Closing the Gap to Bariatric Surgery: Predictors of Non-Progression in Patients with Obesity Class IV and V at a Community-Based Bariatric Center
In brief
52% of patients with class IV or V obesity did not reach surgery
In this single-center study, 38 of 73 patients evaluated for bariatric surgery did not proceed. Those who stalled were less likely to have an established primary care clinician or complete specialist, nutrition, and surgeon follow-up visits; GLP-1 drug use at presentation was also associated with lower progression, but may reflect different care pathways. Navigation may help address these gaps.
- Journal
- Journal of laparoendoscopic & advanced surgical techniques. Part A (Q2)
- Published
- 22 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Hamdan Mallick, Hania Ahmer, Krishnaraj Mahendraraj, Anirudha Goparaju, Theodoros Katsichtis
- PMID
- 42914576
- DOI
- 10.1177/10926429261501239
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 25 October 2026): GLP-1 use and barriers to progressing to bariatric surgery
Abstract
INTRODUCTION: Patients with obesity class IV and V benefit substantially from bariatric surgery, yet many do not complete the preoperative pathway. The contribution of system-level barriers and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy to non-progression remains poorly understood, particularly in community settings. METHODS: We conducted a single-center retrospective study of adults with obesity class IV and V evaluated for bariatric surgery (2024-2025). The primary outcome was progression to surgery. Variables included demographics, comorbidities, insurance, primary care physician (PCP) status, GLP-1 RA use, specialist consultation completion, prior authorization activity, and surgeon follow-up. Chi-square testing, stratified odds ratios, and multivariable logistic regression were performed. RESULTS: Among 73 patients, 38 (52.1%) did not progress to surgery. Demographics and comorbidities were similar between groups. Patients who did not progress had lower PCP establishment (44.7% versus 97.1%, P < .001), fewer completed specialist consultations (28.9% versus 71.4%, P = .001), fewer nutrition visits (P = .004), and fewer surgeon follow-up visits (P < .001). GLP-1 RA use at initial consultation was associated with lower progression to surgery (57.9% versus 11.4%, OR 0.12, P = .008), with consistent findings across insurance types but a weaker association among patients without an established PCP. Patients who did not progress also had higher emergency department utilization and more system-related scheduling barriers (both P < .001). CONCLUSION: Non-progression to bariatric surgery was associated with modifiable system-level barriers, including limited PCP integration, incomplete specialist evaluation, and reduced surgical follow-up. GLP-1 RA use at presentation was also associated with non-progression, although this relationship may reflect differences in treatment pathways rather than a direct treatment effect. Structured patient navigation and integrated medical-surgical obesity care may improve pathway completion.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.