Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018

Ann Surg. 2020 Sep 15. doi: 10.1097/SLA.0000000000004493. Online ahead of print.


OBJECTIVES: Severe obesity is the fastest growing subcategory of obesity in the United States (US) pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for severe obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with severe obesity; and (2) utilization rates and 30-day post-operative outcomes.

SUMMARY BACKGROUND DATA: The 2015-2018 National Health and Nutrition Examination Survey (NHANES) cross-sectional data (N = 19,225) generated US severe obesity prevalence estimates. The 2015-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 day) cohort data was used to compare adolescent and adult (N = 760,076) post-operative outcomes and to calculate utilization rates.

METHODS: The 2015-2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and NHANES data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity and sex and expressed per 1,000.

RESULTS: Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3,846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic white (68.5%, 59.4%, respectively). The overall 2015-2018 MBS utilization rate for youth was 1.81 per 1,000 and 5.56 per 1,000 for adults (P < .001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = .01) but there were no other post-MBS complication differences. From 2015-2018 the US prevalence of youth severe obesity increased in Hispanics and non-Hispanic blacks (P-trend < .001), but non-Hispanic whites had higher rates of MBS utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = .006).

CONCLUSIONS: MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular.

PMID:32941272 | DOI:10.1097/SLA.0000000000004493