.5 (38.4-45.2) vs 42.3 (40.2-45.9) in BS2013 (P=0.034), and 40.4 (37.4-43.8) vs 41.3 (39.0-44.1) in BS2019 (p= 0.023). In the HELIUS cohort, females were both significantly older and had a higher BMI.
OAMPs
In both BS cohorts, hypertension (53 (47.3%) vs 217 (32.5%) in BS2013 and 72 (48.0%) vs 153 (28.1%) in BS2019), type 2 diabetes (29 (25.9%) vs 103 (15.4%) in BS2013 and 36 (24.0%) vs 66 (12.1%) in BS2019), OSA (22 (19.6%) vs 28 (4.2%) in BS2013 and 64 (42.7%) vs 83 (15.2%) in BS2019) and dyslipidaemia (27 (24.1%) vs 82 (12.3%) in BS2013 and 26 (17.3%) vs 49 (9.0%) in BS2019) were significantly more prevalent in males undergoing BS (p≤0.004). Also, previous myocardial infarction (5 (4.5%) vs 4 (0.6%) in BS2013 and 16 (10.7%) vs 13 (2.4%) in BS2019) or other cardiological diagnoses (12 (10.7%) vs 22 (3.3%) in BS2013 and 25 (16.7%) vs 31 (5.7%) in 2019) were more prevalent in males than in females (p<0.001).
In the HELIUS cohort male patients more often had dyslipidaemia (69 (21.2%) vs 217 (15.0%) (p= 0.006) and a history of myocardial infarction (18 (5.6%) vs 27 (1.9%) (p<0.001). In the BS2019 group, men exhibited higher mean (IQR) HbA1c (38.00 (35.00-49.00) vs 36.50 (33.00-40.00)), more often had an elevated HbA1c > 42 (15 (11%) vs 30 (6%)) and had higher percentages of both NIDDM (20 (14.6%) vs 44 (8.9%)) and IDDM (16 (11.7%) vs 22 (4.4%)) vs females (p<0.001). In the HELIUS cohort, sex differences in T2D prevalence were clearly less pronounced than in the surgical group. In both BS2013 and BS2019, men presented significantly more often than females with 2, 3 or 4 OAMPs. In contrast, in the HELIUS cohort no difference in the number of OAMPs between males and females was found. In BS19 males with type 2 diabetes and hypertension used more antidiabetics and antihypertensives vs females (p=0.004), and also used more anticoagulants and cholesterol lowering agents.
Female patients were deemed eligible due to a BMI above 40 without any OAMPs (305 (45.7%) in BS 2013 and 228 (41.8%) in BS2019), despite males presenting with OAMPs independent of BMI. In the HELIUS cohort, an equal proportion of males and females were theoretically eligible for surgery, 216 (66.5%) versus 964 (66,7%).
According to the authors, this study is the first to show that male patients who choose surgery significantly more often suffer from both a higher number of and more advanced medical problems than females.
“This study should prompt physicians to be aware of the unjustified underrepresentation of males in the bariatric surgery population, at the expense of the individual’s obesity related morbidity and mortality risks,” the authors concluded. “Hence, male patients suffering from severe obesity should be referred for BS sooner, as the numbers of years lived with obesity is directly associated with the risk of all-cause morbidity and mortality, and disappointing weight loss results after bariatric surgery.”
The findings were reported in the paper, ‘Are male patients undergoing bariatric surgery less healthy than females?’, published in SOARD. To access this paper, please click here