Study Reveals How Sex and Racial Disparities in Weight Loss Surgery Have Changed Over 20 Years

A new study by Mass General Brigham investigators shows persistent racial disparities and growing sex disparities between patients who discussed and received weight loss surgery between 2000 and 2020. Using artificial intelligence to analyze the medical records of more than 120,000 patients with obesity, researchers found that Black people were less likely than non-Black people to undergo metabolic and bariatric surgery (MBS) – even though both groups were equally likely to discuss it with health care providers. In addition, men were both less likely to discuss and receive MBS than women. These findings, published in Annals of Surgery Open, highlight the need for interventions that encourage patients from all backgrounds to progress from discussion to utilization of MBS.

“As a clinician, I often see patients who could potentially benefit from MBS but who aren’t aware of this treatment option. Patients who discuss MBS are much more likely to undertake it and lose weight,” said corresponding author Alexander Turchin, MD, MS, director of Quality in Diabetes at the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s Hospital (BWH), a founding member of the Mass General Brigham healthcare system. “Our findings indicate that we need to improve these conversations and identify barriers to undergoing surgery once it has been discussed.”

Obesity is a growing public health crisis in the United States, affecting more than 40% of all adults and nearly 50% of Black Americans. Although MBS is considered the most effective long-term treatment for severe obesity, research by other investigators at Mass General Brigham has shown a decline in bariatric surgery as prescriptions for GLP-1 drugs have surged. In addition, prior research has shown that fewer Black and male patients undertake MBS than other racial groups and female patients, respectively. However, it has been unclear how these differences change between patient visits to care providers and over time.

Using an artificial intelligence tool, the research team examined electronic health records of 122,487 adults with class 2 obesity and higher who received care at Mass General Brigham between 2000 and 2022. They determined that most patients (74%) first explored MBS with primary care physicians and that annual patient-provider MBS discussions increased from 3.2% to 10% during the 20-year study period. Of the 11,094 (9.1%) patients who discussed MBS with care providers, 1,348 (12.2%) progressed to surgery. 

While Black and non-Black patients had comparable MBS discussion rates, only 8.4% of Black patients proceeded with surgery, compared to 12.6% of patients from other racial or ethnic groups. Men were significantly less likely to discuss MBS with providers and were much less likely to progress to surgery than women (7.6% versus 14.6%). The researchers also demonstrated that racial differences in MBS progression decreased over the study period, while sex disparities increased during the same time.

The authors propose many reasons that could underlie the observed racial and sex disparities, including heightened medical mistrust and disproportionate social pressure to lose weight. They also note that their analysis was limited to a single health care system in Massachusetts and might not be representative of the entire U.S. population.

“Providers need to ensure that patients have all the available information to make decisions about obesity treatments,” said Turchin. “Future studies will be required to understand how the advent of new medications to treat obesity such as GLP-1 agonists impacts patient-provider discussions about MBS.”

Authorship: In addition to Turchin, Mass General Brigham authors include Benjamin Grobman, Liyun He, Zhou Lan, Abdelrahman Nimeri, and Caroline Apovian. 

Disclosures: Turchin reported research grants from Eli Lilly and consulting fees from Novo Nordisk and Proteomics International Laboratories. Additional author disclosures can be found in the paper. 
 
Funding: This research was funded in part by Patient-Centered Outcomes Research Institute (ME-2019C1-15328).

Paper cited: Grobman B et al. “Race and Sex Disparities in Metabolic / Bariatric Surgery over 20 Years: a Cohort Study” Annals of Surgery Open DOI: 10.1097/AS9.0000000000000540