Disparity in access to bariatric surgery among African-American men

  • A. B. HoffmanEmail author
  • A. A. Myneni
  • H. Orom
  • S. D. Schwaitzberg
  • K. Noyes
2019 SAGES Oral



Despite improvements in safety and effectiveness in surgical management of extreme obesity, men and racial minorities are less likely to receive metabolic and bariatric surgery (MBS) compared to other patient groups. This study examines the racial and gender disparities in access to MBS to understand the mechanism that drives these problems and to propose strategies for closing the disparity gap.


Using 2013–2014 National Health and Nutrition Examination Survey data, we estimated the proportion of individuals, by race and gender, who were eligible for MBS based on Body Mass Index (BMI) and comorbidity profile. We analyzed the 2015 MBS Accreditation and Quality Improvement Program Participant Use Data File to examine differences in patient characteristics, comorbidities, and postsurgical outcomes among African-American (AA) and White men. Predictors of poor outcomes were identified using unconditional logistic regression models.


AA men represented 11% of eligible patients but only 2.4% of actual MBS patients. Compared to White men, AA men were younger, had higher BMI, were more likely to have a history of hypertension, renal insufficiency, required dialysis, and had American Society of Anesthesiologists class 4 or 5 (all P values < 0.01). After surgery, AA men were more likely to suffer from postoperative complications (adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.02–1.52) and stayed in the hospital for more than 4 days (aOR 1.51, 95% CI 1.26–1.82) compared to White men.


Despite being eligible for MBS based on both BMI and obesity-related comorbidities, AA men are significantly less likely to undergo MBS. Those AA men who receive surgery are significantly younger than White men but also experience greater comorbidities compared to White men and all women. Further longitudinal studies into patient-, system-, and provider-level barriers are necessary to understand and address these disparities.


Bariatric surgery Obesity Disparities Men African-American men Postsurgical outcomes 



The authors would like to thank Monami Majumder and the Patient Voices Network of Buffalo, NY for their help in preparing this manuscript.


This manuscript was in part funded by University at Buffalo Surgical Outcomes and Research (UB SOAR) program at the Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.

Compliance with ethical standards


Dr. Hoffman is a paid consultant for Ethicon US, LLC (not related to the study). Dr. Steven Schwaitzberg is a paid consultant for Nu View Surgical, Acuity Bio, Activ Surgical, Human Extensions, Levitra Magnetics, and Arch Therapeutics (not related to the study). Drs. Myneni, Orom, and Noyes do not have any conflicts of interest or financial ties to disclose. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and the centers participating in the ACS MBSAQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Supplementary material

464_2019_7034_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 kb)


