Online informational bariatric seminars: increasing access to bariatric surgery or widening a divide?

Historically our institution has required prospective bariatric patients attend an in-person introductory seminar prior to their first clinic visit. Utilization of the internet has increased dramatically over the last 10 years and in 2016, we added an online seminar. With the emergence of COVID-19 and new rules regarding social distancing, we are currently relying exclusively on web-based orientation. Research suggests there are racial and socioeconomic disparities in the utilization of internet health resources in the general population. To our knowledge this has not been studied in regard to the bariatric population.

A retrospective chart review was performed on patients who attended online (OS) and in-person seminars (IPS). Our primary endpoint was to compare the percentage of patients who underwent surgery. Secondary outcomes included differences in demographic and clinical characteristics between the patients who attended the OS versus the IPS.

Of the 1152 patients who attended a bariatric orientation, 71.2% scheduled an office visit. The IPS patients had a higher rate of office visits and shorter time between orientation and first visit. Of patients eligible for surgery, there was a higher percentage of Caucasians in the OS group while the IPS group had higher rates of Hispanic and African Americans. Patients from the OS group had higher rates of marriage and employment, and lower rates of medical co-morbidities. When controlling for age, sex, race/ethnicity, marital status, employment status and medical co-morbidities, there was no significant impact of type of orientation on progression to surgery.

We found that there was no difference in progression to surgery between the two orientation groups. Importantly, however, we detected marked demographic and clinical differences between the two patient populations. There is an urgent need to address these disparities as we are now heavily relying on patient outreach and education via the internet.