Trends in bariatric surgery, 2002–2012: do changes parallel the obesity trend?



      It is well documented that bariatric surgery is an effective weight loss intervention, and bariatric procedure rates have increased over time. However, there was a period of plateau in procedure rates in the mid to late 2000s. Recent literature has not identified current trends in procedure rates or associations between bariatric surgery and population factors, such as obesity and diabetes.


      The purpose of this study was to determine trends in statewide rates of bariatric operations, obesity, and diabetes over an 11-year period and to determine if population factors are associated with procedure rates.


      Data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) were utilized to identify a study sample population of patients who underwent bariatric procedures from 2002–2012.


      State level population characteristics were obtained from the Behavioral Risk Factor Surveillance System and Census Bureau Data for the 11-year period. Statistical analyses determined rates of surgery, obesity, and diabetes over time, as well as associations between surgery rates and population factors.


      From 2002–2012, bariatric procedure rates increased, with an exponential rise in laparoscopic surgical methods. Procedure rates reached a peak value in 2009 and then plateaued. Statewide obesity and diabetes rates increased over time, although there was no association between these population factors and procedure rates. Women had consistently higher rates of bariatric operations.


      Although bariatric procedures are an evidenced-based effective treatment for obesity, procedure rates were not associated with the increasing obesity and diabetes rates in the United States. Further research is needed to identify factors that affect the adoption and diffusion of bariatric operations to increase diffusion of beneficial innovations and improve overall quality of care and health outcomes.


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      1. Centers for Disease and Control and Prevention. Defining overweight and obesity [monograph on the Internet]. Atlanta, GA: CDC; 2012 [cited 2014 June 1]. Available from:

      2. Robert Wood Johnson Foundation. F as in fat: how obesity threatens America׳s future [monograph on the Internet]. Washington, DC: The Foundation; 2012 [cited 2015 March 1]. Available from: FasInFatFnlRv.pdf.

        • Finkelstein E.
        • Trogdon J.
        • Cohen J.
        • Dietz W.
        Annual medical spending attributable to obesity: payer- and service-specific estimates.
        Health Affairs. 2009; 28: w822-w831
        • Blocker W.P.
        • Ostermann H.J.
        Obesity: evaluation and treatment.
        Disease A Month. 1996; 42: 831-873
        • Maggard M.A.
        • Shugarman L.R.
        • Suttorp M.
        • et al.
        Meta-analysis: surgical treatment of obesity.
        Ann Intern Med. 2005; 142: 547-559
        • Campos G.M.
        • Rabl C.
        • Peeva S.
        • et al.
        Improvement in peripheral glucose uptake after gastric bypass surgery is observed only after substantial weight loss has occurred and correlates with the magnitude of weight lost.
        J Gastrointest Surg. 2010; 14: 15-23
        • Chang S.
        • Stoll C.
        • Song J.
        • Varela J.
        • Eagon C.
        • Colditz G.
        The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012.
        JAMA Surg. 2014; 149: 275-287
        • O׳Brien P.
        • MacDonald L.
        • Anderson M.
        • Brennan L.
        • Brown W.
        Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature.
        Ann Surg. 2013; 257: 87-94
        • Padwal R.
        • Klarenbasch S.
        • Wiebe N.
        • et al.
        Bariatric surgery: a systematic review of the clinical and economic evidence.
        J Gen Internal Med. 2011; 26: 1183-1194
        • Puzziferri N.
        • Roshek T.
        • Mayo H.
        • Gallagher R.
        • Belle S.
        • Livingston E.
        Long-term follow-up after bariatric surgery: a systematic review.
        JAMA. 2014; 312: 934-942
        • Buchwald H.
        • Estok R.
        • Fahrbach K.
        • et al.
        Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.
        Am J Med. 2009; 122: 248-256
        • Neff K.J.
        • le Roux C.W.
        Bariatric surgery: a best practice article.
        J Clin Pathol. 2013; 66: 90-98
        • Buchwald H.
        • Oien D.M.
        Metabolic/bariatric surgery worldwide 2011.
        Obes Surg. 2013; 23: 427-436
        • Samuel I.
        • Mason E.
        • Renquist K.
        • Huang Y.
        • Zimmerman M.
        • Jamal M.
        Bariatric surgery trends: an 18-year report from the International Bariatric Surgery Registry.
        Am J Surg. 2006; 192: 657-662
        • Livingston E.
        The incidence of bariatric surgery has plateaued in the US.
        Am J Surg. 2010; 200: 378-385
        • Nguyen N.
        • Masoomi H.
        • Magno C.
        • Nguyen X.
        • Laugenour K.
        • Lane J.
        Trends in use of bariatric surgery, 2003-2008.
        J Am Coll Surg. 2011; 213: 261-266
      3. Agency for Healthcare Research and Quality. Overview of HCUP [monograph on the Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2013 [cited 2015 March 1]. Available from:

