Bariatric surgery is the most effective treatment for obesity and its associated complications, but it remains underutilized. The degree to which bariatric surgery utilization varies by state is unclear. The aim of this study was to estimate variation in bariatric surgery utilization across U.S. states.


Patients who underwent sleeve gastrectomy or gastric bypass and patients with BMI greater than 40 or BMI greater than 35 with comorbidities between 2010 and 2019 were identified with CPT, ICD-9 and ICD-10 codes using the PearlDiver Mariner insurance claims database. Patients living in Puerto Rico and other U.S. territories were excluded.


99,173 bariatric surgery patients were identified out of 1,789,457 patients eligible for bariatric surgery between 2010 and 2019 (5.5%). Bariatric surgery patients were more likely to be female (78.8% vs. 66.4%) and have commercial insurance (81.4% vs. 70.2%) compared to the eligible population. Bariatric surgery utilization varied widely between states, from 10.4% in New Jersey to 2.1% in Vermont. The Northeast region had the highest rates at 7.95%, and the Midwest had the lowest at 4.47%. The proportion of bariatric surgeries that were sleeve gastrectomies also varied from less than 30% in Alaska, North Dakota, and Rhode Island to more than 80% in New Jersey, Nevada, and Mississippi.


There is significant variation in bariatric surgery utilization between states, with almost a five-fold difference between the states with the highest and lowest utilization.