{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T17:34:00Z","timestamp":1792949640548,"version":"4.5.0"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Patients with obesity class IV and V benefit substantially from bariatric surgery, yet many do not complete the preoperative pathway. The contribution of system-level barriers and glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy to non-progression remains poorly understood, particularly in community settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective study of adults with obesity class IV and V evaluated for bariatric surgery (2024\u20132025). The primary outcome was progression to surgery. Variables included demographics, comorbidities, insurance, primary care physician (PCP) status, GLP-1 RA use, specialist consultation completion, prior authorization activity, and surgeon follow-up. Chi-square testing, stratified odds ratios, and multivariable logistic regression were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 73 patients, 38 (52.1%) did not progress to surgery. Demographics and comorbidities were similar between groups. Patients who did not progress had lower PCP establishment (44.7% versus 97.1%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), fewer completed specialist consultations (28.9% versus 71.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001), fewer nutrition visits (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004), and fewer surgeon follow-up visits (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). GLP-1 RA use at initial consultation was associated with lower progression to surgery (57.9% versus 11.4%, OR 0.12,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .008), with consistent findings across insurance types but a weaker association among patients without an established PCP. Patients who did not progress also had higher emergency department utilization and more system-related scheduling barriers (both\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Non-progression to bariatric surgery was associated with modifiable system-level barriers, including limited PCP integration, incomplete specialist evaluation, and reduced surgical follow-up. GLP-1 RA use at presentation was also associated with non-progression, although this relationship may reflect differences in treatment pathways rather than a direct treatment effect. Structured patient navigation and integrated medical-surgical obesity care may improve pathway completion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10926429261501239","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T01:46:34Z","timestamp":1792719994000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Closing the Gap to Bariatric Surgery: Predictors of Non-Progression in Patients with Obesity Class IV and V at a Community-Based Bariatric Center"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5849-5470","authenticated-orcid":false,"given":"Hamdan","family":"Mallick","sequence":"first","affiliation":[{"name":"Bayhealth Medical Center, Dover, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hania","family":"Ahmer","sequence":"additional","affiliation":[{"name":"Bayhealth Medical Center, Dover, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnaraj","family":"Mahendraraj","sequence":"additional","affiliation":[{"name":"Bayhealth Medical Center, Dover, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anirudha","family":"Goparaju","sequence":"additional","affiliation":[{"name":"Bayhealth Medical Center, Dover, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Katsichtis","sequence":"additional","affiliation":[{"name":"Bayhealth Medical Center, Dover, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-025-07973-8"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.307591"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-023-06742-9"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-023-10030-z"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2018.08.014"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6585-8"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-025-07884-8"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30175-1"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-025-07730-x"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-024-07651-1"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.41380"},{"key":"e_1_3_3_13_1","volume-title":"Academic Health Centers: Leading Change in the 21st Century","author":"Institute of Medicine (US) Committee on the Roles of Academic Health Centers in the 21st Century","year":"2004","unstructured":"12.Institute of Medicine (US) Committee on the Roles of Academic Health Centers in the 21st Century. Kohn LT., eds. Academic Health Centers: Leading Change in the 21st Century. National Academies Press (US): Washington, DC; 2004."},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-0009.2005.00409.x"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.15.1705"},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13861"},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001163"},{"key":"e_1_3_3_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-025-07723-w"},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12567"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medj.2025.100805"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2015.11.028"},{"issue":"5","key":"e_1_3_3_22_1","first-page":"355","article-title":"Care fragmentation, quality, and costs among chronically ill patients","volume":"21","author":"Frandsen BR","year":"2015","unstructured":"21.Frandsen BR, , Joynt KE, , Rebitzer JB, et al. Care fragmentation, quality, and costs among chronically ill patients. 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