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Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis

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Abstract

Background

Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored.

Methods

This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis.

Results

A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4 years), higher patient satisfaction, and BMI (≥ 38.0 kg/m2). Hispanic participants prioritized age (< 55.4 years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3 years, BMI ≥ 35.8 kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6 years) and higher body appreciation.

Conclusion

These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS.

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Data Availability

Drs. Xie and Messiah had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Funding

This work was funded by the National Institutes of Health, National Institute on Minority Health and Health Disparities (Grants R01MD011686).

Author information

Authors and Affiliations

  1. University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA

    Luyu Xie, Folefac Atem, M. Sunil Mathew, Sophia Ngenge, Jackson Francis & Sarah E. Messiah

  2. Center for Pediatric Population Health, Dallas, TX, USA

    Luyu Xie, Folefac Atem, M. Sunil Mathew, Olivia Kapera, Sophia Ngenge, Jackson Francis & Sarah E. Messiah

  3. Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jaime P. Almandoz & Jeffrey N. Schellinger

  4. University of Texas Health Science Center at Houston, School of Public Health, Austin, TX, USA

    Olivia Kapera

  5. Texas Christian University, Department of Nutritional Sciences, Fort Worth, TX, USA

    Elisa Morales Marroquin

  6. Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Carrie McAdams

  7. DFW Bariatrics and General Surgery, Dallas, TX, USA

    Sachin Kukreja

  8. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA

    Benjamin E. Schneider

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  1. Luyu Xie
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  2. Folefac Atem
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Corresponding author

Correspondence to Luyu Xie.

Ethics declarations

Ethical Approval Statement

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.

Role of the Funder

The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.

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Key points

• In the overall study population, the most influential factors driving the decision to complete Bariatric Metabolic Surgery (BMS) include younger age, higher patient satisfaction, and higher body mass index.

• There are racial and ethnic group differences in the factors motivating individuals to complete BMS.

• There is a need for future studies that aim to develop effective interventions to support decision-making for BMS among patients from diverse backgrounds.

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Xie, L., Atem, F., Mathew, M.S. et al. Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis. OBES SURG 34, 1513–1522 (2024). https://doi.org/10.1007/s11695-023-06999-0

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