US Study Identifies Factors Linked to Low Metabolic Bariatric Surgery Uptake
Key Clinical Summary
- Only 3.0% of 109 849 US adults with an incident obesity diagnosis underwent metabolic bariatric surgery within 12 months despite metabolic bariatric surgery (MBS) being an effective treatment for obesity.
- Provider type, body mass index (BMI) category, female sex, and selected medication and diagnostic factors were among the strongest variables associated with MBS uptake.
- The findings suggest persistent disparities in access to MBS and identify opportunities for targeted policies and referral strategies to improve utilization.
Individuals with newly diagnosed obesity in the US remain unlikely to undergo MBS despite its established effectiveness for obesity treatment, according to a cohort study analyzing commercial insurance claims data. Investigators examined demographic, clinical, medication, and health care factors associated with MBS uptake among adults aged 18 to 64 years diagnosed with obesity between 2018 and 2022.
Factors Driving Metabolic Bariatric Surgery Uptake
Researchers analyzed data from the Merative MarketScan Commercial Claims and Encounters Database, identifying 109 849 adults with an incident obesity diagnosis between January 1, 2018, and December 31, 2022. Participants were followed for up to 12 months after diagnosis to determine whether they underwent MBS before December 31, 2023.
The study population had a mean (SD) age of 41.4 (11.8) years, and 63 992 participants (58.3%) were women. Overall, 3268 individuals (3.0%) underwent MBS within 12 months of their initial obesity diagnosis.
Investigators used machine learning and multivariable logistic regression to identify factors associated with surgery. The predictive model demonstrated strong performance, with an area under the receiver operating characteristic curve of 0.88 (95% CI, 0.87-0.90).
Among the variables identified by the random forest model, the strongest contributors included surgeon (not elsewhere classified) as the treating provider, BMI category, family practice as the provider type, and female sex. In adjusted analyses, surgeon (not elsewhere classified [NEC]) as provider was associated with the highest likelihood of MBS (odds ratio [OR], 18.97; 95% CI, 17.11-21.02). Other provider types also demonstrated significant associations, including orthopedic surgeons (OR, 5.33; 95% CI, 4.54-6.24) and dietitians (OR, 2.51; 95% CI, 1.97-3.20).
Additional factors associated with increased MBS uptake included use of miscellaneous antidiabetic agents (OR, 1.42; 95% CI, 1.25-1.62), antidepressant use (OR, 1.13; 95% CI, 1.01-1.25), depressive disorders (OR, 1.16; 95% CI, 1.02-1.33), and female sex (OR, 2.45; 95% CI, 2.22-2.71). Researchers also observed a significant decline in MBS uptake among patients diagnosed during more recent calendar quarters between 2019 and 2022.
Implications for Obesity Care and Referral Pathways
The findings highlight that MBS remains substantially underused among commercially insured adults with newly diagnosed obesity. Although only a small proportion of eligible individuals underwent surgery, uptake varied according to demographic, clinical, medication, and health care characteristics, suggesting that access is influenced by more than disease severity alone.
Provider-related factors emerged as particularly important, indicating that the clinical setting and the types of health care professionals involved in obesity care may influence whether patients ultimately receive surgical treatment. The observed associations with BMI category, sex, and selected comorbidities further suggest that referral pathways and treatment decisions may differ across patient populations.
The authors conclude that understanding these patterns may help identify opportunities to improve access to MBS through targeted policies and interventions designed to support appropriate referral and treatment for obesity.
The study authors concluded that "uptake of MBS was patterned by demographic, clinical, and health care factors." They further stated that these findings "suggest substantial opportunity to improve access to MBS through targeted policies and interventions."
Takeaway for Clinical Practice
This large US cohort study found that only 3.0% of adults with a new obesity diagnosis underwent MBS within 1 year. The results identify provider, demographic, and clinical factors associated with MBS uptake and highlight potential opportunities to improve equitable access to evidence-based obesity treatment.
Reference
Raquib RV, Tokarski A, Doshi I, et al. Sociodemographic, health care, and clinical factors associated with metabolic bariatric surgery uptake among US adults with obesity. JAMA. 2026;335(15):1332-1340. doi:10.1001/jama.2026.2075
