Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015–2018

Abstract

Objectives: Class II (120% > body mass index [BMI] < 140% of the 95th percentile for age and sex) and Class III (BMI > 140% of the 95th percentile for age and sex) obesity are the fastest growing subcategories of obesity in the United States pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for with class II/III obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with class II/III obesity and (2) utilization rates and 30-day postoperative outcomes. Background: The 2015 to 2018 National Health and Nutrition Examination Survey cross-sectional data (N = 19,225) generated US with class II/III obesity prevalence estimates. The 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 days) cohort data were used to compare adolescent and adult (N = 748,622) postoperative outcomes and to calculate utilization rates. Methods: The 2015 to 2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and National Health and Nutrition Examination Survey data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity, and sex and expressed per 1000.Results: Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic White (68.5%, 59.4%, respectively). The overall 2015 to 2018 MBS utilization rate for youth was 1.81 per 1000 and 5.56 per 1000 for adults (P < 0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = 0.01) but there were no other post-MBS complication differences. From 2015 to 2018 the US prevalence of youth with class II/III obesity increased in Hispanics and non-Hispanic Blacks (P trend < 0.001), but among youth who did complete MBS non-Hispanic Whites had higher rates of utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = 0.006). Conclusions: MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular.

Association Between Patient Satisfaction With Their Patient-Physician Relationship and Completion of Bariatric Surgery by Race and Ethnicity Among US Adults

“…Specifically, it was reported that 57.8% of MBS completers were non-Hispanic White, whereas only 17.3% were non-Hispanic Black and 9.4% were Hispanic. 9 In terms of disparities in post-MBS outcomes, studies have shown that non-Hispanic Black patients have a higher incidence of 30-day post-MBS complications compared with their non-Hispanic White counterparts and lower long-term, sustained weight loss compared with non-Hispanic White and Hispanic/Latinx patients. [10][11][12] However, other studies have shown that MBS reduces cardiometabolic disease risk in Hispanic/ Latinx patients 13 and reduces the risk of type 2 diabetes and prediabetes among multiethnic adults.…”

Distribution of comorbidities as primary diagnoses by obesity class among patients in a large US paediatric healthcare system

“…Of particular concern is the increase in the prevalence of children with class II (defined as a body mass index [BMI] >120% of the 95th percentile for age and sex or a BMI of ≥35, whichever is lower) and III obesity (defined as a BMI ≥140% of the 95th percentile for age and sex or a BMI of ≥40 or greater, whichever is lower), which has been labelled an ‘epidemic within an epidemic’ by the American Academy of Pediatrics 2 . Indeed, NHANES analysis has shown a significant positive linear trend of the prevalence of class III obesity from 1999 to 2018 in the US paediatric population 3,4 . Specifically, NHANES 2017–18 data show that 6.5%, or about 4.8 million US youth ages 2‐to‐19 have class II/III obesity and from 2015 to 2018 the US prevalence of severe obesity increased in Hispanic and non‐Hispanic Black youth 4 …”

“…Indeed, NHANES analysis has shown a significant positive linear trend of the prevalence of class III obesity from 1999 to 2018 in the US paediatric population 3,4 . Specifically, NHANES 2017–18 data show that 6.5%, or about 4.8 million US youth ages 2‐to‐19 have class II/III obesity and from 2015 to 2018 the US prevalence of severe obesity increased in Hispanic and non‐Hispanic Black youth 4 …”

“…2 Indeed, NHANES analysis has shown a significant positive linear trend of the prevalence of class III obesity from 1999 to 2018 in the US paediatric population. 3,4 Specifically, NHANES 2017-18 data show that 6.5%, or about 4.8 million US youth ages 2-to-19 have class II/III obesity and from 2015 to 2018 the US prevalence of severe obesity increased in Hispanic and non-Hispanic Black youth. 4 These new paediatric population estimates are particularly concerning because children with obesity have a high prevalence of cardiometabolic disease risk factors including elevated blood pressure, 5 insulin and glucose, and low high-density lipoprotein (HDL) cholesterol.…”

“…3,4 Specifically, NHANES 2017-18 data show that 6.5%, or about 4.8 million US youth ages 2-to-19 have class II/III obesity and from 2015 to 2018 the US prevalence of severe obesity increased in Hispanic and non-Hispanic Black youth. 4 These new paediatric population estimates are particularly concerning because children with obesity have a high prevalence of cardiometabolic disease risk factors including elevated blood pressure, 5 insulin and glucose, and low high-density lipoprotein (HDL) cholesterol. 6,7 Additionally children with obesity are at risk for other comorbidities including obstructive sleep apnea (OSA), 8 asthma, 9 nonalcoholic fatty liver disease (NAFLD), 10 musculoskeletal issues such as impaired mobility and lower extremity joint pain, 11 and psychosocial consequences such as poor self-esteem, 12 depression, 13 anxiety, 13 and autism.…”