Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018
Sarah E. Messiah, Luyu Xie, Folefac Atem, M. Sunil Mathew, Faisal G. Qureshi, Benjamin E. Schneider, Nestor de la Cruz-Muñoz
- This study, published in Annals of Surgery — one of the most respected surgery journals in the world — found that severe obesity among American teenagers was rising sharply from 2015 to 2018, but the number of teens receiving weight loss surgery was not keeping up. This means many teens who could benefit from surgery were not getting access to it.
- The gap between need and access was especially wide for Hispanic and Black teenagers, who are affected by severe obesity at higher rates than other groups but were less likely to receive bariatric surgery during this period. Dr. de la Cruz-Muñoz has been a leading voice in advocating for better access to surgical treatment for these underserved communities.
- This research was part of a larger effort by Dr. de la Cruz-Muñoz and his colleagues to track how many teens are getting weight loss surgery across the country. Their work spans nearly a decade of national data (2015–2023) and has been published in some of the most prominent medical journals, helping to shape national guidelines and improve access to care.
- The findings from this study helped support the American Academy of Pediatrics' 2023 guidelines, which formally recommended that teenagers aged 13 and older with severe obesity be evaluated for bariatric surgery — and called for removing insurance barriers that prevent eligible teens from receiving treatment.
- For families whose teenager is struggling with severe obesity, this research highlights an important message: weight loss surgery is a safe, proven treatment option for teens, and national medical organizations now recommend it for qualifying adolescents. Dr. de la Cruz-Muñoz has been at the forefront of both the research and the clinical care that made these recommendations possible.
This cross-sectional study published in Annals of Surgery analyzed the disparity between rising adolescent Class II and Class III obesity prevalence and metabolic and bariatric surgery (MBS) utilization in the United States from 2015 to 2018. Using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) combined with the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, the study demonstrated that while the prevalence of severe obesity (Class II and III) among US adolescents was increasing significantly during this period, bariatric surgery utilization was not keeping pace — creating a widening gap between disease burden and treatment access. The analysis revealed that this disparity was particularly pronounced among Hispanic and non-Hispanic Black adolescents, who bear a disproportionate burden of severe obesity yet were underrepresented among MBS recipients. The study provided critical epidemiologic evidence supporting the need for improved access to evidence-based surgical treatment for adolescents with severe obesity, particularly in underserved racial and ethnic communities. These findings directly informed subsequent national utilization analyses by the same research team published in JAMA Pediatrics (2023) and The Journal of Pediatrics (2025), creating a continuous surveillance dataset spanning 2015 through 2023 that has tracked the evolution of adolescent MBS access in the United States.
Messiah SE, Xie L, Atem F, Mathew MS, Qureshi FG, Schneider BE, de la Cruz-Muñoz N. Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018. Annals of Surgery. 2022;276(2):324-333. doi:10.1097/SLA.0000000000004493.
