Estimating the Bariatric Surgery Rate in the Potentially Eligible Population within the Brazilian Public Healthcare System, 2017–2023

INTRODUCTION/PURPOSE: Access to bariatric surgery (BS) remains limited in most countries with public healthcare systems, despite the continued rise in obesity prevalence, and Brazil is no exception. This study aimed to estimate the BS rate among adults with severe obesity who were potentially eligible for the procedure in Brazilian state capitals and the Federal District between 2017 and 2023. METHODS: Publicly available national databases were used to obtain the number of performed surgeries and to estimate the eligible population. Severe forms of obesity were defined as body mass index (BMI) ≥ 40 kg/m² or BMI between 35 and 40 kg/m² in the presence of diabetes or hypertension. The BS rate was calculated using, as the denominator, the number of adults with severe forms of obesity who reported having no private healthcare insurance. RESULTS: 1,251,075 adults living in the study sites had severe forms of obesity. Of these, 738,430 reported having no private healthcare insurance. Between 2017 and 2023, 8,205 BS were performed on residents who underwent the procedure in their state capital. Overall, only 1% (95% CI 1.09-1.14) of eligible individuals underwent BS in the Brazilian Unified Health System (SUS) over the study period. CONCLUSION: These findings highlight the extremely limited access to surgical treatment for severe forms of obesity in the SUS, despite the country being a global leader in the absolute numbers of BS. Accurate estimates of the number of potential candidates for BS may help identify barriers to treatment which may, in turn, increase the BS rates in Brazil and elsewhere.