Latent demand in weight-loss surgery as a treatment for obesity exists in many markets, but obesity prevalence is not a driving factor of bariatric surgery utilization. According to a recent study by the American Society for Metabolic & Bariatric Surgery, the states with the highest prevalence of obesity are also the states with poorly performing state economies—and also have low rates of weight-loss surgery per capita, as most of them do not list surgery as an essential health benefit (EHB) under the Affordable Care Act, which means payers are not required to cover the surgeries.