Few eligible patients can get weight loss surgery

By Matthew Perrone

Associated Press

Published: Friday, Feb. 14 2014 9:25 a.m. MST

More than a third of U.S. adults are obese — defined as someone with a BMI of 30 or higher — and that's been the case since the middle of the last decade. Weight loss surgery is recommended for those with a BMI of 40 or those with a BMI of 35 who have other risk factors for heart disease such as diabetes or high blood pressure. A 5-foot-9 person would be obese at 203 pounds.

The most popular procedure is gastric bypass, which involves stapling off a small pouch from the rest of the stomach and connecting it to the small intestine. Patients eat less because the pouch holds little food, and they absorb fewer calories because much of the intestine is bypassed. Another procedure called gastric banding places an inflatable ring over the top of the stomach to restrict how much food it can hold.

The latest long-term studies show that the typical patient loses about 30 percent of their excess weight with the bypass procedure and 17 percent with the band after three years. That compares with weight loss of just 2 to 8 percent with diet and lifestyle changes. Researchers estimate the initial costs of surgery are recouped within 2 to 9 years, as patients cut down on prescriptions, trips to the doctor and emergency hospital care.

On top of all that, two groundbreaking 2012 studies suggest bypass surgery can reverse and possibly cure diabetes.

But only 37 percent of health plans that are sponsored by employers cover weight loss surgery, according to benefits consulting firm Mercer. At large corporations, the coverage rate is higher at 58 percent, but most Americans work for smaller businesses.

The benefit is often hardest to find in states that have the highest levels of obesity, such as Mississippi and Arkansas, where less than 25 percent of employers cover weight loss surgery. Both states have obesity rates over 34 percent, the highest in the country.

When insurers cover weight-loss surgery, it often comes with a number of requirements. Patients must first pass a psychological evaluation, showing that their obesity is not due to an eating disorder or other mental problems that can contribute to weight gain. Most insurers then require six to 12 months of doctor-supervised dieting, in which patients keep a journal of their eating habits and visit their physicians for regular weigh-ins and check-ups.

Surgeons say many patients are unable to keep up with the appointments and never qualify for surgery — a fact which they say helps insurers control costs.

"Half of the people I see drop out because they can't commit to the time away from their jobs," says Dr. Carson Liu, a bariatric surgeon in Los Angeles. "Insurers know that 50 percent of patients will drop out."

America's Health Insurance Plans, the industry trade group, says companies are simply following federal guidelines that recommend surgery for "carefully selected patients" who have failed other methods.

But the National Institutes of Health guidelines insurers point to were issued in 1998, when weight loss surgery was still an emerging field with serious risks. At the time, about 1 in 100 patients died in surgery. The death rate today is 1 in 1,000, making it as safe as a hip replacement, according to surgeons.

Weight loss surgery is now nearly universally accepted in American medicine. Still, the approach is not an easy fix.

Patients must dramatically cut the amount and variety of food they consume, otherwise they will experience cramps, diarrhea and other unpleasant side effects. Additionally, about 20 percent of patients who get the gastric band regain nearly all of their weight within three years — a fact that has led to a decline in popularity for that procedure. Only a small percentage of bypass patients regain their weight.

Doctors who support weight-loss surgery warn that it's not a cost-effective solution for America's obesity epidemic in the long run. Dr. David Katz of Yale University's Prevention Research Center says a smarter approach lies in educating children and adolescents early on about healthy eating and exercise habits.

"We created the problem of severe obesity and we have to deal with it, but scalpels aren't the only solution," he says. "There is a better way."

But for Harrison, who takes 11 medications to control conditions related to her weight, surgery increasingly seems like her only hope.

"I spend every day worrying about how much time I have left. Everything hurts and my health issues get worse all the time," Harrison says.

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