Race and Sex Disparities in Metabolic/Bariatric Surgery over 20 Years: A Cohort Study.

Objectives: To determine how rates of discussion of metabolic and bariatric surgery (MBS) between patients with class 2 obesity and higher and their healthcare providers as well as subsequent progression to MBS have varied by race and sex over the last 20 years.

Background: Obesity is a growing public health crisis. MBS remains the most effective treatment for long-term management of obesity.

Methods: Retrospective cohort study of electronic health records from a large tertiary academic health system using a previously validated natural language processing algorithm. The primary outcomes were discussion of MBS between eligible patients and providers and progression to surgery. Multivariable logistic regression was used to determine the association between sociodemographic factors, time, and discussion and receipt of MBS.

Results: Among 122,487 patients included in the analysis, 11,094 (9.1%) patients discussed MBS with their providers. Of these, 1348 (12.2%) progressed to MBS. Between 2000 and 2020 the annual fraction of patients who had a discussion of MBS with their providers rose from 3.2% to 10.0% (P < 0.001). Black people were equally likely to discuss MBS with providers as non-Black people (9.5 vs 9.0%, P = 0.09) but were less likely to progress to MBS (8.4 vs 12.6%, P < 0.001). These disparities in progression narrowed over the study period (P = 0.044). Men were less likely than women to both discuss (8.1% vs 9.6%, P < 0.001) and receive MBS (7.6% vs 14.6%, P < 0.001), and these disparities increased over the study period.

Conclusions: Interventions to reduce racial disparities in utilization of MBS should focus on progression from discussion to MBS. Interventions to increase the uptake of MBS among men are required across the care cascade.