Dr. Michael Kachmar
High rates of obesity are associated with an increased risk of developing a number of chronic health conditions, including heart disease, diabetes, stroke, high blood pressure and various types of cancer.
Given its connection to diseases requiring surgical treatment, American patients with the most severe forms of obesity would be expected to make up a growing share of surgical care. But a new national study led by a USF Health surgeon found the opposite.
the study found that patients with the highest levels of obesity, as measured by body mass index, or BMI, underwent the fewest surgical operations each year. In essence, the higher a person鈥檚 BMI, the less likely they were to receive surgical care.
The findings raise potential concerns because patients with higher BMI have increasing medical and surgical needs, yet their representation among surgical cases declined over time. Such underrepresentation is especially notable in light of the research team's prior over the past two decades.
, assistant professor of surgery in the and a bariatric and metabolic surgeon at Tampa General Hospital, served as the study鈥檚 first author.
鈥淲hat stands out to me as a surgeon is both the direction of the trend and what may be happening before a patient even reaches the operating room,鈥 Dr. Kachmar said. 鈥淭his population has a substantial obesity-related disease burden, and prior work shows it is growing rapidly. So, when patients with the highest BMI become less represented among surgical cases over time, it raises an important question: are we identifying and addressing the barriers these patients may face along the pathway to care, from referral and imaging to anesthesia evaluation, hospital resources, insurance requirements and preoperative optimization?鈥
Investigators from USF Health, Pennington Biomedical Research Center and LSU Health New Orleans analyzed more than 11.6 million multispecialty surgical cases from the American College of Surgeons National Surgical Quality Improvement Program between 2005 and 2022. The analysis included procedures across multiple surgical specialties and evaluated trends by BMI.
The research team found that as BMI increased, patients were progressively less represented in surgical care over time. The trend was most pronounced among patients with the highest BMI levels, including those with severe obesity.
The findings are significant because obesity is closely associated with many conditions that may require surgery, including hernias, gallbladder disease, osteoarthritis and cancer. If patients with severe obesity are receiving fewer procedures over time, it raises important questions about where obstacles may be occurring in the surgical care pathway.
The study does not identify a single cause for the trend. However, researchers note that there could be several factors, including greater surgical complexity, higher perioperative risk, limited access to specialized equipment or infrastructure, delayed evaluation and differences in eligibility for some elective procedures.
Researchers say the findings point to the need for health systems to better understand how patients with severe obesity move through surgical treatment. Kachmar suggests researchers and health providers should work to identify and address the underlying factors that prevent patients from accessing the medical and surgical care they need, including referral patterns, preoperative evaluation, hospital infrastructure, insurance coverage, patient counseling and other points in the care pathway.
鈥淭here are absolutely clinical reasons why some patients with very high BMI may be deferred or optimized before surgery,鈥 Dr. Kachmar said. 鈥淏ut the numbers are stark. This population is growing rapidly, and we should not be seeing the kind of decline in surgical representation that we observed. That tells us we need to look much more closely at where these patients are being delayed, redirected or lost along the pathway to surgical care.鈥