A new study shows that the number of Americans who had weight-loss surgery quadrupled between 1998 and 2002

Jul 13 2005

A new study shows that the number of Americans who had weight-loss surgery quadrupled between 1998 and 2002.

According to the government study, during the same period, hospital costs also roses more than six times, from $157 million a year to $948 million a year.

The average cost per surgery also rose by about 13 percent, from $11,705 to $13,215.

It is forecast that costs will go even higher.

Apparently although 71,733 operations were performed in 2002, compared to 13,386 in 1998, only 0.6 percent of about 11.5 million morbidly obese individuals who could have been candidates for the procedure actually had it.

Dr. Shawn Garber, chief of bariatric surgery at Mercy Medical Center in Rockville Center, in New York, says without doubt the incidence of obesity is rising, and public awareness, gained from celebrities, has brought more attention to the surgery.

As more procedures are now being performed via laproscopy, with smaller incisions and quicker recovery, they are more appealing to patients.

Current estimates say almost one-third of the U.S. population is now obese and close to 5 percent are morbidly obese.

According to the study, to be considered eligible for weight-loss (bariatric) surgery, an individual must have a BMI greater than 40 or greater than 35 with attendant complications such as type 2 diabetes.

This in fact means that about 395,000 Americans aged 65 to 69 will be medically eligible for the surgery this year, a number that could increase to 475,000 in 2010.

There are apparently two main types of bariatric surgery, one which reduces the size of the stomach and one which also bypasses part of the intestines.

Treatment with weight-loss drugs usually results in less weight shed.

In studies of people who have had surgery for obesity, it has been found that, with gastric bypass, patients lost 61.6 percent to 70.1 percent of their excess weight, and as a result, 76.8 percent of individuals saw their diabetes disappear.

Garber says this option, right now, is good as there are no others available.

He says the success rate for medical programs is 5 percent, and there are no good drugs on the market.

He also says many of these people are suffering from medical problems such as diabetes and sleep apnea, and they need to do something.

Study co-author Dr. Claudia Steiner, a senior research physician at the Agency for Healthcare Research and Quality (AHRQ), says ideally it would be better if people did not become obese, but this particular intervention has been shown to work.

This study provides the first national estimates on this subject, and was based on data from the Nationwide Inpatient Sample, which draws information from 37 states.

A great deal of the increase in bariatric surgery was attributed to a 900 percent rise in operations in people aged 55 to 64.

This group alone accounted for 11 percent of all weight-loss surgeries in 2002, while patients 18 to 55 years old accounted for 88 percent.

According to the study, adolescents and the elderly made up the rest.

The study found that Roux-en-Y gastric bypass (RGB) operations, which reduce the size of the stomach while also bypassing part of the intestines, accounted for about 85 percent of weight-loss procedures, and women accounted for 84 percent of all surgeries in 2002.

Steiner says that the largest increase in average cost was seen in surgeries covered by Medicaid: an increase of 17.7 percent despite declining hospital days, and this is clearly a concern for Medicaid and for private insurers, which cover 83 percent to 84 percent of the people who opt for this type of surgery.

Obesity, says Steiner is associated with health conditions such as diabetes and hypertension, and those conditions increase the risk of cardiovascular disease and early death.

The government study appears in the current edition of Health Affairs.

http://www.healthaffairs.org/ and http://www.ahrq.gov/