A call to arms: obese men with more severe comorbid disease and underutilization of bariatric operations.
BACKGROUND
Despite similar rates of obesity among American men and women, population-based studies suggest that bariatric surgery patients are disproportionately female. We sought to assess this observation quantitatively.


METHODS
Data were prospectively collected from 1,368 consecutive patients evaluated for bariatric surgery over a 4-year period. The prevalence of diabetes mellitus (DM), hypertension (HTN), dyslipidemia (DYS), obstructive sleep apnea (OSA), gastroesophageal reflux disease, depression, back pain (BKP), and musculoskeletal peripheral disease was assessed. A severity score from 1 to 5 had been assigned to each comorbidity based on the Assessment of Obesity Related Comorbidities Scale (AORC). Metabolic syndrome (MetS) was defined as the concurrent presence of DM, HTN, and DYS.


RESULTS
The majority of patients were female (n = 1,115, 81.5%). Male patients were older (44.5 ± 9.5 vs. 42.6 ± 9.6 years, p = 0.0044) and had higher body mass index (48.7 ± 7.8 vs. 46.6 ± 7.4 kg/m(2), p < 0.0001). On average, men presented with 4.54 serious comorbidities and 3.7 complicated comorbidities (AORC score ≥3), whereas women presented with 4.15 serious comorbidities and 3.08 complicated comorbidities. More men presented with DM (36.4 vs. 28.9%, p = 0.0154), HTN (68.8 vs. 55.3%, p = 0.0001), OSA (71.9 vs. 45.7%, p < 0.0001), and MetS (20.9 vs. 15.2%, p = 0.0301). Men also presented with more complicated DM (33.2 vs. 23.9%, p = 0.0031), DYS (36.8 vs. 23.5%, p < 0.0001), HTN (58.9 vs. 44.6%, p < 0.0001), BKP (25.3 vs. 19.3%, p = 0.0378), OSA (56.9 vs. 30.1%, p < 0.0001), and MetS (17.8 vs. 10.0%, p = 0.001).


CONCLUSIONS
Although men typically comprise less than 20% of bariatric surgery patients, they potentially have more to gain from these operations. Men present later in life, with more advanced obesity, and with more complicated comorbidities. Such findings mandate more research and resources to investigate this barrier to treatment and to provide the morbidly obese male with the surgical care he clearly needs.
Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Sacramento, CA, 95817, USA.
Gina N
GN
Farinholt
Aaron D
AD
Carr
Eun Jin
EJ
Chang
Mohamed R
MR
Ali
D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult