SAGES 2026 Annual Meeting Emerging Technology Session

Weight Loss Across the Map: Rural–Urban Differences After Bariatric Surgery in Epic Cosmos

Background:

-Obesity disproportionately affects rural populations1

-Observational data suggests rural populations experience delays in receiving care related to geographic isolation and logistical barriers2

-Prior studies looking at rural metabolic and bariatric surgery (MBS) are limited by sample size3,4

-Little is known regarding the factors of rural living on the impact of weight loss after MBS

Methods:

-A cross-sectional, retrospective analysis

-Data: Epic Cosmos

-A prospectively maintained, all-payer, nationwide dataset

-Electronic health records data from over 300 million patient charts

-Isolated patients who underwent roux-en-y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2017-2023

-Demographics and weight measurements in encounters after MBS

-Rural Urban Communting Area (RUCA)& codes obtained for each patient

-Scores from 1-6 were considered urban/suburban

-Scores 7-10 were considered rural

-Exclusion criteria: revisional surgery, those without RUCA codes

-Percent Total Body Weight Loss (%TBWL) at 12 and 24-months were evaluated as well as primary non-response (loss of <10% TBWL)

Discussion:

-Rural patients were slightly older, more likely to be white, had higher rates of co-morbidities, and had a higher weight at the time of surgery.

-Rural patients were more likely to undergo RYGB than their urban counterparts

-Of the patients with available weight data at 6, 12, and 24 months, there were no differences in %TBWL between the groups

-The proportion of patients with primary non-response after MBS didn’t differ between rural and urban patients

Weight Loss Across the Map: Rural-Urban Differences After Bariatric Surgery in Epic Cosmos