Objective Bariatric surgery has been shown to be the most
effective method of achieving weight loss and alleviating
obesity-related comorbidities. Yet, it is not being used equitably.
This study seeks to identify if there is a disparity in payer
status of patients undergoing bariatric surgery and what factors
are associated with this disparity.
Methods We performed a case-control analysis of National
Inpatient Sample. We identified adults with body mass index
(BMI) greater than or equal to 25 kg/m2 who underwent bariatric
surgery and matched them with overweight inpatient
adult controls not undergoing surgery. The sample was analyzed
using multivariate logistic regression.
Results We identified 132,342 cases, in which the majority had
private insurance (72.8%). Bariatric patients were significantly
more likely to be privately insured than any other payer status;
Medicare- and Medicaid-covered patients accounted for a low
percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29–
0.37, p < 0.001; Medicaid 8.7%, OR 0.21, 95% CI 0.18–0.25,
p < 0.001). Medicare (OR 1.54, 95% CI 1.33–1.78, p < 0.001)
and Medicaid (OR 1.31, 95% CI 1.08–1.60, p = 0.007) patients
undergoing bariatric surgery had an increased risk of complications
compared to privately insured patients.
Conclusions Publicly insured patients are significantly less
likely to undergo bariatric surgery. As a group, these patients
experience higher rates of obesity and related complications
and thus are most in need of bariatric surgery

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• The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes