Original articles|Articles in Press

Supervised Weight Loss Requirements Disproportionately Affect Black Patients Seeking Weight Loss Surgery


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        Both program- and insurance-mandated SWL sessions greater for Black patients
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        Increasing SWL requirements significantly reduced odds of surgery at one year



      We use our high-volume institutional experience with a majority Black population to examine the role of supervised weight loss (SWL) requirements perpetuating disparities in bariatric surgery.


      A retrospective review was conducted of all patients seen at our institution’s bariatric surgery clinic in 2018. Odds of undergoing surgery within one year and mean number of SWL requirements were determined using descriptive statistics for Black patients as compared to non-Hispanic white patients. Finally, a logistic model was constructed to examine likelihood of undergoing an operation within one year for patients of varying SWL requirements.


      University hospital


      335 patients were included (75% Black, 25% White). Within one year, 37% of Black patients compared to 53% of White patients had undergone an operation (RR 0.7, p= 0.01). Mean insurance mandated SWL sessions was significantly higher for Black patients (3.6 ± 2.8) versus non-Hispanic White patients, (2.2 ± 2.7) (p < 0.01). Mean program mandated SWL sessions were also significantly higher for Black patients (2.5 ± 2.6), versus non-Hispanic White patients (0.8 ± 1.8) (p < 0.01). Increasing SWL requirements significantly reduced the odds of undergoing surgery at one year within the entire cohort (OR 0.86, p<0.01).


      Black patients are disproportionally affected by SWL requirements, which strongly correlates with decreased likelihood of undergoing a bariatric operation as compared to their white counterparts. Even after overcoming barriers to see a bariatric surgery provider, Black patients still face disproportionally more barriers to surgery. Bariatric centers must be sensitive to the effect of SWL requirements, as it is negatively associated with the likelihood of a patient receiving a bariatric operation.

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