P2.195: Limited Geographic Access to Adolescent Metabolic and Bariatric Surgical Care in the US

Background: Recent guidelines from the American Academy of Pediatrics recommend weight loss pharmacotherapy plus lifestyle intervention for adolescents age ≥12 years with obesity (BMI ≥ 95th percentile), and evaluation for metabolic and bariatric surgery (MBS) for individuals ≥13 years with severe obesity (BMI ≥ 99th percentile). The increasing use of GLP-1 receptor agonists has accelerated demand for multidisciplinary obesity-focused care for adolescents. To evaluate the availability of such care, we performed a geospatial analysis to quantify the proportion of US adolescents with proximity to pediatric-focused MBS care.

Methods: A cross-sectional geospatial analysis was conducted assessing geographic access to centers accredited by MBS and Quality Improvement Program (MBSAQIP) to perform MBS on individuals under 18 years of age. MBSAQIP-accredited centers designated to provide adolescent-specific care were identified from the publicly available MBSAQIP website (www.mbsaqip.org). Centers’ geocoded addresses were used to generate 60-, 90-, and 120-minute one-way driving isochrones via the Valhalla Isochrone Application Programming Interface and OpenStreetMap road network. The population of adolescents (10– < 18 years) living inside or outside the isochrones was derived from the 2020 US Census American Community Survey. Rural or urban classification was assigned based on Rural-Urban Commuting Area codes. The proportion of adolescents residing within each isochrone distance was assessed nationally, by state, and by rural-urban classification.

Results: A total of 104 MBSAQIP centers with adolescent designation were identified, consisting of 7 freestanding pediatric hospitals (i.e., adolescent-only centers) and 97 adult comprehensive centers across 31 states. Nationally, 47.5% (16.1 million) of adolescents lived further than 60 minutes from an accredited center, 36.3% (12.3 million) lived further than 90 minutes, and 25.4% (8.6 million) lived further than 120 minutes (Figure 1). Geographic access to accredited centers was significantly lower in rural compared to urban areas for 60-minute (20.4% vs 62.3%, p< 0.001), 90-minute (42.0% vs 71.9%, p< 0.001), and 120-minute driving times (58.1% vs 82.0%, p< 0.001). Regional disparities were also observed: Midwest and Mountain West regions had the largest proportions of adolescents without geographic access to bariatric care, while the Eastern US had the highest access rates. States with the most limited geographic access included Alaska, Hawaii, Idaho, Louisiana, Mississippi, Montana, Nevada, New Mexico, and Vermont where more than 90% of adolescents lacked access to an accredited center within a 120-minute drive.

Conclusion: Despite the rising demand for adolescent MBS, nearly half of adolescents must travel an hour or more to access accredited, adolescent-focused care. State and regional disparities are concerning, as many areas with the highest pediatric obesity rates have little to no access to accredited adolescent MBS care. Policies expanding telehealth services and insurance coverage, facilitating cross-state licensure, and incentivizing comprehensive pediatric obesity medical and surgical programs for adolescents are critical to improving access.