Bariatric Surgery Offer in Brazil: a Macroeconomic Analysis of the Health system’s Inequalities



Brazil currently holds the second place in the worldwide ranking of the largest number of bariatric surgical procedures performed. The offer of bariatric surgery in the public health system is not sufficient for its demand; it remains to be determined whether the recent economic downturn affected this offer.


To analyze the proportion of bariatric surgeries performed by the public system in Brazil and assess the influence of macroeconomic variables over time.


This is a nationwide analysis which correlated the estimated number of bariatric surgeries in Brazil in both public and private health-providing systems from 2003 through 2017 with the main macroeconomic variables of Brazil during the evaluated period (gross domestic product [GDP], inflation rate, and unemployment rate), and both overall and public healthcare expenditures.


The proportion of surgeries performed in the public system varied from 7.1% in 2014 to 10.4% in 2004. There was a significant positive correlation between the public proportion of surgeries with the unemployment rate (R = 0.55666; P = 0.03868). There were significant negative correlations between the proportion of public surgeries with the public health expenditure per capita (R = − 0.88811; P = 0.00011) and with the public percentage of healthcare expenditure per capita (R = − 0.67133; P = 0.01683).


There were direct correlations between the number of public bariatric procedures and the unemployment rate, as well as with the public healthcare expenditure per capita. Despite the increase in the number of public procedures, its proportion reveals an insufficiency of the current offer of bariatric surgery provided by the public system.

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  1. 1.

    World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: WHO; 2014. p. 1–298.

    Google Scholar 

  2. 2.

    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    CAS  Article  Google Scholar 

  3. 3.

    Borisenko O, Adam D, Funch-Jensen P, et al. Bariatric surgery can Lead to net cost savings to health care systems: results from a comprehensive European decision analytic model. Obes Surg. 2015 Sep;25(9):1559–68.

    Article  Google Scholar 

  4. 4.

    Magro DO, Ueno M, Coelho-Neto JS, et al. Long-term weight loss outcomes after banded Roux-en-Y gastric bypass: a prospective 10-year follow-up study. Surg Obes Relat Dis. 2018;14(7):910–7.

    Article  PubMed  Google Scholar 

  5. 5.

    Cazzo E, Ramos AC, Pareja JC, et al. Nationwide macroeconomic variables and the growth rate of bariatric surgeries in Brazil. Obes Surg. 2018;28:3193–8.

    Article  PubMed  Google Scholar 

  6. 6.

    Costa NDR. Brazilian healthcare in the context of austerity: private sector dominant, government sector failing. Cien Saude Colet. 2017;22(4):1065–74.

    Article  Google Scholar 

  7. 7.

    Monteiro CN, Beenackers MA, Goldbaum M, et al. Use, access, and equity in health care services in São Paulo, Brazil. Cad Saude Publica. 2017;33(4):e00078015.

    Article  Google Scholar 

  8. 8.

    Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, Endoluminal, and Revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and Endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.

    CAS  Article  Google Scholar 

  10. 10.

    Ponce J, Nguyen NT, Hutter M, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011-2014. Surg Obes Relat Dis. 2015;11(6):1199–200.

    Article  Google Scholar 

  11. 11.

    Ponce J, DeMaria EJ, Nguyen NT, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in 2015 and surgeon workforce in the United States. Surg Obes Relat Dis. 2016;12(9):1637–9.

    Article  Google Scholar 

  12. 12.

    Ramos AC. Brazil looking for completing his space in bariatric surgery. Arq Bras Cir Dig. 2014;27(Suppl 1):1.

    Article  Google Scholar 

  13. 13.

    Malta DC, Bernal RTI, Andrade SSCA, et al. Prevalence of and factors associated with self-reported high blood pressure in Brazilian adults. Rev Saude Publica. 2017;51(suppl 1):11s.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Sociedade Brasileira de Cirurgia Bariátrica e Metabólica. Volume cirurgias bariátricas (por ano) [Bariatric surgery numbers (per year)]. Available from: []. Accessed September 10, 2018.

  15. 15.

    Ministério da Saúde, Brasil. Datasus: Informações de Saúde 2018 [Datasus: data on health 2018]. Available from: []. Accessed: September 10, 2018.

  16. 16.

    Brasil. Instituto de Pesquisa Econômica Aplicada (Ipea). Ipeadata. Macroeconomic. Most request series. []. Accessed September 10, 2017.

  17. 17.

    World Health Organization. Global health expenditure database. []. Accessed September 10, 2018.

  18. 18.

