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Studying the Effects of Bariatric Surgery

Obesity in the U.S.

As America's collective waist line continues to grow, so does the mortality rate associated with that trend.  Between the years 1971 and 2000 obesity in the United States has increased from 14.5% to 30.9% according to a study published in the Journal of American Medical Association (JAMA) in 2002, and the final death toll attributed to obesity in 2000 was 400,000.  That number trails only smoking, which came in with 435,000 associated deaths according to study results published in March of 2004 by the U.S. Centers for Disease Control and Prevention (CDC).  That's enough for the World Health Organization to declare obesity a global epidemic.  But if diet and exercise aren't enough to help some Americans shed the weight and associated health risks like diabetes, liver disease, and sleep apnea, can bariatric surgery (sometimes referred to as obesity surgery) reverse recent trends?

A Studious Debate

The fact that bariatric surgery can reverse obesity related diseases such as diabetes in some patients has never been debated, nor has the fact that the reduction in weight that the surgery offers relieves stress on the body and internal organs that could be potentially life threatening.  What has been debated is whether or not the possibility of reward is great enough to undergo such a major surgery that drastically reduces stomach volume and has many associated risks.  There have been many studies published in the past few years, several since 2002, that attempt to evaluate and quantify the risk and reward associated with bariatric surgery.

The most recent such study was published in the October 2004 edition of the Journal of the American College of Surgeons.  In this study, a sample section of 66,109 obese patients was taken from the Washington State Comprehensive Hospital Abstract Reporting System between 1987 and 2001.  Of these patients, all of whom were diagnosed with morbid obesity, but none of whom died during hospitalization, 3,328 underwent the stomach stapling form of bariatric surgery known as gastric bypass.  One of the most important findings of this study; nearly 2% of patients died in the first thirty days following surgery, a number much higher than some of the more conservative figures that estimate a 0.1-0.5% associated mortality rate.  In addition, however, the study also showed that 27% fewer patients that had the surgery had died in comparison to those who did not have surgery in a 15 year follow up, a finding that has been substantiated by several other patient studies. 

Looking for Experience

The study showed that factors such as age, the type of hospital and the presence of diseases or health problems other than obesity increased the chance of mortality.  The most significant factor that increased the chance of death, however, was physician inexperience.  Patients that were operated on by a doctor that had performed less than 20 such procedures had a mortality rate that was 4.7 times higher than the rest of the group.  In corroboration with this study was a report in the October 2004 Annals of Surgery that found that the mortality rate of patients at hospitals performing more than 100 bariatric procedures a year was almost 1% lower than those performing less than 50.  Not only were instances of death lower, so were instances of complication, length of hospital stay, and overall costs. 

With statistics like these it is no wonder that the American Society of Bariatric Surgery (ASBS) recommends that you choose a surgeon with extensive experience, and is currently developing an initiative that will award facilities a "Center of Excellence" designation based on surgical outcomes.

Trends in Insurance Coverage

In the past year, Medicare has removed language from its policy that designates obesity as a non-illness, paving the way, some believe, for future insurance coverage of things like bariatric surgery.  A few insurance providers, including Michigan's M-Care, have started providing benefits for obese policyholders including discounts on weight control programs and bariatric surgery.  On the other hand, providers like Blue Cross and Blue Shield of Florida, plan to cancel their coverage of bariatric surgery at the beginning of 2005.  The discrepancies in these facts mimic attitudes toward the surgery itself.  Proponents herald the surgeries possible long-term benefits, while skeptics fear immediate surgical risks.  An August 2004 study in Obesity Surgery has shown that surgery in morbidly obese patients decreases long-term health care costs, but detractors fear that some patients do not use surgery only as a last resort, and may incur additional medical costs due to surgical complications. 

Gastric Bypass Surgery Surgery Information Guide

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