bariatric surgery

Obesity Surgery Lacks in Areas Where Obesity Rates Are Highest

In the United States, a state’s economic status and insurance coverage policies are bigger determining factors in how many individuals undergo bariatric surgery than the prevalence of obesity within the state, according to a new study.1

The study, authored by Eric DeMaria, MD, and colleagues, was presented at ObesityWeek on Thursday, November 15.


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To reach this conclusion, the researchers evaluated the number of bariatric surgeries that were performed in each state in 2016 by collecting data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

They then cross-referenced those numbers with each state’s obesity rate, economic ranking, and policy of whether bariatric or weight-loss surgery was covered as an essential health benefit under the Affordable Care Act.

According to DeMaria, none of the states with the 5 highest obesity rates—all of which are in the South and all of which but 1 are in the bottom 10 in terms of economic status—is in the top 20 in terms of number of bariatric surgeries performed.

“This suggests that those with the greatest need for bariatric surgery, the standard of care for severe obesity, may have the least access and opportunity to receive treatment,” said DeMaria.2

In fact, the 5 states with the fewest bariatric surgeries per capita were ranked in the bottom half economically. Further, 3 out of the 5 did not include bariatric surgery as an essential health benefit.

The states that had the highest number of bariatric surgeries per capita in the country are all in the Northeast and consider bariatric surgery an essential health benefit.

No state had a bariatric surgery rate more than 0.6% for its residents with obesity.


“Bariatric surgery remains one of the most underutilized treatments in America, and there is great variability in its application because of barriers to access including insurance coverage, economic conditions, and other factors,” said Wayne J English, MD, one of the study’s co-authors. “There is a great need to offer universal coverage for bariatric surgery so that treatment for a life-threatening disease is not determined by where you happen to live.”2

—Colleen Murphy



  1. DeMaria E, English WJ, Mattar SG, Brethauer S, Hutter M, Morton JM. State variation in obesity, bariatric surgery, and economic ranks: a tale of two Americas. Paper presented at: ObesityWeek 2018; November 11-15, 2018; Nashville, TN. Accessed November 16, 2018.
  2. New study finds most bariatric surgeries performed in Northeast, and fewest in South where obesity rates are highest, and economies are weakest [press release]. Nashville, TN: American Society for Metabolic & Bariatric Surgery; November 15, 2018. Accessed November 16, 2018.