This review of over 135,000 patients provided insight into the demographics of bariatric surgery patients. From a disparity perspective it was not surprising that fewer black patients received bariatric surgery and even fewer black patients paid cash for their surgery. It is well known that obesity and its associated comorbidities are more prevalent among minorities, lower socioeconomic classes, and less educated groups. It is also well known that black patients are under-represented as weight loss surgery patients.
A very important outcome not discussed in detail was the overall success of weight loss surgery in blacks and whites. Did the 4% difference in weight loss result in more failures in the black group? How was success after weight loss surgery defined? On multivariate analysis, was being black, or being in a lower socioeconomic class or in a less educated group, regardless of race, independent risk factors for weight loss surgery failure at 1 year? Or was weight loss surgery successful regardless of these variables?
A large database review may not provide information regarding the success of preoperative and postoperative behavioral modification programs. Were blacks less likely to complete a program because of costs? If so, this may represent a difference in socioeconomic status and not physiology. It is well known that compliance with nutrition and exercise has a short- and long-term effect on weight loss before and after surgery. Nutritional supplements and exercise programs are rarely covered by insurance and thus represent another cost that may result in a disparity in access not related to physiology, culture, or geography.
Finally, can the differences in this study be directly attributed to a demographic as diverse as the black race? For this conclusion, it would be necessary to differentiate and determine the value of the various ethnic origins (West Indies vs. West Africa) and geographic cultures (New York vs. Mississippi) that exist in the study population.
Terrence M. Fullum, M.D., professor of surgery, Howard University College of Medicine; chief, Division of General, Minimally Invasive, and Bariatric Surgery; and Director, Howard University Center for Wellness and Weight Loss Surgery, Howard University Hospital, Washington. He has no disclosures.
