title: Unmet need for bariatric surgery.
abstract: BACKGROUND
  With the rising prevalence of severe obesity and type 2 diabetes (T2D), bariatric surgery offers a clinical and cost-effective treatment for carefully selected patients. Despite this, the provision of surgical services varies significantly between countries.
  
  
  OBJECTIVE
  To inform health service planning by estimating the number of people who would potentially benefit from bariatric surgery.
  
  
  METHODS
  Nationally representative sample of community-dwelling older adults.
  
  
  METHODS
  We applied two separate evidence-based criteria sets for eligibility for bariatric surgery. For the first set of criteria, we considered those with body mass index≥40 kg/m2or≥35 kg/m2and one or more of the following: T2D, hypertension, previous myocardial infarction, or sleep apnea. For the second set of criteria, we considered patients with T2D and body mass index≥35 kg/m2, with one or more of the following: previous myocardial infarction, elevated urine albumin-creatinine ratio, retinopathy, neuropathy, or peripheral vascular disease. Prevalence estimates were applied to census figures for 2011, estimating absolute numbers meeting the criteria.
  
  
  RESULTS
  Among adults aged≥50 years, 7.97% (95% confidence interval [CI]: 7.23, 8.78), representing 92,573 people (95% CI: 83,978, 101,981), met criteria one and 0.97% (95% CI: 0.73, 1.28), representing 11,231 people (95% CI: 8471, 14,890), met criteria two. With fewer than 1/100,000 population publicly funded surgeries taking place annually, current service provision meets much less than 0.1% of the need.
  
  
  CONCLUSIONS
  While many adults who fulfill the eligibility criteria for bariatric surgery may not want or require it, the current level of need for bariatric surgical services is not being met. A strategy to develop and expand the provision of bariatric care is urgently needed.
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland. Electronic address: kate.oneill@ucc.ie.
authors.forename: Kate N
authors.initials: KN
authors.lastname: O'Neill
authors.affiliation: Bariatric Medicine Service, Galway Diabetes Research Centre, HRB Clinical Research Facility, Galway, Ireland.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Finucane
authors.affiliation: Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland.
authors.forename: Carel W
authors.initials: CW
authors.lastname: le Roux
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland; Department of Statistics, University College Cork, Ireland.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Fitzgerald
authors.affiliation: Department of Epidemiology and Public Health, University College Cork, Ireland.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kearney
mesh_terms: D000368:Aged; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000150:complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D020380:Needs Assessment; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000453:epidemiology
keywords: Bariatric surgery eligibility; Severe obesity; Type 2 diabetes