BACKGROUND: Obesity is increasingly prevalent and associated with higher morbidity and mortality. Bariatric surgery, particularly sleeve gastrectomy, provides durable weight loss and improves obesity-related conditions like type 2 diabetes and cardiovascular disease. Despite its benefits, significant concerns regarding inequities in access to bariatric surgery persist. This study aims to evaluate recent trends in bariatric surgery rates and to investigate patterns of access to bariatric surgery. METHODS: A population-based study of age-adjusted bariatric procedure rates in adults in NSW, Australia, was conducted over the financial years 2013/14 to 2021/22. Trends in age-adjusted procedure rates were assessed by demographics and healthcare settings. RESULTS: In 2021/22, 179.6 bariatric procedures per 100,000 population were performed, an 89.7% increase since 2013/14 (p <
0.001). Laparoscopic sleeve gastrectomy, the most common procedure, increased by 94.1% to 112.6/100,000/year (p <
0.001). Females had 3.6 times higher rates than males (232.3/100,000/year vs 64.9/100,000/year). The greatest increases occurred in younger patients (125.9% in the 18-24 age group
142.4% in the 25-34 age group, p <
0.001). Private hospital rates were 15.6 times higher than public (132.2/100,000/year vs 8.5/100,000/year) and rose 92.3% (p <
0.001), whilst public hospital rates declined by 17.9% (p = NS). Patients from regional areas had the highest rates (175.7/100,000/year) and largest increase (169.8%
89.4/100,000/year to 241.8/100,000/year, p <
0.001). CONCLUSIONS: Bariatric surgery rates continue to increase, particularly among females, despite similar obesity prevalence between sexes. Most surgery is conducted in the private sector, suggesting differential access based on financial circumstances. Rates are highest in younger people, although obesity-related comorbidities increase with age. Regional patients undergo surgery at higher rates than rural patients despite greater obesity prevalence with increasing rurality. Efforts to address these disparities are essential to improve equitable access to obesity treatments.