High obesity levels linked to fewer surgical procedures in Americans

Researchers from LSU's Pennington Biomedical Research Center and collaborating institutions have found that Americans with the highest levels of obesity are undergoing fewer surgical procedures overall. These procedures include common operations like knee or hip replacement, hernia surgery, and surgery of the breast, prostate and colon – operations that are frequently done for cancer.

Study authors say these trends are concerning because rising obesity nationally should lead to more, not less, surgeries for common obesity-related diseases and ailments. The study, "Increasing Obesity Severity is Associated with Less Surgical Care in the United States," published in Obesity, analyzed more than 11.6 million surgical cases from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2005 and 2022.

Investigators found that patients having a higher body mass index (BMI) or extreme obesity experienced progressively lower representation in surgical care over time. Despite the increased prevalence of extreme obesity, these individuals appear to be undergoing fewer operations year after year.

Since it is known that obesity is associated with increased risks for a number of conditions that are treated by surgical intervention, there is a critical need to identify the mechanisms underlying these disparities to enable equitable healthcare access to higher BMI populations.

This study reveals a concerning disconnect between the growing prevalence of severe obesity and access to surgical care for a variety of common operations. Individuals at the highest BMI levels carry the greatest burden of obesity-related disease, yet they appear to be receiving proportionally fewer surgical interventions each year."

Dr. Vance Albaugh, senior author, Pennington Biomedical and the Metamor Institute

The research team used multinomial logistic regression models adjusted for demographics, health status and comorbidities to evaluate surgical trends across BMI categories. Results showed that the higher the BMI category, the greater the decline in operative representation over time.

Researchers suggest the findings may reflect multiple barriers to care, including:

• Increased surgical complexity and perioperative risk
• Limited access to specialized equipment and infrastructure
• Reduced eligibility for elective procedures
• Delayed diagnosis and preventive care access

The authors warn that reduced access to surgical intervention could contribute to worsening health outcomes and more advanced disease presentation among patients with severe obesity.

"Understanding and addressing these disparities is increasingly urgent," said Dr. Philip Schauer, director of the Metamor Institute and United Companies Life Insurance Co./Mary Kay and Terrell Brown Chair at Pennington Biomedical. "As obesity prevalence continues to rise, healthcare systems must ensure equitable access to surgical evaluation, treatment and supportive infrastructure for patients across all BMI categories. Having severe obesity should not exclude someone from getting the surgical care they need whether it's gallbladder surgery, hernia surgery or hemorrhoid surgery, for example."

The study also examined trends across surgical specialties, including general surgery, gynecology, cardiac surgery and thoracic surgery. Declines in surgical representation among higher BMI groups were most pronounced in general surgery and abdominal procedures.