Why don't more men get weight loss surgery?

Despite the fact that obesity in America affects men and women evenly, women are much more likely than men to undergo weigh loss surgery.

In fact, a recent study found that 80 percent of bariatric surgeries in the U.S. are performed on women—in large part because women have more body issues than men do.

Researchers from University of California San Diego looked at 190,705 patients in the U.S. who underwent bariatric surgery (gastric bypass or sleeve gastrectomy) from 1998 to 2010. They found that there was an 80/20 split of women versus men, which held true for every year. The researchers wondered why, considering just as many men are obese as women.

“Even though we have a 50-50 percent split in obesity rates among U.S. men and women, women get 80 percent of the bariatric surgeries and men only 20 percent. That’s a very uneven distribution,” said study author Santiago Horgan, chief of the Division of Minimally Invasive Surgery at UC San Diego Health System, in a press release.

(Gender gap in bariatric surgery by race.)

In the study, Horgan and his team hypothesize several forces could be at play: (1) Men are less likely to have health insurance. (2) Men are less likely to qualify for the surgery. (3) Men are less concerned about their health until they get older and face more serious problems and (4) Men don’t have the same body image issues that women do.

However, when you look at the gender breakdown for each category, it appears body image might play the largest role. Here’s what the researchers found:

According to U.S. Census data from 2010, 17.7 percent of males were uninsured versus only 14.9 percent of females. It’s a difference, but not a major one. (Researchers also pointed out that lack of coverage may signal men’s lack of concern for their health.)

In terms of qualifying, a recent study found that 62 percent of their female participants were eligible for bariatric surgery versus 38 percent of males.

When looking at body image acceptance, though, the gap grows a little larger.

The authors point to a study that found that obese men are much more satisfied with their body than women are. Specifically, 72.8 percent to 94.0 percent of overweight and obese men were satisfied with their body, compared to only 56.7 percent to 85 percent of overweight and obese women.

“As being thin is particularly valued in women and connotes control and competence, it is logical for females to desire to reach this goal and thus seek surgical assistance if unable to do so otherwise,” explained the authors in the study.

They added that the gender gap for surgery is highest in California, which they say “is consistent with the notion that body image consciousness within California’s population is high.”

The study also found that the gender gap lessened as men got older—into their 70s—as they were more likely to get surgery when it affected their mortality.

(Gender gap by age)

“Men may seek bariatric surgery late, as a means to achieve improvement in comorbid conditions instead of as a preventive weight loss therapy alone,” they said.

The authors argue, however, that it’s much better to seek out weight loss surgery before health problems escalate. Their suggestion? More should be done to educate men about this option.

As the authors conclude, “A possible intervention would be a public health campaign to educate the public, specifically men, about the fact that bariatric surgery is not an operation to improve body image, but, rather, it is an important tool to treat and prevent health maladies.”

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.