Closing the Gap to Bariatric Surgery: Predictors of Non-Progression in Patients with Obesity Class IV and V at a Community-Based Bariatric Center

Introduction: 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. Methods: We conducted a single-center retrospective study of adults with obesity class IV and V evaluated for bariatric surgery (2024–2025). 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. Results: 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%, P < .001), fewer completed specialist consultations (28.9% versus 71.4%, P = .001), fewer nutrition visits ( P = .004), and fewer surgeon follow-up visits ( P < .001). GLP-1 RA use at initial consultation was associated with lower progression to surgery (57.9% versus 11.4%, OR 0.12, P = .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 P < .001). Conclusion: 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.