Race, sex disparities persist in weight-loss surgery
Click Here to Manage Email Alerts
Key takeaways:
- Men were less likely than women and Black patients were less likely than those of other races to undergo weight-loss surgery.
- Sex disparities increased over time while racial disparities narrowed slightly.
Men were less likely than women to have weight-loss surgery, and that gap has widened over time, while Black patients were less likely than those of other races to have a procedure, and that gap has narrowed slightly, new data show.
“Metabolic/bariatric surgery is a safe and very effective treatment of obesity,” Alexander Turchin, MD, MS, director of quality in diabetes at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, told Healio. “Nevertheless, previous research has shown that Black patients undergo metabolic/bariatric surgery less frequently than white patients, even though they have higher rates of obesity and its complications. It is also known that men undergo metabolic/bariatric surgery at significantly lower rates than women, despite having similar risks of complications. The goal of this study was to understand why this happens and how it has changed over the last 20 years.”
Disparities in weight-loss surgery
Turchin and colleagues conducted a retrospective cohort study of electronic health records of 122,487 patients eligible for weight-loss surgery. The primary outcomes were discussion of weight-loss surgery between patients and health care professionals and progression to weight-loss surgery.
Among the cohort, 9.1% discussed weight-loss surgery with a health care professional, and of those, 12.2% progressed to surgery.
The percentage of patients who had a weight-loss surgery discussion rose from 3.2% in 2000 to 10% in 2020, according to the researchers.
Compared with patients of other races, Black patients were just as likely to discuss weight-loss surgery with a health care professional (Black patients, 9.5%; other patients, 9%; P = .09), but were less likely to progress to surgery (8.4% vs. 12.6%; OR = 0.56; 95% CI, 0.45–0.7; P < .001), though the disparity narrowed between 2000 and 2020 (P = .044), Turchin and colleagues found.
Compared with women, men were less likely to discuss weight-loss surgery with a health care professional (8.1% vs. 9.6%; P < .001) and to undergo surgery (7.6% vs. 14.6%; OR = 2.06; 95% CI, 1.79-2.37; P < .001), and this disparity widened by 2.7% per year between 2000 and 2020 (P = .037), the researchers found.
‘We were surprised’
“We were surprised to see that sex disparities in metabolic/bariatric surgery are actually growing despite the adverse health effects of obesity becoming more widely publicized in the media,” Turchin told Healio.
Clinicians may need to take a more active role in raising the topic of weight-loss surgery with their patients, he said.
“As clinicians, we need to talk about weight-loss surgery to our patients. There are many people who could benefit from it; for whom it could reduce the risk of heart attacks, cancer and death,” he told Healio. “We need to make it clear to our patients that excess weight has numerous adverse health consequences, and that treating it can improve both quality and duration of their lives. We need to make sure that our patients have the information they need to make decisions on how they can improve their long-term health.”
He also noted that the topic is important because advances in anti-obesity medications “do not make weight-loss surgery irrelevant.”
“There are many people who may not tolerate weight-loss medications; for whom weight-loss medications are not effective; or for whom they are not effective enough,” Turchin told Healio. “All of these individuals could benefit from weight-loss surgery, alone or in combination with weight-loss medications. Just because we have a new toy, we can’t forget about the tried-and-true treatment of obesity — weight-loss surgery — that has helped thousands of patients over the years.”
For more information:
Alexander Turchin, MD, MS, can be reached at aturchin@bwh.harvard.edu.
Collapse
Read more about
Click Here to Manage Email Alerts