        • Buchwald H.
        • Oien D.M.
        Metabolic/bariatric surgery worldwide 2008.
        Obes Surg. 2008; 19: 1605-1611
      4. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for bariatric surgery for treatment of morbid obesity [monograph on the Internet]. Baltimore, MD: CMS; 2009 [cited 2014 October 1]. Available from:

      5. Zhao Y, Encinosa W. Bariatric surgery utilization and outcomes in 1998 and 2004. Healthcare Cost and Utilization Project Briefs, Statistical Brief #23 [monograph on the Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2007 [cited 2014 September 1]. p. 1–7. Available from:

      6. Dartmouth Institute. Variation in the care of surgical conditions: obesity [monograph on the Internet]. Lebanon, NH: Dartmouth Institute; 2014 [cited 2014 November 1]. Available from:

      7. International classification of diseases—clinical modification (ICD-9-CM) professional edition for hospitals. 9th ed, rev. Los Angeles, CA: Practice Management Information Corporation; 2012

        • Centers for Disease and Control and Prevention
        Behavioral Risk Factor Surveillance System [monograph on the Internet].
        CDC, Atlanta, GA2013 ([cited 2014 September 1]. Available from:
        • United States Census Bureau
        About us [homepage on the Internet].
        United States Census Bureau, Washington, DC2014 ([cited 2015 April 1]. Available from:
        • Kohn G.
        • Galanko J.
        • Overby D.
        • Farell T.
        Recent trends in bariatric surgery case volume in the United States.
        Surgery. 2009; 146: 375-380
        • Henkel D.
        • Remington P.
        • Athens J.
        • Gould J.
        Trends in bariatric surgery for morbid obesity in Wisconsin: a six year follow-up.
        Wisconsin Med J. 2010; 109: 21-27
        • Chaudoir S.R.
        • Dugan A.G.
        • Barr C.H.
        Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures.
        Implement Sci. 2013; 8
        • Durlak J.A.
        • DuPre E.P.
        Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation.
        Am J Community Psychol. 2008; 41: 327-350
        • Greenhalgh T.
        • Robert G.
        • Macfarlane F.
        • Bate P.
        • Kyriakidou O.
        Diffusion of innovations in service organizations: systematic review and recommendations.
        Millbank Q. 2004; 82: 581-629
        • Flum D.
        • Kwon S.
        • MacLeod K.
        • et al.
        The use, safety, and cost of bariatric surgery before and after Medicare׳s National Coverage Decision.
        Ann Surg. 2011; 254: 860-865
      8. Downey M, Still C. The Affordable Care Act’s impact on persons with obesity [monograph on the Internet]. 2013 [cited 2015 January 1]. Available from:

      9. Varney S. Obamacare insurance won’t cover weight-loss surgery in many states [monograph on the Internet]. Kaiser Health News; 2013 [cited 2015 January 1]. Available from:

        • Tian W.
        • Hurley R.E.
        • Clement D.G.
        The diffusion of bariatric surgery programs within US community hospitals: 1995-2000.
        Int J Public Policy. 2010; 5: 204-221
        • Fuchs H.
        • Broderick R.
        • Harnsberger C.
        • et al.
        Benefits of bariatric surgery do not reach obese men.
        J Laparoendosc Adv Surg Tech. 2015; 25: 196-201
        • Bertakis K.
        • Azari R.
        • Helms J.
        • Callahan E.
        • Robbins J.
        Gender differences in the utilization of health care services.
        J Fam Pract. 2000; 49: 147-152
        • McCarty T.
        Can bariatric surgery be done as an outpatient procedure?.
        Adv Surg. 2006; 40: 99-106
      10. Centers for Disease and Control and Prevention. Behavioral Risk Factor Surveillance System. Annual Survey Data, 2013 [monograph on the Internet]. Atlanta, GA: CDC; 2013 [cited 2015 April 1]. Available from: