Researchers from Rush University Medical Center in Chicago conducted a state-by-state analysis of nearly 100,000 patients who had bariatric surgery (either sleeve gastrectomy or gastric bypass) between 2010 to 2019 from a pool of 1,789,457 patients who were deemed eligible for surgery but did not get it. Patient data was obtained from the PearlDiver Mariner insurance claims database.
According to the study, the overall utilization of bariatric surgery was highest in New Jersey (10.4%), Rhode Island (9.6%) and Delaware (9.2%) and lowest in Vermont (2.1%), Arkansas (2.6%), Alabama (2.8%) and West Virginia (2.8%) – a four to five-fold difference in utilization rates between states. The U.S. Centers for Disease Control and Prevention (CDC) reports Midwestern (33.9%) and Southern (33.3%) states have the highest prevalence of obesity, followed by states in the Northeast (29.0%) and the West (27.4%).
“The best treatment for severe obesity is also unfortunately the most underutilized by many of the very people who can most benefit,” said study co-author Scott Schimpke, MD, Assistant Professor, Division of Minimally Invasive and Bariatric surgery, Rush Medical College. “These state disparities in utilization, and the factors contributing to it, need to be better understood and addressed to ensure equitable access to bariatric surgery and to reduce the burden of obesity in America.”
The study authors note that multiple factors may contribute to state variation in bariatric surgery utilization, including physician beliefs, the number of bariatric surgeons, financial incentives, insurance coverage, policy differences, and patient characteristics. Only about 256,000 bariatric surgeries were performed in the U.S. in 2019, which represents less than 1% of the country’s currently eligible surgical population.
Eligible adults include those with a body mass index (BMI) of at least 35 with an obesity-related condition such as diabetes, or a BMI of at least 40. BMI is an estimate of body fat based on weight and height. The CDC reports 42.4% of adults in the U.S. had obesity in 2017-2018. Another 9.2% had severe obesity. Obesity is linked to more than 40 diseases including type 2 diabetes, hypertension, heart disease, stroke, sleep apnea, osteoarthritis and at least 13 different types of cancer.,,
“Bariatric surgery remains one of the most underutilized treatments in all of medicine,” said Matthew M. Hutter, MD, MPH, President of the ASMBS and Professor of Surgery at Harvard Medical School, who was not involved in the study. “Access to this life-saving and transformational treatment should not be determined by zip code but rather by medical need.”
Metabolic/bariatric surgery has been shown to be the most effective and long-lasting treatment for severe obesity, resulting in significant weight loss and resolution or improvements in diabetes, heart disease, sleep apnea and many other obesity-related diseases. The safety profile of laparoscopic bariatric surgery has become comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.
About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.
*Sat 6.12.21 Paper Session 3
“Variation in bariatric surgery utilization by state from 2010 to 2019: analysis of the PearlDiver Mariner database”
Presentation: 4:11 PM – 4:16 PM ET; Discussion 4:16 PM – 4:19 PM ET
Main Presenter: Seungjun Kim
Co-Author: Scott Schimpke
1The Effectiveness and Risks of Bariatric Surgery: An Updated Systematic Review and Meta-analysis, 2003-2012. Accessed from: https://jamanetwork.com/journals/jamasurgery/fullarticle/1790378
2Steele CB, Thomas CC, Henley SJ, et al. Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014. MMWR Morb Mortal Wkly Rep 2017;66:1052–1058. DOI: http://dx.doi.org/10.15585/mmwr.mm6639e1
3Centers for Disease Control and Prevention. (2015) The Health Effects of Overweight and Obesity. Accessed from: https://www.cdc.gov/healthyweight/effects/index.html
4Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370
5Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/