Patients With Severe Obesity Are Increasingly Being Denied Surgery, Study Finds

People with severe obesity are undergoing fewer surgical procedures than expected, despite the rapid growth of this patient population, according to a new study published in the journal Obesity.

Researchers analyzed data from 11.6 million surgical cases recorded between 2005 and 2022 through the National Surgical Quality Improvement Program. They found that the likelihood of undergoing surgery declined progressively as body mass index (BMI) increased.

The trend was especially pronounced among individuals with extremely high BMI values. Even after accounting for age, sex, race, and other medical conditions, patients with the highest levels of obesity were significantly less likely to receive surgical treatment over time.

According to lead author Vance Albaugh, many patients with severe obesity are told they must lose substantial amounts of weight before they can qualify for procedures such as joint replacements, hernia repairs, or hysterectomies.

Researchers initially expected that people with higher BMI would account for a growing share of surgical procedures because obesity is associated with numerous health conditions that may require surgery. Instead, the analysis revealed the opposite pattern.

The reasons behind this trend are likely complex. Obesity is associated with longer operations, a higher risk of complications, wound infections, and more difficult postoperative recovery. In addition, some healthcare facilities may lack equipment and infrastructure designed to accommodate patients with severe obesity.

The study also suggests that systemic factors may play a role, including insurance limitations, institutional policies, concerns about surgical risks, and potential weight-related bias within healthcare systems.

Experts warn that reduced access to surgery could have serious consequences. Delays in treatment may worsen outcomes for conditions such as cancer and other diseases where timely surgical intervention is critical.

Commenting on the findings, Melanie Jay noted that healthcare systems may inadvertently discourage treatment of higher-risk patients because quality metrics often focus on complication rates and hospital stays. She suggested that these measures should better account for the increased risks associated with treating patients with severe obesity.

Researchers also highlighted another possible factor: some patients may avoid seeking medical care because of stigma, mobility limitations, or difficulties accessing diagnostic equipment such as CT and MRI scanners that cannot accommodate larger body sizes.

The authors conclude that there is an urgent need to better understand the barriers preventing people with severe obesity from receiving surgical care and to develop policies that ensure more equitable access to treatment.