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The Bariatric Experience Long Term (BELONG): Factors Related to Having Bariatric Surgery in a Large Integrated Healthcare System

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Abstract

Purpose

Bariatric surgery is the most effective treatment for severe obesity, but currently, only 1–2% of all eligible patients undergo surgery each year. This study examined which factors were associated with a patient receiving bariatric surgery after referral in a real-world healthcare setting.

Materials and Methods

The current study used the baseline survey and electronic medical record (EMR) data from the Bariatric Experience Long Term (BELONG) study (n = 1975). Predictors of who did (n = 1680) and who did not (n = 295) have surgery were analyzed using multivariate logistic regression.

Results

Participants (n = 1975; 42.4% response rate) were primarily women (84%) and either non-Hispanic Black or Hispanic (60%). In the fully adjusted multivariate model, the strongest predictors of having surgery were being a woman (OR = 3.17; 95% CI = 2.15, 4.68; p < .001) and losing at least 5% of their body weight in the year before surgery (OR = 3.16; 95% CI = 2.28, 4.38; p < .001). The strongest predictors of not having surgery were a ≥ BMI 50 kg/m2 (OR = .39; 95% CI = .27, .56; p < .001) and having a higher physical comorbidity burden (OR = .84; 95% CI = .75, .94; p = .004).

Conclusions

Practices such as 5–10% total weight loss before surgery and selection of patients with safer operative risk profiles (younger with lower comorbidity burden) may inadvertently contribute to under-utilization of bariatric surgery among some demographic subpopulations who could most benefit from this intervention.

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Acknowledgments

The authors would like to thank the patients who participated in this study without whom the study could not have been done.

Funding

This work was funded by an award from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) #R01DK108522.

Author information

Authors and Affiliations

  1. Marriage and Family Therapy Program, Touro University Worldwide, Los Alamitos, CA, USA

    Darren D. Moore

  2. Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA

    David E. Arterburn & Marlaine Figueroa Gray

  3. College of Nursing, University of South Florida, Tampa, FL, USA

    Yun Bai & Ming Ji

  4. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Melissa Cornejo, Silvia Paz, Brianna Taylor, Tae K. Yoon, Deborah Rohm Young & Karen J. Coleman

  5. Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA, USA

    Cecelia L. Crawford

  6. Center for Public Health Nutrition, University of Washington, Seattle, WA, USA

    Adam Drewnowski

  7. SM Division of Public Health Sciences, Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, NC, USA

    Kristina H. Lewis

Authors
  1. Darren D. Moore
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  2. David E. Arterburn
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  3. Yun Bai
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  13. Deborah Rohm Young
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  14. Karen J. Coleman
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Corresponding author

Correspondence to Karen J. Coleman.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The Kaiser Permanente Southern California institutional review board (IRB) for human subjects approved all study procedures and waived the requirement for signed informed consent; however, all participants provided informed consent for the study during the phone and email/web-based recruitment for the study. The IRB also approved using the EMR to determine eligibility without obtaining consent.

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Moore, D.D., Arterburn, D.E., Bai, Y. et al. The Bariatric Experience Long Term (BELONG): Factors Related to Having Bariatric Surgery in a Large Integrated Healthcare System. OBES SURG 31, 847–853 (2021). https://doi.org/10.1007/s11695-020-05045-7

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  • DOI: https://doi.org/10.1007/s11695-020-05045-7

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