Gastric Bypass Results Over Time in Black and White

Tea TimeNew data this week in SOARD tells us once again that gastric bypass can produce impressive results over time for someone with severe obesity. After ten years, Su-Hsin Chang and colleagues found that their cohort of 1,104 patients had maintained an average 31 percent reduction in body weight.

Best Results for White Women

But it also tells us that this system of care provides the best results for white women. Being white and female predicted better results. Black persons received less follow up care. But receiving that follow-up care was not a predictor of better weight loss outcomes.

This is hardly the first time that racial disparities in bariatric surgery have surfaced. In fact, at ObesityWeek earlier this month, it was a major topic of discussion.

Black persons face greater barriers to care – both leading up to surgery and in follow-up. As Karen Coleman explained in one of these discussions at ObesityWeek, the problem goes very deep:

“It’s not that Black patients are riskier. It’s that our healthcare system is so racist at its core that it is putting some of our patients at a disadvantage.”

Uncomfortable Facts to Face

This is one of the largest cohorts to date on very long-term results from gastric bypass. It’s not perfect. Follow-up is difficult, so data for many patients after ten years was simply unavailable. These data come from a single large medical center.

But it is strong enough to tell us that we have a system of bariatric care that provides good outcomes for white women. For some others, it’s not as good. Certainly, it’s not surprising that the system might be optimized for white women. These are the people who, up until now, are the ones who most often seek bariatric surgery.

But the question we must answer in all fairness is: can we continue to tolerate these disparities?

Click here for the study by Chang et al, here for a thread by one of the authors discussing it, and here for an earlier study of ten-year outcomes. For perspective on eliminating inequities in treating and preventing obesity, click here.

Tea Time, painting by Jean Metzinger / WikiArt

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November 24, 2021