Yewande Alimi

Introduction Bariatric surgery is the most effective durable treatment for severe obesity, yet neighborhood context may shape both progression to surgery and the ability to sustain postoperative health behaviors. We examined bariatric surgery utilization and postoperative body mass index (BMI) change in relation to tract-level food insecurity and neighborhood vulnerability in Washington, DC. Methods Retrospective EHR-based cohort study of adult Washington, DC residents with BMI data and census tract linkage (2020–2023). Bariatric referral/order, consultation, and completed surgery were identified; BMI measures were linked to tract-level indicators of food insecurity, poverty, social vulnerability, and deprivation. We compared surgical and non-surgical patients; mapped tract-level BMI change using choropleth maps; identified space–time clusters of utilization using retrospective scan statistics; and compared social determinants between high- and low-utilization clusters using analysis of variance. Results Among 41,617 adult obese DC residents, 1,129 (2.7%) had a bariatric referral/order, 1,952 (4.7%) had a bariatric consultation, and 472 (1.1%) underwent surgery. Surgical patients were predominantly Black/African American (90%); concentrated in Wards 5 (31%), 7 (34%), and 8 (30%). Tract-level BMI patterns were more favorable among surgical than non-surgical patients. Space–time analysis identified two high- and two low-utilization clusters. Compared with low-utilization clusters, high-utilization clusters had higher food insecurity (88.1 vs. 5.4%; p < 0.001), poverty (81.0 vs. 27.6%; p < 0.001), uninsured rates (5.1 vs. 2.4%; p < 0.001), and overall social vulnerability (10.5 vs. 5.8; p < 0.001), Neighborhood Deprivation Index (1.533 vs. − 0.721); all four SVI subdomains were higher (p < 0.001, except housing type and transportation, p = 0.019). Conclusion Bariatric surgery utilization clustered in neighborhoods with high structural and social vulnerability and postoperative BMI reduction was observed across neighborhoods. Incorporating neighborhood context into bariatric care may help identify areas for targeted referral, access support, and postoperative resource allocation to promote equitable treatment.

Purpose The study aim was to assess the impact of clinically significant weight loss (CSWL; ≥5% weight reduction) on postoperative complications following abdominal wall reconstruction with the component separation technique (CST). Methods A retrospective review of patients who underwent open ventral hernia repair (VHR) with CST from November 2008 to January 2022 was performed. Cohorts were stratified by presence of CSWL from baseline weight at preoperative consultation. Results Of 180 total patients, 40 (22.2%) achieved CSWL prior to VHR. Mean age was 59.6 ± 11.2 years. Patients in the CSWL cohort represented a higher average body mass index (BMI) (33.6 vs. 31.7 kg/m², p = 0.076), and were obese more frequently (80.0% vs. 56.4%, p = 0.007). The CSWL cohort had a higher proportion of patients in Ventral Hernia Working Group (VHWG) classification II (82.5% vs. 63.6%) while the non-CSWL cohort had more VHWG classification III/IV (20.0% vs. 10.0%, p = 0.078). Mean follow-up duration was 6.1 ± 13.4 months. Complications, including 30- and 90-day surgical site occurrence (SSO), return to operating room, readmission, and hernia recurrence (CSWL: 5.0% vs. non-CWL 1.4%, p = 0.179), were comparable between cohorts. BMI was an independent predictor of any complication (OR 1.07, p = 0.044) and 90-day SSO (OR 1.10, p = 0.043). Conclusion Achievement of CSWL prior to open VHR utilizing CST results in similar post-reconstruction outcomes to patients who maintained a comparable BMI at baseline. Higher day-of-surgery BMI was more consequential to postoperative complications than percent weight loss.

Background Sleeve gastrectomy to Roux-en-Y bypass conversion is a commonly performed procedure, yet data are limited on outcomes and their predictors. The purpose of this study is to characterize the long-term outcomes of patients after sleeve-to-bypass conversion and identify predictors of post-conversion outcomes. Methods We performed a retrospective cohort study of patients who underwent sleeve-to-bypass conversion for obesity across four hospitals from 06/2017 to 04/2023. Predictors of the below-average percent excess weight loss (%EWL; relative to pre-conversion weight) at 1 and 2 years following conversion were identified using multivariate logistic regression models adjusting for comorbidities, demographics, and neighborhood socioeconomic status. Results 150 Patients undergoing sleeve-to-bypass conversion were identified. 99 had 1-year data and 63 had 2-year data. Mean %EWL at 1- and 2-years following conversion were 40.2% and 37.4%, respectively. EWL > 40% after sleeve gastrectomy was an independent predictor of the below-average %EWL 1-year post-conversion (OR 10.0, 95% CI 2.2–63.0, p < 0.01), and BMI > 40 kg/m² at the time of conversion was an independent predictor of both 1- and 2-year below-average %EWL post-conversion (p = 0.01 and 0.05, respectively). Insignificant predictors of the below-average %EWL after conversion included: weight regain after sleeve, time between sleeve and conversion, alimentary limb length, and any bariatric surgery prior to sleeve gastrectomy. Conclusion Patients should be counseled that the typical expected %EWL for sleeve-to-bypass conversion is less than the 50% EWL benchmark of success for index bariatric operations. The main predictors of a suboptimal conversion outcome are > 40% EWL after sleeve or > 40 BMI kg/m² at the time of conversion. Most variables in our analysis were not predictors of post-conversion %EWL, including weight regain between sleeve and conversion, alimentary limb length, and time interval between procedures, which suggests that these factors should not play a large role when considering sleeve-to-bypass conversion.

Background and Objective: Obesity and its associated chronic medical conditions such as diabetes and hypertension are among the leading health concerns in the developed world. Bariatric and metabolic surgery has emerged as an established and definitive treatment for severe obesity. Given the disproportionate burden of obesity and diabetes on different racial and socioeconomic populations, studies have assessed the impact of these disparities in bariatric surgery patients. Methods: A comprehensive search of the current literature utilizing the following keywords was performed: bariatric surgery and a combination of disparities, outcomes, complications, mortality, access to care or socioeconomic factors. Key Content and Findings: We review the impact of ethnoracial differences on access to care and outcomes of bariatric surgery including weight loss, comorbidity remission, complications and mortality. Existing literature demonstrates reduced weight loss and higher complication rates in non-Hispanic Black patients compared to White patients with trends toward normalization of weight loss variation and comorbidity remission among ethnic groups over longer follow up times. Conclusions: Bariatric surgeons should consider ethnoracial and socioeconomic when counseling patients regarding bariatric surgery to support patients at risk of poorer outcomes. Further prospective research is needed to examine impact of ethnoracial and socioeconomic disparities on bariatric surgery patients.