Go figure: Slimmer US regions have more bariatric surgery

The areas with the country’s thinnest populations are also the ones where people undergo the most bariatric operations, new research shows. A 2004 analysis of the 2002 Nationwide Inpatient Sample (NIS) revealed that bariatric operations are performed two and four times more often in the Western and the Northeastern regions of the country, respectively, than in the Southern ones, where morbid obesity is significantly higher. The South had the lowest number of procedures per 100,000 people of any area in the country in both men and women and across all age groups, except individuals aged 60 years or older. The variation across the country is quite striking. Rates of procedures are consistently highest in the regions that carry the lowest burden of morbid obesity.

Doctor and colleagues compared 2002 NIS data with national census statistics and obesity prevalence figures from the Centers for Disease Control 2002 Behavioral Risk Factor Surveillance System to assess how obesity across the country correlated with rates of bariatric operations. Overall, 69,656 Americans underwent obesity surgery in 2002. Of these, 85 percent were women, of whom 76 percent were between the ages of 18 and 49 years. The number of procedures per 100,000 morbidly obese individuals ranged from as low as 139 in men 60 years of age or older in the Midwest to as high as 5,156 in women aged 40 to 49 in the Northeast. The true variation across the country may be far higher than the study suggests. The NIS data are difficult to break down into smaller areas, but significant fluctuations should be expected within the four regions, according to a Professor of Surgery, University of Michigan, Ann Arbor. The many alternatives in financing bariatric procedures and the high demand for these operations exacerbate the disparities. Not all states have mandated bariatric coverage, and only some insurance companies offer reimbursement to certain people. Many people pay for bariatric procedures out of pocket.

In bariatrics, the need is far in excess of our capacity to do it in terms of centers and surgeons with interest and experience to do it. Surgeons can elect to practice where they want and do as many cases as they want. The concern now shifts to what – if anything – should be done to resolve the variation. More funding for obesity education and treatment may be required in regions with high obesity rates where operations are few. However, he said that the study offers only a glimpse of the country’s situation in 2002 and does not conclude whether the variation is problematic. We don’t know the optimal rates of operation for bariatric surgery. These data may help us determine what those rates should be. The analysis did show, however, that morbidly obese men tend to undergo surgery at an older age than morbidly obese women. Public health initiatives should be undertaken to target men at earlier stages in the disease process.

The situation may be somewhat different in 2005. The practice of bariatric surgery has changed dramatically in the three years since the last data were available. More than 150,000 Americans are expected to undergo surgery for morbid obesity in 2005.