Sociodemographic, Health Care, and Clinical Factors Associated With Metabolic Bariatric Surgery Uptake Among US Adults With Obesity
Authors' conclusion
In this cohort study of individuals with an initial obesity diagnosis, uptake of MBS was patterned by demographic, clinical, and health care factors. This finding suggests substantial opportunity to improve access to MBS through targeted policies and interventions.
Study context
- Population
- Adults aged 18–64 years with incident obesity diagnosis, 2018–2022, Merative MarketScan Commercial Claims and Encounters Database; excluding pregnancy-related visits, missing body mass index (BMI) Z-code or prior metabolic bariatric surgery (MBS); mean age 41.4 years, 58.3% women
- Participants
- 109,849 adults
- Outcome
- Factors associated with MBS uptake
- Follow-up
- Within 12 months of index
Methodological detailsinsurance claims database, machine learning (random forest, SHAP), multivariable logistic regression
- Insurance claims database
- Machine learning (random forest, SHAP)
- Multivariable logistic regression
Main finding
As reported in the abstract
- Received MBS
- 3268 (3.0%)
- Random forest model AUC
- 0.88 (0.87-0.90) (95% CI)
- Mean SHAP value, surgeon (NEC) as provider
- 0.00918 (0.00893-0.00945) (95% CI)
- Mean SHAP value, BMI category
- 0.00501 (0.00499-0.00503) (95% CI)
- Mean SHAP value, family practice as provider
- 0.00372 (0.00370-0.00374) (95% CI)
- Mean SHAP value, female sex
- 0.00370 (0.00368-0.00371) (95% CI)
- OR, surgeon (NEC) as provider
- 18.97 (17.11-21.02) (95% CI)
- OR, orthopedic surgeon as provider
- 5.33 (4.54-6.24) (95% CI)
- OR, dietitian as provider
- 2.51 (1.97-3.20) (95% CI)
- OR, antidiabetic agents, miscellaneous
- 1.42 (1.25-1.62) (95% CI)
- OR, psychotherapeutics, antidepressants
- 1.13 (1.01-1.25) (95% CI)
- OR, depressive disorders
- 1.16 (1.02-1.33) (95% CI)
- OR, female sex
- 2.45 (2.22-2.71) (95% CI)
Observational data: associations, not effects.
Further findings
Temporal trend in MBS uptake · 2019 through 2022
- Significant decrease in MBS uptake for individuals with incident obesity diagnosis in more recent year-quarters
Original publication
Sociodemographic, Health Care, and Clinical Factors Associated With Metabolic Bariatric Surgery Uptake Among US Adults With Obesity. JAMA Netw Open. Published 1 June 2026. doi:10.
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