Social determinants of health (SDOH) may impact the utilization of metabolic and bariatric surgery (MBS). More research is needed to evaluate the relationship between SDOH and treatment engagement pre- and post-MBS. The current study sought to examine relationships between SDOH and undergoing MBS, and SDOH and post-MBS follow-up in a large, racially diverse sample of patients seeking MBS at two academic medical centers. Demographic data and follow-up visit attendance at 1-year post-MBS were abstracted from the EMR. Social Deprivation Index (SDI) was calculated based on the Robert Graham Center's SDI data set, with higher scores indicating greater overall socioeconomic deprivation. Participants (N = 895) identified primarily as women (82.1%) and African American (45.7%) or White (44.2%). Mean age was 42.4 (+-11.5) years, and mean BMI was 47.3 (+-8.5) kg/m2. Of the study participants, 572 underwent MBS and 282 did not undergo surgery within a year of their pre-MBS psychosocial evaluation. The SDI was lower for participants who underwent MBS (M = 46.55, +-28.78) compared to those who did not (M = 52.48, +-28.86), t (892) = 2.90, p <.01. This relationship held true when controlling for race (OR = 0.99, 95% CI: 989, 1.00, p<.05). Individuals with a higher SDI were less likely to attend follow-up visits post-surgery (t (541) = 3.141, p <.01). This relationship also remained statistically significant when accounting for race (OR = 0.99, 95% CI: .985,.998, p<.05). Study findings highlight the importance of future research considering the contribution of socioeconomic disparities to patient engagement in MBS.