Weighed Down by Paperwork: Identifying Barriers to Metabolic and Bariatric Surgery Evaluation in the United States

Obesity affects over 42% of U.S. adults, yet access to metabolic and bariatric surgery (MBS) remains limited despite its proven efficacy. While use of GLP-1 receptor agonists has risen in the past three years, MBS volume has declined over 25% during the same period. Reported barriers to MBS include long wait times, societal sigma, fear of surgery, and insurance restrictions. This study investigated appointment accessibility and program requirements for patients seeking MBS.

We conducted a secret shopper study of bariatric surgery centers in North Carolina (n=18) and South Carolina (n=17) June - August 2025. Trained callers contacted each program twice, once posing as a patient with Medicaid and once as a patient with private insurance, to request an initial consultation appointment. Data collected included appointment wait times, required documentation, pre-surgical prerequisites, and administrative barriers.

Of the 24 centers successfully contacted, all accepted private insurance and 94.3% accepted Medicaid. Median wait time to appointment was 20 days, with no difference by insurance type. On average, programs required 1.7 calls before reaching a scheduler. Most centers (77.1%,n=27) required pre-appointment steps such as an online application, seminar, or PCP referral. Eleven centers could not be reached due to incorrect contact information, and two offered only online intake forms.

Rather than insurance-related disparities, we found that administrative barriers such as repeated call attempts, inaccurate contact information, and variable prerequisites were the main obstacles to MBS access. The lack of standardization across programs highlights the need to streamline the evaluation process.