A recently published study in the journal Obesity sought to determine whether individuals with higher BMI have been receiving proportionally more surgical care over time. Noting that approximately 41% of the U.S. population has obesity, with those who have BMIs above 60 increasing in prevalence most rapidly, the researchers hypothesized that “higher BMI groups would account for a growing proportion of operative volume over time” due to the association between obesity and surgical disease burden.
After analyzing all multispecialty National Surgical Quality Improvement Program cases from 2005 to 2022 alongside trends among BMI categories while adjusting for demographics and comorbidities, they found the opposite was true—specifically, that increasing obesity severity is associated with less surgical care in this country.
“Regression models demonstrated decreased odds of patients with BMI ≥ 50 kg/m2 undergoing surgery over consecutive years, with increasingly higher BMI groups representing greater declines,” they report.
Their conclusion: “Despite increased growth in higher BMI populations, individuals in these categories undergo fewer surgical operations annually. These findings demonstrate a critical need to understand these inequalities, which are underscored by rising obesity prevalence that may be contributing to poor access to surgical care as well as increased morbidity/mortality of presentation with more advanced disease.”
Access the full study here.
Study leader Michael Kachmar, DO, assistant professor of surgery at USF Health Morsani College of Medicine and a bariatric and metabolic surgeon at Tampa General Hospital, was interviewed for an article on the university’s website.
In the article, Dr. Kachmar says “what stands out to me as a surgeon is both the direction of the trend and what may be happening before a patient even reaches the operating room. This population has a substantial obesity-related disease burden, and prior work shows it is growing rapidly. So, when patients with the highest BMI become less represented among surgical cases over time, it raises an important question: are we identifying and addressing the barriers these patients may face along the pathway to care, from referral and imaging to anesthesia evaluation, hospital resources, insurance requirements and preoperative optimization?
“There are absolutely clinical reasons why some patients with very high BMI may be deferred or optimized before surgery,” he added. “But the numbers are stark. This population is growing rapidly, and we should not be seeing the kind of decline in surgical representation that we observed. That tells us we need to look much more closely at where these patients are being delayed, redirected or lost along the pathway to surgical care.”
