Background. People living in regional Queensland, Australia, have less access to health care than their metropolitan neighbours; a gap that is wider if they are also of Aboriginal and Torres Strait Islander ethnicity. The Bariatric Surgery Initiative (BSI) aims to provide metabolic bariatric surgery as a public service accessible to all Queenslanders for patients with morbid obesity according to need, regardless of location or ethnicity. Methods. We investigated the BSI’s progress in closing the metro-regional gap by comparing the distribution of referrals for surgery with the geographic and ethnic spread of obesity across Queensland in 2017–2019. Results. Regional Queensland is home to 59.8% of Queensland’s individuals with obesity, whereas 40.2% live in metropolitan Brisbane. In contrast, 47.8% of referrals were from regional areas, with 52.2% received from Brisbane. We found that more patients from metropolitan than regional areas underwent metabolic bariatric surgery, probably due to a paucity of referrals from regional locations. Aboriginal and Torres Strait Islander peoples were able to access the service and all patients realised significant health benefits after surgery. Conclusions. The BSI improved access to this service, and inequities in metro-regional access may depend on patient choice and healthcare provider awareness of the BSI. Trial registration. This initiative was a quality improvement study focused on providing access to care rather than a clinical trial; as such it was not registered as a clinical trial.