Increasing Obesity Severity Is Associated With Less Surgical Care in the United States

Document Type

Article

Publication Date

6-8-2026

Publication Title

Obesity

Abstract

Objective: Approximately 41% of the US population has obesity, though the prevalence of the highest BMI populations (e.g., ≥ 60 kg/m2) is increasing most rapidly. Given the association between obesity and surgical disease burden, we hypothesized that higher BMI groups would account for a growing proportion of operative volume over time. This study examined whether individuals with higher BMI have been receiving proportionally more surgical care over time. Methods: All multispecialty National Surgical Quality Improvement Program (NSQIP) cases from 2005 to 2022 were analyzed (n = 11,634,075). Multinomial logistic regression was performed to analyze trends among BMI categories ( < 30.0, 30.0-39.9, 40.0-49.9, 50.0-59.9, 60.0-69.9, and ≥ 70 kg/m2), while adjusting for demographics and comorbidities. Results: Regression models demonstrated decreased odds of patients with BMI ≥ 50 kg/m2 undergoing surgery over consecutive years, with increasingly higher BMI groups representing greater declines. Patients with BMI 30.0-39.9 kg/m2 demonstrated increased proportional operative volume. Conclusions: Despite increased growth in higher BMI populations, individuals in these categories undergo fewer surgical operations annually. These findings demonstrate a critical need to understand these inequalities, which are underscored by rising obesity prevalence that may be contributing to poor access to surgical care as well as increased morbidity/mortality of presentation with more advanced disease.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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