OBJECTIVES: Obesity rates increased globally in the last century. We investigated predictors of treatment and recovery in patients under 40 years with available diagnosis of obesity in the United States using the PINC AI™ Healthcare Database.

METHODS: Patients were 12-39 years old newly diagnosed with obesity in hospitals between 01/01/2017 and 12/31/2020, followed for ≥ 3 years through 12/31/2023. Time to bariatric surgery, weight-loss drugs, and normal-weight diagnosis were evaluated separately using Cox regressions adjusted for age (pediatric [12-17 years], adult [18-39]), sex, race (White, Black, Asian, Other), and facility setting (urban, rural).

RESULTS: Patients (N = 745,832) were 32 years old on average (SD = 6.9), mostly men (69%), White (63%), and treated in urban hospitals (88%). Pediatric (vs. adult) patients were less likely over time to receive bariatric surgery (Adjusted Hazard Ratio [aHR] [95%CI] = 0.07 [0.05-0.08]) and weight-loss drugs (aHR [95%CI] = 0.45 [0.42-0.47]), but more likely over time to receive normal-weight diagnosis (aHR [95%CI] = 1.77 [1.63-1.91]). Women (vs. men) were more likely over time to receive bariatric surgery (aHR [95%CI] = 2.54 [2.48-2.60]) and weight-loss drugs (aHR [95%CI] = 1.63 [1.59-1.64]), but less likely over time to receive normal-weight diagnosis (aHR [95%CI] = 0.86 [0.83-0.89]). Black (vs. White) patients were less likely over time to receive bariatric surgery (aHR [95%CI] = 0.83 [0.82-0.85]) and weight-loss drugs (aHR [95%CI] = 0.77 [0.76-0.78]), but more likely over time to receive normal-weight diagnosis (aHR [95%CI] = 1.39 [1.34-1.44]). Patients treated in rural (vs. urban) hospitals were less likely over time to receive bariatric surgery (aHR [95%CI] = 0.71 [0.66-0.73]), weight-loss drugs (aHR [95%CI] = 0.77 [0.75-0.78]), and normal-weight diagnosis (aHR [95%CI] = 0.68 [0.64-0.72]). P-values < 0.001.

CONCLUSIONS: Adults, women, White patients, and patients treated in urban hospitals were most likely to receive obesity treatment. Improving treatment across populations is urgently warranted.