There are persistent racial disparities and growing sex disparities between patients who discussed and received bariatric and metabolic surgery (BMS) between 2000 and 2020, a study by Brigham and Women’s Hospital (BWH), Boston, MA, investigators has found.
Using artificial intelligence to analyse 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 BMS - 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 BMS than women. These findings highlight the need for interventions that encourage patients from all backgrounds to progress from discussion to utilisation of BMS.
"As a clinician, I often see patients who could potentially benefit from BMS but who aren't aware of this treatment option. Patients who discuss BMS are much more likely to undertake it and lose weight," said corresponding author, Dr Alexander Turchin, director of Quality in Diabetes at the Division of Endocrinology, Diabetes and Hypertension at BWH. "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 BMS is considered the most effective long-term treatment for severe obesity, research by other investigators 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 BMS 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 BMS with primary care physicians and that annual patient-provider BMS discussions increased from 3.2% to 10% during the 20-year study period. Of the 11,094 (9.1%) patients who discussed BMS with care providers, 1,348 (12.2%) progressed to surgery.
While Black and non-Black patients had comparable BMS 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 BMS 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 BMS 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 US 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."
The findings were featured in the paper, 'Race and Sex Disparities in Metabolic / Bariatric Surgery over 20 Years: a Cohort Study', published in the Annals of Surgery Open. To access this paper, please click here
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