Racial Differences in the Predictors of Interest in Bariatric Surgery in the Rural, Southeastern USA

  • Irma Corral
  • Hope LandrineEmail author



Although African-Americans have a higher prevalence of severe obesity than Whites, they are less likely to have bariatric surgery. Demographic, healthcare, and knowledge variables contribute to this racial disparity but have not been examined separately by race.


Examine the role of demographic, healthcare, and knowledge variables in African-Americans’ versus Whites’ interest in bariatric surgery.


A random sample of 293 African-American and 259 White adults were surveyed door-to-door in the rural south. The survey assessed weight, height, demographics, access to healthcare, and knowledge of and interest in bariatric surgery.


African-Americans had significantly lower knowledge of bariatric surgery than Whites but there were no racial differences in interest in the surgery. The logistic regression predicting African-Americans’ interest in the surgery from demographic, healthcare, obesity, and knowledge variables revealed that obesity (OR = 4.7) and the health benefits (OR = 3.3) were the only predictors. The same regression for Whites found that knowing someone who had the surgery (OR = 3.7) was the sole predictor.


Knowledge variables may be stronger than healthcare and demographic variables as predictors of interest in bariatric surgery among rural, southern, African-Americans and Whites. Whites’ willingness to consider the surgery might be enhanced by favorable stories/blogs by those who had the surgery, whereas African-Americans’ interest might be increased by information on the additional health benefits of the surgery. These culturally tailored messages from healthcare providers might increase utilization of and reduce racial disparities in bariatric surgery.


Race and ethnicity Bariatric surgery Disparities 


Compliance with Ethical Standards

All procedures performed were in accordance with the ethical standards for research involving humans. The study had the approval of the IRB of East Carolina University.

Informed Consent

Informed consent was obtained from all study participants.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults,1999-2008. JAMA. 2010;303:235–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Courcoulas AP, Yanovski SZ, Bonds D, et al. Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg. 2014;49(12):1323–9.CrossRefGoogle Scholar
  4. 4.
    Lo CC, Ash-Houchen W, Gerling HM, Cheng TC. Data spanning three decades illustrate racial disparities in likelihood of obesity. Ethn Health. 2018;4:1–16. Scholar
  5. 5.
    Koh K, Elder TE, Grady SC, Darden JT, Vojnovic I. Explained and unexplained racial and regional inequality in obesity prevalence in the United States. Ethn Health. 2018;22:1–14.CrossRefGoogle Scholar
  6. 6.
    Safford MM, Brown TM, Muntner PM, Durant RW, Glasser S, Halanych JH, et al. Association of race and sex with risk of incident acute coronary heart disease events. JAMA. 2012;308:1768–74.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Signorello LB, Schlundt DG, Cohen SS, Steinwandel MD, Buchowski MS, McLaughlin JK, et al. Comparing diabetes prevalence between African Americans and Whites of similar socioeconomic status. Am J Public Health. 2007;97:2260–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Elk R, Landrine H. Cancer disparities. New York: Springer & American Cancer Society; 2012.Google Scholar
  9. 9.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMedGoogle Scholar
  10. 10.
    National Institutes of Health Consensus Development Panel. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115:956–61.CrossRefGoogle Scholar
  11. 11.
    Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.CrossRefPubMedGoogle Scholar
  12. 12.
    Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.CrossRefPubMedGoogle Scholar
  13. 13.
    Sjöström L, Gummesson A, Sjöström CD, Narbro K, Peltonen M, Wedel H, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden. Lancet Oncol. 2009;10(7):653–62.CrossRefPubMedGoogle Scholar
  14. 14.
    Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Martins C, Strømmen M, Stavne OA, Nossum R, Mårvik R, Kulseng B. Bariatric surgery versus lifestyle interventions for morbid obesitychanges in body weight, risk factors and comorbidities at 1 year. Obes Surg. 2011;21(7):841–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Bhogal SK, Reddigan JI, Rotstein OD, Cohen A, Glockler D, Tricco AC, et al. Inequity to the utilization of bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2015;25(5):888–99.CrossRefPubMedGoogle Scholar
  18. 18.
    Martin M, Beekley A, Kjorstad R, Sebesta J. Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis. Surg Obes Relat Dis. 2010;6(1):8–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Wee CC, Huskey KW, Bolcic-Jankovic D, Colten ME, Davis RB, Hamel MB. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity. J Gen Intern Med. 2014;29(1):68–75.CrossRefPubMedGoogle Scholar
  20. 20.
    Wallace AE, Young-Xu Y, Hartley D, Weeks WB. Racial, socioeconomic, and rural–urban disparities in obesity-related bariatric surgery. Obes Surg. 2010;20(10):1354–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Wen M, Fan JX, Kowaleski-Jones L, Wan N. Rural–urban disparities in obesity prevalence among working age adults in the United States. Am J Health Promot. 2018;32(2):400–8.CrossRefPubMedGoogle Scholar
  22. 22.
    James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K. Racial/ethnic health disparities among rural adults - United States, 2012-2015. MMWR Surveill Summ. 2017;66(23):1–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cabral DN, Napoles-Springer AM, Miike R, et al. Population- and community-based recruitment of African Americans and Latinos. Am J Epidemiol. 2003;158:272–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Christensen AI, Ekholm O, Glumer C, Juel K. Effect of survey mode on response patterns: comparison of face-to-face and self-administered modes in health surveys. Eur J Pub Health. 2013;24(2):327–32.CrossRefGoogle Scholar
  25. 25.
    Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the public health disparities geocoding project. Am J Public Health. 2005;95(2):312–23.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hao Y, Landrine H, Jemal A, Ward KC, Bayakly AR, Young JL, et al. Race, neighborhood characteristics, and disparities in receipt of chemotherapy for colorectal cancer. J Epidemiol Community Health. 2011;65(3):211–7.CrossRefPubMedGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  1. 1.Department of Psychiatry & Behavioral Medicine, Division of Behavioral Medicine, Brody School of MedicineEast Carolina UniversityGreenvilleUSA
  2. 2.Departments of Psychology and Public Health, Center for Health Disparities, Brody School of MedicineEast Carolina UniversityGreenvilleUSA

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