Socioecological Factors Associated with Ethnic Disparities in Bariatric Surgery Utilization - Diversity Supplement R01MD011686

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Metabolic and bariatric surgery (MBS) is a safe and medically effective treatment choice for severe obesity. Yet, despite (1) an increase in the number of MBS procedures performed in the United States annually, and (2) the fact that many express interest in MBS, only about 50% of referred or eligible persons for MBS complete the procedure. Furthermore, studies have documented Hispanics and non-Hispanic Blacks (NHB) are significantly less likely than non-Hispanic Whites (NHW) to complete MBS despite higher rates of both severe obesity and obesity-related comorbidities (e.g. type 2 diabetes, heart disease, cancer). Reasons for the ethnic group disparities in post-MBS weight loss and comorbidity resolution are largely unknown. The recent COVID-19 pandemic added greater complexity to this challenge as hospitals repeatedly cancelled elective surgeries, including MBS, to accommodate anticipated surges in COVID-19-related hospitalizations. Additionally, a significant portion of pre- and post-MBS care has moved to a telehealth model. Post-MBS patients may not be comfortable with, have the means or desire to attend in-person visits due to continued COVID-19 concerns. Beyond risk mitigation for transmission of COVID-19, telehealth for post-MBS patients may improve healthcare access for those who have limited mobility or are housebound; however, more information is needed on what these patients value from in-person visits to make telehealth more acceptable and effective. Future studies should identify individual and environmental factors, including patient motivation to use this platform of care delivery, and evaluate whether these factors are correlated with the type of provider interface used (e.g. video, audio-only, and real-time vs. asynchronous communication) and body weight outcomes. In addition, weight loss maintenance and patient experience/satisfaction with the different models of delivery should also be explored. The goal of this supplement is to enhance our current parent study survey battery with dissemination and implementation (D & I) qualitative interviews, specifically related to post-operative care delivered via telehealth in a subsample (n=40) of our MBS completers (n=200). The proposed study will focus on how patient telemedicine D & I metrics (e.g. acceptability, feasibility) differ by ethnic group. This project is within the scope of the parent grant (patient-provider relationships is one of our battery sub-domains) and enhances our ability to achieve the approved aims: (AIM 1) Identify the socioecological characteristics associated with the following four patient-determined MBS groups: (1) early-completers of MBS (< 3 months), (2) later-completers of MBS (>3 months but within 12-15 months), (3) non-completers of MBS because surgery was electively cancelled after being scheduled; and (4) non-completers due to no interest in MBS after receiving a medical referral (AIM 2) Determine how differences in Groups 1 and 2 relate to post-operative weight loss and comorbidity resolution at 6- 12- and 24-months post-MBS; and (AIM 3) Explore the mediating and moderating effects of ethnicity, intrapersonal, interpersonal, clinical and other environmental interactions on MBS completer group differences.