Socioecological Factors Associated With Ethnic Disparities In Bariatric Surgery Utilization - DEIA Mentorship Supplement

项目摘要 代谢和减肥手术（MBS）是治疗严重肥胖症的一种安全有效的治疗选择。然而， 尽管（1）每年在美国进行的MBS程序的数量增加，并且（2） 事实上，许多人表示有兴趣在按揭证券化，只有约50%的转介或合资格的人为按揭证券化实际上 接受手术。此外，研究表明，西班牙裔和非西班牙裔黑人（NHB） 与非西班牙裔白人（NHW）相比，完成MBS的可能性显著降低，尽管严重的 肥胖和肥胖相关的合并症（例如2型糖尿病、心脏病、癌症）。种族原因 MBS后体重减轻和并发症解决的组间差异在很大程度上是未知的;因此， 目前正在实施以下目标：目标1。确定与之相关的社会生态特征 以下四个患者确定的MBS组：（1）MBS的早期完成者（<3个月），（2）后期完成者 MBS（> 3个月但在12 - 15个月内），（3）由于手术是选择性的， （4）在接受医疗检查后，由于对MBS没有兴趣而没有完成 转诊。AIM 2.确定第1组和第2组的差异与术后体重减轻和合并症的关系 MBS后6 - 12个月和24个月的消退。AIM 3.探索种族的中介和调节作用， 个人、人际、临床和其他环境相互作用对MBS承诺小组的影响 差异对于这一行政补充，我们建议在1年内（1）加强我们目前的母公司 研究与两个额外的子项目，第一个由我们目前的博士后研究员（博士领导。 Marroquín），题为MBS和种族对血液和肠道微生物与 第二个由我们的临床合作者（Jaime Almandoz博士）领导，题为“深入探索 不同种族患者对MBS完成和MBS后体重减轻的体重耻辱和偏见， 有自己的一套具体目标;（2）从DEIA增加两个额外的研究生研究助理培训名额 Morales Marroquín和Almandoz博士的项目;（3）加强目前的 指导基础设施，以扩大我们的夏季学者计划的本科生;和（4）使用家长 R01是成功团队科学的一个例子。这些目标将达到在教师，博士后，研究生， 和本科培训水平，并将促进通过各级同行辅导，由家长领导 授予首席研究员。总而言之，迄今为止，母公司奖已经产生了有影响力的工作， 在大流行后的恢复工作中为MBS患者提供临床护理。我们的家长补助金提供了一个很好的例子 团队，跨学科科学，以及代表流行病学，外科学，精神病学， 内分泌学和肥胖医学可以成功地合作，产生有影响力的结果，以改善 弱势群体的健康。在这里，我们建议继续通过一个跨学科的重点 基础/临床科学分项目和一个临床/公共卫生分项目。

PROJECT ABSTRACT 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 people express interest in MBS, only about 50% of referred or eligible persons for MBS actually undergo 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; therefore, the following aims are being conducted: 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. AIM 3. Explore the mediating and moderating effect of ethnicity, intrapersonal, interpersonal, clinical, and other environmental interactions on MBS commitment group differences. For this administrative supplement we are proposing over 1 year to (1) enhance our current parent study with two additional sub-projects, the first one led by our current postdoc fellow (Dr. Elisa Morales- Marroquín) titled Role of MBS and Ethnicity on the Relationship Between the Blood and Gut Microbiotas and the second led by our clinical collaborator (Dr. Jaime Almandoz) titled An In-Depth Exploration of the Impact of Weight Stigma and Bias on MBS Completion and Post-MBS Weight Loss in Ethnically Diverse Patients, each with their own set of specific aims; (2) add two additional graduate research assistant training slots from DEIA backgrounds to assist Drs. Morales Marroquín and Almandoz with their projects; (3) enhance the current mentoring infrastructure to expand our Summer Scholars Program for undergraduates; and (4) use the parent R01 as an example of successful team science. These goals will reach trainees at the faculty, postdoc, graduate, and undergraduate training level and will promote peer-to-peer mentoring through all levels, led by the parent grant Principal Investigator. In summary, the parent award has produced impactful work to date that is informing clinical care for MBS patients in post-pandemic recovery efforts. Our parent grant provides an excellent example of how team, interdisciplinary science, and scientists representing epidemiology, surgery, psychiatry, endocrinology, and obesity medicine can successfully collaborate to produce impactful outcomes to improve the health of vulnerable populations. Here we propose to continue with that interdisciplinary emphasis via one basic/clinical science sub-project and one clinical/public health sub-project.