  1. 1.
    Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. NCHS Data Brief: 1–8Google Scholar
  2. 2.
    Finkelstein EA, Trogdon JG, Cohen JW, Dietz W (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood) 28:w822–w831CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (2018) The health effects of overweight and obesity. Heavy Weight, Department of Health and Human Services, AtlantaGoogle Scholar
  4. 4.
    US Bureau of Labor Statistics (2018) CPI inflation calculator. Databases, tables & calculators by subject. US Bureau of Labor Statistics, Washington, DCGoogle Scholar
  5. 5.
    American Society for Metabolic and Bariatric Surgery (2018) Who is a candidate for bariatric surgery?. American Society for Metabolic and Bariatric Surgery, GainsvilleGoogle Scholar
  6. 6.
    Pentin PL, Nashelsky J (2005) What are the indications for bariatric surgery? J Fam Pract 54:633–634PubMedGoogle Scholar
  7. 7.
    Kaplan LM (2003) Body weight regulation and obesity. J Gastrointest Surg 7:443–451CrossRefPubMedGoogle Scholar
  8. 8.
    Kokkinos A, Alexiadou K, Liaskos C, Argyrakopoulou G, Balla I, Tentolouris N, Moyssakis I, Katsilambros N, Vafiadis I, Alexandrou A, Diamantis T (2013) Improvement in cardiovascular indices after Roux-en-Y gastric bypass or sleeve gastrectomy for morbid obesity. Obes Surg 23:31–38CrossRefPubMedGoogle Scholar
  9. 9.
    Weiner RA (2010) Indications and principles of metabolic surgery. Chirurg 81:379–394 quiz 395 CrossRefPubMedGoogle Scholar
  10. 10.
    Fuchs HF, Broderick RC, Harnsberger CR, Chang DC, Sandler BJ, Jacobsen GR, Horgan S (2015) Benefits of bariatric surgery do not reach obese men. J Laparoendosc Adv Surg Tech A 25:196–201CrossRefGoogle Scholar
  11. 11.
    Young MT, Phelan MJ, Nguyen NT (2016) A decade analysis of trends and outcomes of male vs female patients who underwent bariatric surgery. J Am Coll Surg 222:226–231CrossRefPubMedGoogle Scholar
  12. 12.
    Berger ER, Huffman KM, Fraker T, Petrick AT, Brethauer SA, Hall BL, Ko CY, Morton JM (2018) Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg 267:122–131CrossRefPubMedGoogle Scholar
  13. 13.
    Mainous AG 3rd, Johnson SP, Saxena SK, Wright RU (2013) Inpatient bariatric surgery among eligible black and white men and women in the United States, 1999–2010. Am J Gastroenterol 108:1218–1223CrossRefPubMedGoogle Scholar
  14. 14.
    US Department of Health and Human Services Office of Minority Health (2017) Obesity and African Americans. US Department of Health and Human Services, RockvilleGoogle Scholar
  15. 15.
    United States Renal Data System (2016) 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes, Digestive and Kidney Diseases, BethesdaGoogle Scholar
  16. 16.
    United States Renal Data System (2018) 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, BethesdaGoogle Scholar
  17. 17.
    Jannah N, Hild J, Gallagher C, Dietz W (2018) Coverage for obesity prevention and treatment services: analysis of medicaid and state employee health insurance programs. Obesity (Silver Spring) 26:1834–1840CrossRefGoogle Scholar
  18. 18.
    US Centers for Medicare and Medicaid Services (2006) Decision Memo for Bariatric Surgery for the Treatement of Morbid Obesity (CAG-00250R). In: US Centers for Medicare and Medicaid Services (ed) US Centers for Medicare and Medicaid Services, BaltimoreGoogle Scholar
  19. 19.
    Becker C (2019) Health reform and health mandates for obesity. National Conference for State Legislatures, DenverGoogle Scholar
  20. 20.
    Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (Published January 2017) User Guide for the 2015 Participant Use Data File (PUF)Google Scholar
  21. 21.
    Department of Health and Human Services Office for Human Research Protections (2018) 45 CFR 46-Protection of Human Subjects, 2018 Requirements: 104 Exempt research. Department of Health and Human Services Office for Human Research Protections, RockvilleGoogle Scholar
  22. 22.
    National Center for Health Statistics (2014) National Health and Nutrition Examination Survey, NHANES 2013–2014. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  23. 23.
    United States Census Bureau (2015) 2015 American Community SurveyGoogle Scholar
  24. 24.
    Wood MH, Carlin AM, Ghaferi AA, Varban OA, Hawasli A, Bonham AJ, Birkmeyer NJ, Finks JF (2019) Association of race with bariatric surgery outcomes. JAMA Surg 154:e190029CrossRefPubMedGoogle Scholar
  25. 25.
    Sheka AC, Kizy S, Wirth K, Grams J, Leslie D, Ikramuddin S (2018) Racial disparities in perioperative outcomes after bariatric surgery. Surg Obes Relat Dis 15:786–793CrossRefPubMedGoogle Scholar
  26. 26.
    Moore D, Cooper C, Davis-Smith YM (2016) African American obese mens’ attitudes and perceptions of bariatric surgery: a phenomenological study. Spectrum 4:43–60Google Scholar
  27. 27.
    Griffith DM, Ober Allen J, Gunter K (2011) Social and cultural factors influence African American men’s medical help seeking. Res Soc Work Pract 21:337–347CrossRefGoogle Scholar
  28. 28.
    Kutner M, Greenberg E, Jin Y, Paulsen C (2006) The Health Literacy of America’s Adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). US Department of Education. National Center for Education Statistics, Washington, DCGoogle Scholar
  29. 29.
    The Henry J, Foundation Kaiser Family (2018) Men’s health disparities. State Health Facts, San FranciscoGoogle Scholar
  30. 30.
    Blair IV, Steiner JF, Fairclough DL, Hanratty R, Price DW, Hirsh HK, Wright LA, Bronsert M, Karimkhani E, Magid DJ, Havranek EP (2013) Clinicians’ implicit ethnic/racial bias and perceptions of care among Black and Latino patients. Ann Fam Med 11:43–52CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    FitzGerald C, Hurst S (2017) Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18:19CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Hall WJ, Chapman MV, Lee KM, Merino YM, Thomas TW, Payne BK, Eng E, Day SH, Coyne-Beasley T (2015) Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health 105:e60–e76CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    van Ryn M, Burgess D, Malat J, Griffin J (2006) Physicians’ perceptions of patients’ social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease. Am J Public Health 96:351–357CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Wee CC, Huskey KW, Bolcic-Jankovic D, Colten ME, Davis RB, Hamel M (2014) Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med 29:68–75CrossRefPubMedGoogle Scholar
  35. 35.
    Long SK, Bart L (2017) Patients feel comfortable talking to providers about sensitive issues, but providers dont often ask. Health Reform Monitoring Survey, Urban Institute Health Policy Center, Washington DCGoogle Scholar
  36. 36.
    Ward SH, Gray AM, Paranjape A (2009) African Americans’ perceptions of physician attempts to address obesity in the primary care setting. J Gen Intern Med 24:579–584CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Jackson CL, Redline S, Kawachi I, Williams MA, Hu FB (2013) Racial disparities in short sleep duration by occupation and industry. Am J Epidemiol 178:1442–1451CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Dimick J, Ruhter J, Sarrazin MV, Birkmeyer JD (2013) Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. Health Aff (Millwood) 32:1046–1053CrossRefGoogle Scholar
  39. 39.
    Pirson M, Dehanne F, Van den Bulcke J, Leclercq P, Martins D, De Wever A (2018) Evaluation of cost and length of stay, linked to complications associated with major surgical procedures. Acta Clin Belg 73:40–49CrossRefPubMedGoogle Scholar
  40. 40.
    Tevis SE, Kennedy GD (2013) Postoperative complications and implications on patient-centered outcomes. J Surg Res 181:106–113CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • A. B. Hoffman
    • 1
    Email author
  • A. A. Myneni
    • 1
  • H. Orom
    • 2
  • S. D. Schwaitzberg
    • 1
  • K. Noyes
    • 1
    • 3
  1. 1.Department of Surgery, Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloUSA
  2. 2.Department of Community Health and Health Behavior, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloUSA
  3. 3.Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloUSA

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