Bariatric surgery – a growth industry

Hospitals Pressured by Soaring Demand for Obesity Surgery

Dozens of hospitals are adding special operating suites for the procedure, called bariatric surgery, which attracted wide notice after public figures like Al Roker of “Today” on NBC, Sharon Osbourne of “The Osbournes” on MTV and Representative Jerrold Nadler, a Manhattan Democrat, had it done. Some bariatric surgeons are fully scheduled 12 months in advance, and hundreds of doctors have jumped into the field recently and started to advertise their availability.

Bariatric procedures – meant for obese people who are at extremely high risk of severe health problems, as defined by a National Institutes of Health consensus – surged more than 40 percent last year, to 80,000. This year, the number is expected to climb to 120,000, according to Frost & Sullivan, a consulting firm. Spending on bariatrics is approaching $3 billion a year, at an average cost of $25,000 for each procedure.

With the number of people eligible for the procedures growing by an estimated 10 to 12 percent a year, bariatric surgery can be profitable for hospitals ? and even more so for surgeons. But the costs are a major concern for insurance companies and employer health plans. Surgeons say that some insurers routinely delay approvals.

“The companies throw up roadblocks,” said Dr. James Rosser, a surgeon at Beth Israel Medical Center in Manhattan. “They keep requesting more information. Patients are left to really hound the insurance companies to get the approvals.”

Doctors and patients, meanwhile, are putting pressure on insurers to lower the body-size threshold for paying for the operation for people who have advanced problems with diabetes and other weight-related diseases. That could triple the number of people potentially eligible for the operation to more than 30 million, a panel of medical advisers to the national Blue Cross and Blue Shield association was told recently.

One group having trouble winning access to treatment is the poor, among whom obesity is an especially acute concern. Doctors say that Medicaid programs in many states have been reluctant to pay for the procedures. At the University of California at Davis, for example, Medi-Cal patients face a 12-year wait for bariatric surgery, said Dr. Bruce M. Wolfe, a bariatric surgeon and professor of surgery. Medi-Cal reimburses Davis for the procedure at less than a third of the hospital’s cost.

This story makes one think. Clearly the surgery – which I must note carries small but major risk (including mortality) – helps many patients. I have seen patients whose lives have greatly benefitted. We (physicians) probably all have.

However, I do find it sad that we have to resort to this extreme therapy for obesity. That severe obesity is epidemic (and perhaps endemic) saddens most observers. We should develop better prevention for this problem. Exercise and a healthy diet work. How can we reconfigure our society to encourage exercise and smarter eating?