Psychological factors, along with social determinants of health such as race, food security, and education level play significant roles in whether a patient will have bariatric surgery for the treatment for obesity, according to a team of researchers from Penn State College of Medicine. Their findings were published in Surgery for Obesity and Related Diseases.

Although bariatric surgery is effective in the treatment of severe obesity, the majority of eligible patients do not undergo the procedure. To examine determining factors of bariatric surgery, the researchers analyzed data from preoperative psychological assessments of 1234 patients who were candidates for bariatric surgery and completed preoperative psychological assessment from 2017 through early 2020. The majority of the patients identified as women (n=946) and White (n=862). Among the study participants, 23% received benefits through the federal government’s Supplemental Nutrition Assistance Program (SNAP).

Key Findings

The researchers found that patients who underwent bariatric surgery were more likely to be White, have higher education levels, did not receive SNAP, and were considered food secure, according to the study results

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Thus, patients who identified as Black, Hispanic, and in other minority groups, were less likely to undergo surgery compared with White patients. The findings that patients receiving SNAP and those with lower levels of education were less likely to have surgery are significant given that both education and economic factors can influence nutrition and dietary behaviors that contribute to obesity and overall wellness, according to the researchers.

In addition to identifying social determinants of health that may contribute to a patient’s likelihood of pursuing surgery, researchers examined psychological factors as well. They found that depression and anxiety are common among candidates for bariatric surgery and that patients with higher levels of depression or anxiety were less likely to proceed with surgery. Based on these findings, the researchers recommended that depression and anxiety should be monitored closely in postoperative patients to reduce the risk of self-harm and suicide.

 “Future studies are needed to develop interventions to overcome treatment barriers and gaps in progressing to surgery, as well as more upstream factors, such as overall patient referral,” said lead author Melissa Butt, DrPH, of the department of public health services at Penn State College of Medicine in Hershey, Pennsylvania.


Butt M, Simmers J, Rogers AM, Chinchilli VM, Rigby A. Predictors of surgical intervention for those seeking bariatric surgery. Surg Obes Relat Dis. 2021;17(9):1558-1565. doi:10.1016/j.soard.2021.06.003