Defense Date

7-7-2025

Graduation Date

Summer 8-8-2025

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Melanie T. Turk

Committee Member

Melissa Kalarchian

Committee Member

Melanie Jay

Keywords

Bariatric surgery, Obesity, Determinants, Minorities, Social determinants of health

Abstract

Background: Bariatric surgery is the most effective treatment for patients with Class 3 obesity. However, of individuals who start the bariatric surgical process, only about half undergo surgery. Factors associated with completion, including race, have been described; however, consistent evidence on obstacles remains to be identified.

Objectives: To explore variables based on the Social Ecological Model (SEM) that may be related to bariatric surgery completion.

Setting: A large, private hospital with a Bariatric Center of Excellence in New York City

Methods: This retrospective chart review utilized data from adults who established an initial bariatric surgery visit from April 1, 2012, to April 1, 2020. A complete case analysis was performed after removing cases with missing data. A series of bivariate tests followed by hierarchical binary logistic regression analyzed the association of variables guided by the SEM and surgery completion. Lastly, we examined the moderating effect of race on the relationships between the explanatory variables and surgery completion.

Results: A total of 2421 patients were included. Identifying as Black, female, and single, having private health insurance, and being in the 1st and 4th quartiles of food insecurity were correlated with bariatric surgery completion at the bivariate level. However, in multivariate analysis, race was no longer significantly associated with surgery completion, and no significant moderating effects were found for race.

Conclusion: Identifying as female, being single, having private health insurance, and having low food insecurity was significantly associated with completing bariatric surgery. Race was not associated with surgery completion after controlling for other factors.

Language

English

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