Socioecological factors associated with ethnic disparities in metabolic and bariatric surgery utilization: a qualitative study

Ashley Ofori, Juang Keeton, Quiera Booker, Benjamin Schneider, Carrie McAdams, Sarah E. Messiah

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background: Metabolic and bariatric surgery (MBS) is a safe and effective treatment choice for severe obesity. Yet only approximately 50% of those referred to MBS complete the procedure. Studies show that racial minority groups are less likely than non-Hispanic whites to complete MBS despite having higher rates of severe obesity and co-morbidities. Objectives: To conduct a qualitative study to determine facilitators and challenges to racially diverse patients completing MBS based on the 4 socioecological model domains (intrapersonal, interpersonal, organization/clinical interaction, and societal/environmental). Setting: One university-based surgery practice serving a racially diverse patient population. Methods: Focus groups and in-depth interviews were conducted (Spring 2019) among patients (n = 24, 70% female, 50% non-Hispanic black, 4% Hispanic) who completed MBS over the past year. Social support members were also included (n = 7). Grand tour questions were organized by the 4 socioecological model domains and within the context of MBS completion. Data were audio-recorded, transcribed, and coded. A thematic analysis combining a deductive and inductive approach was conducted. Codes were analyzed using Dedoose to identify themes/subthemes. Results: Ten themes and 15 subthemes were identified. Key intra- and interpersonal facilitators to MBS completion included social support systems, primary care physician support of MBS, co-morbidity resolution, discrimination experiences, and mobility improvements. Key community and environment themes associated with post-MBS sustained weight loss included community support groups and access to healthy foods and exercise facilities. No themes or subthemes varied by race. Conclusions: Educating primary care physicians and social support networks about the benefits of MBS could improve utilization rates. MBS patients have a desire to have their communities provide resources to support their postoperative success.

Original languageEnglish (US)
Pages (from-to)786-795
Number of pages10
JournalSurgery for Obesity and Related Diseases
Issue number6
StatePublished - Jun 2020


  • Bariatric
  • Disparity
  • Metabolic
  • Race
  • Surgery
  • Utilization

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Socioecological factors associated with ethnic disparities in metabolic and bariatric surgery utilization: a qualitative study'. Together they form a unique fingerprint.

Cite this