Purpose Despite the high burden of obesity-related disease among Māori and Pacific peoples, access to publicly funded bariatric surgery in Aotearoa remains inequitable. This systematic review examines barriers, facilitators, and disparities in access to bariatric surgery, identifying key themes and policy implications. Methodology A Kaupapa Māori-aligned systematic review was conducted, searching PubMed, Scopus, Embase, Medline, CINAHL, and Cochrane for studies published from 2000 onward. Exclusions included case reports, non-New Zealand studies, conference abstracts, and editorials. Study quality was assessed using MMAT, adapted CONSIDER framework, and MAORI framework. Results 334 studies underwent screening, with 101 full texts assessed. A total of 26 studies met the inclusion criteria. Ethnic and geographic disparities in bariatric surgery access were evident. Māori and Pacific patients faced barriers, including restrictive preoperative requirements, inconsistent referral pathways, and geographic inequities. Referral acceptance rates were lower despite comparable clinical needs. Facilitators included whānau and community support, a strong personal desire for improved quality of life, and culturally responsive care models, which enhanced engagement with bariatric services. Conclusion Persistent disparities in bariatric surgery access reinforce systemic inequities in Aotearoa’s healthcare system. Policy changes, including prioritisation criteria adjustments and culturally tailored interventions, are needed to improve equitable access. Greater integration of Kaupapa Māori principles and equitable resource distribution is essential for addressing disparities and improving long-term health outcomes for Māori and Pacific peoples.