Access to bariatric surgery in Aotearoa, New Zealand – a scoping review

Despite the high burden of obesity-related disease among Māori, the indigenous people of Aotearoa, New Zealand (NZ), Pacific peoples, and people who live rurally experience inequitable access to publicly funded bariatric surgery. This scoping review examines barriers, facilitators, and inequities in access to bariatric surgery, identifying key themes and gaps in the current literature. A Kaupapa Māori-aligned methodological stance was employed to ensure culturally safe data interpretation and analysis. PubMed, Scopus, Embase, Medline, CINAHL, and Cochrane were searched to identify studies published between January 1st, 2000, and April 30th, 2025. Case reports, editorials, conference abstracts, and non-New Zealand studies were excluded. Twenty-five studies met eligibility criteria. Significant disparities in access were found by ethnicity, geography, and socioeconomic status. Māori, Pacific, rural, and socioeconomically deprived populations experience higher rates of attrition and face greater barriers, including restrictive preoperative requirements, regional variability in referrals due to unclear processes. Men were underrepresented and tended to present with higher comorbidity at the time of surgery. Facilitators included strong personal and whānau motivations, culturally responsive care, and community-integrated models. Access to bariatric surgery in NZ presents as an amalgamation of systemic and structural inequities, persisted by a lack of coordinated national data to inform clinical decisions. Although equity indicators consistently influenced access, few studies addressed their root causes or intersectionality. Culturally grounded models like Kaupapa Māori and Pacific-led programmes show promise. Continued investment in equity-focused research and policy is critical to ensure those most in need receive care and health services meet their legislative responsibilities to deliver equitable health care.