Much of the recent growth in bariatric surgery, paradoxically, has come largely because of insurers' willingness to cover it, as well as high-profile post-operative endorsements from celebrities such as Al Roker of the "Today" show and Randy Jackson of "American Idol" fame.
Even a small number of insurers stopping coverage is a blow to the industry, which is booming so rapidly some hospitals are dedicating operating rooms to bariatric operations.
For The Record
Los Angeles Times Friday April 02, 2004 Home Edition Main News Part A Page 2 National Desk 4 inches; 138 words Type of Material: Correction
Obesity surgery -- An article Monday in the Health section about insurers limiting coverage of weight-loss surgery incorrectly attributed a quotation to Susan Pisano, a spokeswoman for America's Health Insurance Plans. The statement -- ''Some of the newer surgeons doing this [gastric bypass surgery] have only taken one weekend class, taught on cadavers or pigs, before they start operating. It's scary" -- should have been attributed to Dr. Peter Vash, medical director of the Lindora Medical Clinic in Costa Mesa. Also, a statement attributed to Pisano about the possible financial reasons for insurers declining to pay for the surgery mischaracterized her views on the subject. Pisano's point was that insurers are concerned that people are being recommended for obesity surgery who are not appropriate candidates for the treatment based on standards set by the National Institutes of Health.
For The Record
Los Angeles Times Monday April 05, 2004 Home Edition Health Part F Page 5 Features Desk 4 inches; 138 words Type of Material: Correction
Obesity surgery -- An article in last Monday's Health section about insurers limiting coverage of weight-loss surgery incorrectly attributed a quotation to Susan Pisano, a spokeswoman for America's Health Insurance Plans. The statement -- ''Some of the newer surgeons doing this [gastric bypass surgery] have only taken one weekend class, taught on cadavers or pigs, before they start operating. It's scary" -- should have been attributed to Dr. Peter Vash, medical director of the Lindora Medical Clinic in Costa Mesa. Also, a statement attributed to Pisano about the possible financial reasons for insurers declining to pay for the surgery mischaracterized her views on the subject. Pisano's point was that insurers are concerned that people are being recommended for obesity surgery who are not appropriate candidates for the treatment based on standards set by the National Institutes of Health.
The long-term stakes are enormous: Almost two-thirds of adults in the United States are overweight, and 30% are obese, according to a study by the national Centers for Disease Control and Prevention in Atlanta. What's more, the number of morbidly obese people, defined as anyone 150 pounds or more overweight, is growing even faster. They grew from 1 in 2,000 Americans in 1986 to 1 in 400 by 2000, according to a study by the Santa Monica-based think tank Rand Corp. The typical man in that category now weighs 373 pounds and is 5 feet, 10 inches tall.
In the most common type of bariatric surgery, a surgeon attaches the patient's small intestine directly to a pouch that has been created in the stomach. Food then bypasses part of the small intestine, which reduces the body's absorption of calories and nutrients. In a newer option, used about 15% of the time, a silicone band is placed around the top of the stomach to restrict the amount of food it can hold.
Both options have risks. About 2% of patients die during or shortly after gastric bypass surgery, from complications including pulmonary embolisms and leakage in the intestines; about half that rate die during banding surgery, researchers say. Even those who come out fine can suffer long-term problems such as higher rates of anemia and metabolic bone diseases caused by the loss of vitamin absorption.
Patients can regain the weight by overeating (they turn to high-calorie liquids like milkshakes) or not exercising enough, which doctors say is essential. Further, some physicians believe that the banding procedure doesn't work as well in the long run as gastric bypass, though they don't know why.
According to the National Institutes of Health, which set up widely used clinical recommendations in 1991, the surgery should be considered only for those with a body-mass index (a mathematical formula based on height and weight) above 40 -- or about 100 pounds overweight. Slightly less obese people can qualify as long as they have life-threatening complications such as high blood pressure or coronary disease.
