Equitable access to bariatric surgery: an exploration of trends in health inequalities and patient profiles over the last 15-years
Bibliographic record
Abstract
Background Bariatric surgery is a safe and effective treatment for obesity and associated co-morbidities. Equality of access to bariatric surgery in the NHS has long posed a serious challenge with significant variation in eligibility criteria between different regions. Obesity disproportionately affects more deprived groups and some ethnic minorities, who have also been shown to experience a worse quality of healthcare and poorer health outcomes. This study aimed to understand the profile of patients accessing bariatric surgery and explore changes in trends over a 15-year period to identify important areas of development for obesity-related healthcare services in our region. Methods This was a retrospective study of all patients undergoing primary and revisional bariatric surgery (gastric band, sleeve gastrectomy, RNY and single anastomosis bypass) for weight loss at our regional bariatric surgical centre since its inception in 2008 until the end of 2022. Data was extracted from a combination of electronic records and a surgical database. Variables included gender demographic and procedure related data, baseline characteristics including height, weight, deprivation scores, co-morbidities, bloods, and micronutrient levels. Changes in patient profiles were mapped over the 15-year period and compared to population-level data derived from the national census and other publicly available sources. Results 2062 (mean age 47) patients were included. 11 (0.5%) patients were aged over 70 and 155 (7.5%) were less than 30 years of age. 75% patients were women; 42% of patients in 2013 were men which steadily decreased to 17% in 2022 (p < 0.05). The mean BMI of patients undergoing surgery was 54 in 2010 and gradually decreased to 48 in 2022 (p<0.05). White British patients represented 93% of all patients. This decreased from 96.5% in 2009 to 86% in 2022. White British ethnicity was estimated to make up 81% of patients with obesity in the NW of England. Conclusions Several major groups who are likely to significantly benefit from bariatric surgery are disproportionately under-represented by patients accessing treatments for obesity. This includes those at the extremes of ages, men, lower BMI patients and ethnic minority groups. Trends over the last 15 years have either worsened or have insufficiently improved to bridge the gap in health inequalities. The findings from our study underscore the urgent need for wider-scale targeted approaches which aim to address obesity and increase more equitable access to these life-changing treatments.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".