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Racial Disparities in Bariatric Surgery

A number of recent studies describe substantial racial disparities in accessing surgical treatment for obesity. Significant racial disparities in the health burden of obesity have been known for some time. So understanding disparate access to treatment is essential to understanding the larger picture.

The American Journal of Gastroenterology just published a study of inpatient bariatric surgery in the U.S. among eligible patients that found twice as many white patients received obesity surgery as black patients did. This was true despite the fact that nearly twice as many black women met objective criteria for the surgery.

One of the authors, Sonia Saxena, commented on the reasons behind these disparities:

Our new findings suggest that differences in insurance coverage are part of the reason why black Americans are less likely to have bariatric surgery, but it may not be the whole story. We need more research to look at whether cultural differences, perhaps a greater acceptance of obesity, lack of awareness of the risks or mistrust of doctors, might also be contributing.

In another study, Mathias Worni and colleagues analyzed data from the Nationwide Inpatient Sample of AHRQ and found that utilization rates for obesity surgery improved between 2002 and 2008 for African Americans, but not for Latinos. For both groups utilization remained significantly lower than for white patients.

On top of the disparities of access, two other recent studies document disparities in outcomes. Geoffrey Nguyen and Akash Patel found that black patients undergoing bariatric surgery suffered higher rates of inpatient mortality than whites. These disparities were highest for men and at hospitals with low surgical volumes.

In yet another study, Lily Cheung and colleagues found that African American and Latino patients undergoing obesity surgery had 25% less successful outcomes than white patients, as measured by percent excess weight lost.

Adding racial disparities to the well documented bias against larger patients more generally leaves us wondering, how can healthcare providers and policymakers accept this sorry state of affairs?

Click here to read more in HealthDay, click here to read the study in AJG, click here to read the study by Worni et al, click here to read the study by Nguyen and Patel, and click here to read the study by Cheung et al.

Walk Participant, photograph © Michael L. Baird / flickr

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