Background: Bariatric surgery is the most effective long-term treatment for morbid obesity; however, it is under-utilized. This study examines the association between morbid obesity rates, bariatric surgeon presence, and utilization of bariatric surgery in the United States.
Methods: Healthcare Cost and Utilization Project's 2013 National Inpatient Sample was used to determine the incidence of inpatient bariatric procedures using ICD-9 codes. The Center for Disease Control's 2013 Behavioral Risk Factor Surveillance System survey was analyzed to determine estimates of bariatric surgery qualified adults, aged 18-70, with BMI ≥ 40 or ≥ 35 with diabetes. The number of bariatric surgeons was determined from four online sources: searches of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program accredited bariatric programs, American Society for Metabolic and Bariatric Surgery membership, and two adjustable gastric band manufacturer "find a surgeon" search tools. Correlations between rates of morbid obesity, bariatric surgeon presence, and incidence of inpatient bariatric surgery were determined.
Results: The defined bariatric surgery eligible population comprised between 3.6% (New England) to 6.8% (East South Central) of the total division population (p < 0.001). Incident rates of bariatric surgery ranged from 0.9% in East South Central to 2.2% in New England (p < 0.001). 2124 bariatric surgeons were identified. The rate of bariatric surgery by division was negatively correlated with division morbid obesity rates (r = - 0.65) and strongly positively correlated with surgeon presence (r = 0.91). After adjusting for demographic differences between divisions, surgeon presence remained highly associated with surgery utilization (p < 0.001).
Conclusions: Rates of bariatric surgery procedures in the U.S. are minimally correlated with rates of morbid obesity and are strongly correlated with the number of available bariatric surgeons. Effective therapy for the morbidly obese may be limited by the lack of qualified surgeons.
Keywords: Access to care; Bariatric surgery; Morbid obesity.