    Chaim EA, Pareja JC, Gestic MA, et al. Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian public health system. Arq Gastroenterol. 2017;54(1):70–4.

    Article  Google Scholar 

  19. 19.

    Watts J. Brazil's health system woes worsen in economic crisis. Lancet. 2016;387(10028):1603–4.

    Article  Google Scholar 

  20. 20.

    Barbosa-Filho FH. A crise econômica de 2014/2017 [the economic crisis of 2014/2017]. Estudos avançados. 2017;31(89):51–60.

    Article  Google Scholar 

  21. 21.

    Agência Nacional de Saúde Suplementar, Brasil [National Agency for supplementary health, Brazil]. Dados gerais: Beneficiários de planos privados de saúde, por cobertura assistencial (Brasil - 2007-2017) [general data: beneficiaries of private health plans, by assistance coverage (Brazil, 2007-2017)]. []. Accessed: September 01, 2018.

  22. 22.

    Alkire BC, Peters AW, Shrime MG, et al. The economic consequences of mortality amenable to high-quality health care in low- and middle-income countries. Health Aff (Millwood). 2018;37(6):988–96.

    Article  Google Scholar 

  23. 23.

    Norte A, Sospedra I, Ortíz-Moncada R. Influence of economic crisis on dietary quality and obesity rates. Int J Food Sci Nutr. 2018:1–8.

  24. 24.

    Oddo VM, Nicholas LH, Bleich SN, et al. The impact of changing economic conditions on overweight risk among children in California from 2008 to 2012. J Epidemiol Community Health. 2016;70(9):874–80.

    Article  Google Scholar 

  25. 25.

    Ribera A, Slof J, Ferreira-González I, et al. The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement. Eur J Health Econ. 2018;19(7):945–56.

    Article  Google Scholar 

  26. 26.

    Weiner AB, Conti RM, Eggener SE. National Economic Conditions and patient insurance status predict prostate Cancer diagnosis rates and management decisions. J Urol. 2016;195(5):1383–9.

    Article  Google Scholar 

  27. 27.

    Fujihara N, Lark ME, Fujihara Y, et al. The effect of economic downturn on the volume of surgical procedures: a systematic review. Int J Surg. 2017;44:56–63.

    Article  PubMed  Google Scholar 

  28. 28.

    Borges NB, Ferraz MB, Chacra AR. The cost of type 2 diabetes in Brazil: evaluation of a diabetes care center in the city of São Paulo, Brazil. Diabetol Metab Syndr. 2014;6(1):122.

    Article  Google Scholar 

  29. 29.

    Kelles SM, Machado CJ, Barreto SM. Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization. Arq Bras Cir Dig. 2014;27(4):261–7.29.

    Article  Google Scholar 

  30. 30.

    Ministério da Saúde, Brasil. Cinco fatos que você precisa saber sobre a cirurgia bariátrica no SUS [five facts you need to know about bariatric surgery in the public system]. []. Accessed: September 16, 2018.

  31. 31.

    Ministério da Saúde, Brasil [Department of Health, Brazil]. Portaria 425 [ordinance 425]. []. Accessed: April 20, 2018.

  32. 32.

    Conselho Federal de Medicina, Brasil [Federal Council of Medicine, Brazil]. Resolução 2131/2015 [resolution 2131/2015]. []. Accessed: September 09, 2018.

  33. 33.

    Welbourn R, le Roux CW, Owen-Smith A, et al. Why the NHS should do more bariatric surgery; how much should we do? BMJ. 2016;353:i1472.

    Article  PubMed  Google Scholar 

  34. 34.

    Ahmad A, Laverty AA, Aasheim E, et al. Eligibility for bariatric surgery among adults in England: analysis of a national cross-sectional survey. JRSM Open. 2014;5(1):2042533313512479.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Scheffer M, Cassenote A, Guilloux AGA, et al. Demografia Médica no Brasil 2018 [Medical demography in Brazil 2018] Available from: [] Accessed: December 12, 2018.

  36. 36.

    Federação Brasileira de Hospitais. Cenário dos hospitais no Brasil 2018 [Scenery of hospitals in Brazil 2018]. Available from: []. Accessed: December 15, 2018.

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Correspondence to Everton Cazzo.

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Cazzo, E., Ramos, A.C. & Chaim, E.A. Bariatric Surgery Offer in Brazil: a Macroeconomic Analysis of the Health system’s Inequalities. OBES SURG 29, 1874–1880 (2019).

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  • Bariatric surgery
  • Obesity
  • Economics
  • Socioeconomic factors
  • Economic indexes