360 The First Step Towards Achieving an Equitable Tier 4 Bariatric Service; Assessing the Local Bariatric Inequality Gap

Abstract Aim National adult obesity prevalence is highest among Black individuals (34.8%) and in most deprived areas (35.9%). Given Calderdale and Huddersfield Foundation Trust (CHFT) serves two commissioned multi-ethnic regions (Calderdale and Kirklees), with obesity prevalence of >25%, we aimed to assess access to Tier 4 bariatric service by ethnicity and deprivation backgrounds. Method This collaborative initiative, involving CHFT Bariatric service and regional Public Health teams, retrospectively collected data on sex, ethnicity, postcode, and referrer information from referrals aged 18+ (1st January - 31st July 2024) using CHFT’s database. Public health records yielded regional obesity figures and national database provided Index of Multiple Deprivation (IMD) deciles (1= most deprived, 10= least deprived). Statistical analysis performed using Microsoft Excel. Results 30,563 GP-registered-patients met eligibility for Tier 4 bariatric referral. Only 246 referrals were received within this 7-month period, of which 78% were female. Despite Kirklees’ 2.5-fold larger population than Calderdale, 115 referrals received from Kirklees and 124 from Calderdale. Ethnicity was predominantly White British (85%), with much lower representation from ethnic minorities compared to local population demographics. Referral patterns varied regionally by deprivation; most frequent referrals came from more deprived areas of Calderdale (IMD Decile 2) and less deprived areas of Kirklees (IMD Decile 8). Conclusions Significant disparities exist in access to Tier 4 bariatric service with under-representation of males, ethnic minorities and individuals from deprived backgrounds. Referral rates are disproportionately low relative to eligible population. Targeted educational outreach program for primary care services with low referral rates and under-represented patients is recommended to improve access equity.