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Obesity persists as surgery barrier among transgender adults

More than a quarter of transgender or gender-nonbinary adults presented with obesity when seeking gender-confirmation surgery, and those considered ineligible due to high BMI were unable to lose weight to qualify for the procedures, according to findings from a single-center study published in Endocrine Practice.

Joshua D. Safer

“When we get to the point where we are taking care of transgender people in the way that we should be — beyond the current lack of trained transgender care providers and the lack of insurance coverage for transgender people — it will still be the case that there are barriers to care, which we will have to identify and overcome,” Joshua D. Safer, MD, medical director of the Center for Transgender Surgery and Medicine at the Mount Sinai Health System, and an Endocrine Today Editorial Board Member, said in an interview. “Among these is overweight and obesity among those patients seeking gender-confirmation surgery. Simply expecting people to be motivated enough to be able to lose that significant weight — we’re talking about people with a very high BMI — is not realistic.”

In a retrospective chart review, Safer and colleagues analyzed data from 1,457 transgender or gender-nonbinary individuals with a documented BMI who were seen for a gender-confirmation surgery consult between October 2015 and February 2019 at the Center for Transgender Medicine and Surgery at Mount Sinai (mean age, 35 years; 48% white; 75% transgender women). Researchers assessed the prevalence of obesity among surgery candidates at consult and the most recent subsequent visit, and evaluated the current default preoperative self-monitored weight management protocol.

Within the cohort, 58% of adults had a BMI of at least 25 kg/m². Of those, 382 individuals (26%) had obesity, defined as a BMI of at least 30 kg/m2 at initial surgical consult.

Doctor and tape measure 2019

More than a quarter of transgender or gender-nonbinary adults presented with obesity when seeking gender-confirmation surgery, and those considered ineligible due to high BMI were unable to lose weight to qualify for the procedures.
Source: Adobe Stock

“Overall, the rate of obesity among transgender and gender-nonbinary patients was statistically significantly higher than among cisgender patients at the co-located Comprehensive Health Program, which was 18% during this same period (P < .001), with greater BMI noted among the trans-masculine patient community,” the researchers wrote.

Among 1,389 patients with BMI documented within 3 months of their consultation and at a subsequent clinical visit, 357 (26%) had obesity and 189 (14%) were deemed ineligible for gender-confirmation surgery at baseline. Self-monitored weight management was encouraged for preoperative weight loss to achieve an eligible BMI. However, despite some weight loss, all patients remained within the prescribed BMI range of obesity.

No patients initially deemed ineligible due to elevated BMI became eligible at a subsequent surgical consult visit.

“Instead, a greater proportion of transgender surgical candidates were deemed ineligible due to elevated BMI,” the researchers wrote.

“It is known from the obesity literature that something like 1% of people who try to lose weight do so in a sustained way,” Safer said. “The fact that we saw this cohort had no success despite the fact that they are a motivated crowd was pretty striking. We know in general that bariatric surgery is the most successful strategy for people with very high BMI to get themselves to a safe place, if they can follow the other requirements of those surgeries.” – by Regina Schaffer

Disclosures: Safer reports he has served on an advisory panel for Endo Pharmaceuticals in 2018.

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