Black Patients Are Less Likely to Get Weight Loss Surgery

A recent study published in the Annals of Surgery Open revealed disparities in access to weight-loss surgery among Black patients. While Black individuals are just as likely as other racial groups to discuss the procedure with their doctors, they are significantly less likely to undergo the surgery. This disparity persists despite the increasing safety and effectiveness of metabolic and bariatric surgery (MBS) over the past two decades.

The study, which analyzed records of over 122,000 patients with obesity, found that approximately 10 percent of Black patients discussed weight-loss surgery with their doctor, compared to 9 percent of patients from other racial groups. However, only 8 percent of those Black patients ultimately underwent the surgery, compared to nearly 13 percent of other patients. This disparity highlights the urgent need to identify and address the barriers preventing Black patients from accessing this potentially life-changing treatment.

Obesity affects more than 40 percent of U.S. adults, including nearly 50 percent of Black Americans, researchers said in background notes.

“As a clinician, I often see patients who could potentially benefit from metabolic and bariatric surgery (MBS) but who aren’t aware of this treatment option,” senior researcher Dr. Alexander Turchin, director of quality in diabetes at the Brigham and Women’s Hospital Division of Endocrinology, Diabetes and Hypertension, said in a news release.

Several factors may contribute to this disparity, including:

• Mistrust of the medical system: Historical injustices and ongoing experiences of discrimination can lead to mistrust, making Black patients hesitant to undergo invasive procedures. This mistrust can be compounded by a lack of diversity among healthcare providers, making it harder for Black patients to find physicians they feel comfortable with and trust.
• Socioeconomic factors: Disparities in income, insurance coverage, and access to quality healthcare can limit access to weight-loss surgery. Black patients may face greater financial burdens, including higher out-of-pocket costs and difficulty taking time off work for surgery and recovery.
• Lack of culturally competent care: Patients may feel more comfortable discussing sensitive topics like weight and body image with providers who understand their cultural background and experiences. Culturally competent care can help address specific concerns and build trust with Black patients.
• Implicit bias: Unconscious biases among healthcare providers may influence their recommendations and treatment decisions, inadvertently contributing to disparities in care. These biases can affect how providers perceive Black patients’ health concerns and their willingness to offer certain treatments.

“Patients who discuss MBS are much more likely to undertake it and lose weight,” Turchin continued. “Our findings indicate that we need to improve these conversations and identify barriers to undergoing surgery once it has been discussed.”

To address these disparities, healthcare providers should:

• Promote weight-loss surgery as a viable option for all eligible patients: Ensure that information about MBS is presented in a clear and unbiased manner, free from assumptions or stereotypes.
• Actively engage in conversations about weight and obesity: Create a safe and non-judgmental space for patients to discuss their concerns and explore treatment options.
• Identify and address individual barriers to surgery: Proactively discuss potential concerns, including financial constraints, access to care, and fear of complications.
• Acknowledge the potential impact of mistrust: Be sensitive to the historical context of medical mistrust and address any concerns patients may have about the healthcare system.
• Increase diversity in the healthcare workforce: A more diverse workforce can help improve cultural understanding and reduce implicit bias in healthcare settings.

“Providers need to ensure that patients have all the available information to make decisions about obesity treatments,” Turchin concluded. “Future studies will be required to understand how the advent of new medications to treat obesity such as GLP-1 agonists impacts patient-provider discussions about MBS.”