Obesity options show promise: Study says bariatric surgery worth the risk; patients may live longer after procedure
By DEBBIE GILBERT
Two major studies released this week show that patients who undergo surgery to treat morbid obesity live longer, healthier lives.
The research, published in the New England Journal of Medicine, indicates that 10 years after having bariatric surgery such as gastric bypass, patients were 40 percent less likely to have died than similarly obese people who did not have surgery.
The majority of the surgical patients did not gain back the weight they lost. And for most, health problems such as high blood pressure and diabetes are a thing of the past.
None of this is news to Dr. Dan Procter, a Gainesville surgeon who's been performing bariatric procedures for 15 years.
"On average, our patients maintain about 85 percent of their weight loss," he said. "And research shows the procedure cures about 90 percent of the patients who had type 2 diabetes."
Procter and his partner, Dr. Robert Richard, operate at Northeast Georgia Medical Center's Lanier Park campus, which houses a designated "center of excellence" for bariatric surgery.
The procedures they perform are minimally invasive, and the patient usually goes home from the hospital within a day or two. Yet there's still a perception, which Procter believes is perpetuated by TV news reports, that the surgery is "drastic" and "radical."
"With centers of excellence like ours, the risk of dying from bariatric surgery is about the same as the risk of dying from having your gallbladder taken out," he said.
"The frustration for Dr. Richard and me is that insurance companies continue to deny (coverage for) gastric bypass. They still claim that it's 'experimental,' or that it's a cosmetic procedure. We try to explain that we are not treating obesity; we are treating the diabetes, the sleep apnea, the other co-morbidities that go along with it."
The current standard to qualify for gastric bypass is that the patient should have a body-mass index (BMI) of 40, which is usually at least 100 pounds overweight.
Patients may also be accepted if they have a BMI of 35 along with co-morbidities such as diabetes or hypertension. But Procter thinks the minimum BMI should be lowered to 30.
"The BMI is kind of an arbitrary measure," he said. "The criteria shouldn't be about how much the person weighs. It's about the medical problems their obesity is causing."
Gastric bypass surgery typically costs $20,000 to $25,000. That's no small chunk of change. But the trade-off is that after surgery, patients no longer need most of the medications they were taking to treat their obesity-related illnesses. And they're less likely to be rushed to the hospital with a catastrophic emergency such as a heart attack.
"Studies show that the (gastric bypass) operation pays for itself within two years," Procter said.
Yet, instead of becoming a routine, acceptable treatment for morbid obesity, bariatric surgery is covered by fewer insurance companies now than it was five years ago.
"About 25 to 30 percent of our patients are self-pay," said Natalie Bagwell, coordinator of the bariatrics program at Lanier Park. "They do have insurance, but it won't cover the surgery. A lot of policies have an exclusion clause (for gastric bypass), so you can't even appeal the decision."
The state insurance plan that covers public school employees has stopped covering bariatric surgery, and Bagwell said that has had a big impact.
"Schoolteachers are trying to pay for it themselves. They're taking out loans, getting second mortgages on their houses," she said. "That's just a shame."
Amy Neese, bariatrics liaison at Procter's clinic, said after BlueCross BlueShield of Georgia stopped covering the procedure in early 2006, the clinic's caseload dropped from 500 surgeries a year to about 300.
A spokeswoman for BlueCross did not respond to a request for comment Friday.
And even the plans that still cover bariatrics have put a lot of restrictions on coverage.
"Most of them require the patient to first spend six months on a physician-supervised diet," Neese said. "These are people who have already been dieting all their life and it hasn't worked."
South Hall resident Wonda Coppin said it took her a year of "jumping through all the hoops" before her insurance plan would agree to pay for the surgery. She had to follow their required six-month diet plan, even though she had been dieting since she was about 12 years old, to no avail.
"I would have temporary weight loss, but then I would gain back twice as much," Coppin said.
She decided to pursue surgical treatment because she realized obesity was compromising her health.
"I was having hip and knee problems," she said. "With both my pregnancies, I had gestational diabetes. And I was tired all the time. I had no energy to play with my kids, who are now 4 and 7."
On July 18, Coppin finally had her surgery, with the goal of losing 150 pounds. When she returned to Procter's office Friday for her five-week post-operative visit, she had already lost 47 pounds.
"I can feel the difference," she said. "I'm having less joint pain. I'm looking forward to being able to do things with my family instead of sitting on the sidelines."
Coppin's case is typical, according to Procter. But there are many patients just like her who need treatment and can't afford it.
"I'm hoping that (the new studies) will result in more insurance companies being willing to cover the surgery," Procter said.
"There are an estimated 5 million morbidly obese people in this country. We're only treating about 1 percent of the people who need it, and that's criminal."
Why would an insurance plan refuse to cover a treatment that has been proven effective? Procter thinks it has to do with the perception that obesity is caused solely by a lack of "willpower."
"For some reason, it's still OK to discriminate against obese people," he said. "But it's not like they chose to be that way. We know that there are genetic factors at work."
Procter understands how the insurance industry works. But he still thinks companies must address the medical consequences of obesity.
"It's morally the right thing to do," he said. "If you can give someone a better life, you should."
Contact: dgilbert@gainesvilletimes.com; (770) 718-3407