Bariatric surgery is the only health care intervention that facilitates significant and sustained weight loss.1 Surgery results in remission of diabetes in 80% to 90% of obese patients with diabetes, and reduces the risk of death associated with obesity by nearly 30%.2 More than 5% (at least 15 million)3 of the US adult population meets the criteria for obesity surgery (body mass index [BMI] ≥ 40 or BMI ≥ 35 with other conditions such as diabetes). In actuality, only a small fraction of this group is considered for and undergoes surgery (180 000 estimated bariatric surgery procedures in 2006).4 This mismatch between eligibility and receipt of surgical care is related to multiple factors, including the ways in which the health care system considers patients for surgery and delivers bariatric surgical care. Growing evidence also suggests that the cohort that does undergo surgery is not drawn evenly from the pool of candidates with extreme obesity. Understanding the factors involved in these mismatches is essential to developing a rational and equitable approach to bariatric surgery.
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