Gina N Farinholt, MD, Aaron D Carr, MD, Mohamed R Ali, MD
University of California, Davis
Despite similar rates of obesity among American men and women, population-based studies suggest that bariatric surgery patients are disproportionately female. The UC Davis experience suggests that when the obese male does present for bariatric surgery, his obesity is more advanced and comorbid diseases are more severe. We sought to quantitatively assess this observation.
Demographic, anthropomorphic, and comorbidity data were prospectively collected from 1368 consecutive patients evaluated for bariatric surgery over a four-year period. The prevalence of depression (DEP), diabetes mellitus (DM), dyslipidemia (DYS), gastroesophageal reflux disease (GERD), hypertension (HTN), back pain (BP), and obstructive sleep apnea (OSA) were assessed. A severity score from 1-5 had been assigned to each comorbidity, upon patient presentation, based on the Assessment of Obesity Related Comorbidities Scale (AORC). Patients requiring treatment or those who had complications of the disease were given a score of 3, 4, or 5 and designated as having "complicated" comorbid disease. Metabolic syndrome (MetS) was defined as the concurrent presence of DM, HTN and DYS. Statistical significance was considered at the α=0.05 level.
The majority of patients were female (n=1115, 82%). Male patients were older (44.5 ± 9.5 years vs 42.6 ± 9.6 years, p<0.01) and had higher body mass index (BMI) (48.7 ± 7.8 kg/m2 vs 46.6 ± 7.4 kg/m2, p<0.0001). More women presented with class I or II obesity (BMI < 40 kg/m2) (14.3% vs 5.1%, p<0.0001), while more men presented with class IV obesity (BMI 50-59 kg/m2) (29.6% vs 22.8%, p<0.05). The differences in patients with class III and class V obesity was not statistically significant.
On average, men presented with 4.54 serious comorbidities and 3.70 “complicated” comorbidities, while women presented with 4.15 serious comorbidities and 3.08 “complicated” comorbidities. More men presented with DM (36.4% vs 29.0%, p<0.05), HTN (68.8% vs 55.3%, p<0.0001), OSA (71.9% vs 45.7%, p<0.0001) and MetS (20.9% vs 1.5%, p<0.0001). Men also presented with more “complicated” DM (32.4% vs 23.9%, p<0.01), DYS (36.8% vs 23.3%, p<0.0001), HTN (58.5% vs 44.5%, p<0.0001), BP (26.1% vs 18.9%, p<0.05), OSA (56.5% vs 30.0%, p<0.0001) and MetS (17.8% vs 10%, p<0.001).
More women presented with GERD (52.7% vs 41.5%, p<0.01), “complicated” GERD (26.6% vs 18.2%, p<0.01) and “complicated” depression (37.4% vs 28.9%, p<0.01).
Although men typically comprise less than 20% of bariatric surgery patients, they have more to gain from these operations. Men present later in life, with more advanced obesity, and with more “complicated” comorbidities. Most notably, they have a significantly higher incidence of metabolic syndrome and are, thus, predisposed to cardiovascular disease. Such findings mandate more research and resources to investigate this barrier to treatment and to provide the morbidly obese male with the surgical care he clearly needs.
Session: Podium Presentation
Program Number: S086