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

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.

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.

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.

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.