Monday, July 18, 2011

Weight-Loss Surgery Cost-Effective for All Obese, Study Suggests

Bariatric surgery is not only cost-effective for treating people who are severely obese, but also for those who are mildly obese, according to a new study from Washington University School of Medicine in St. Louis. The findings support making bariatric surgery available to all obese people, the researchers say.

Patients who have the surgery are more likely to keep weight off over time and have fewer medical problems related to their weight, indicating the procedure is a good value. But beyond being cost-effective, the analysis shows that bariatric surgery actually saves health-care dollars for the most severely obese patients who also have diseases related to their weight such as diabetes, heart disease and high blood pressure.
"If lifetime medical costs are taken into consideration, surgery saves severely obese patients money," says Su-Hsin Chang, PhD, a postdoctoral research associate in the Division of Public Health Sciences and first author on the study published in the journal Maturitas.
National Institutes of Health (NIH) guidelines say candidates for bariatric surgery should have a body mass index (BMI) of 40 or more (about 100 pounds overweight for men and 80 pounds overweight for women on average) or a BMI of 35 to 40 if they also have obesity-related diseases. Many insurance companies pay for the procedure only if patients meet these criteria.
"Insurance companies often pay for treating obesity-related diseases," Chang says. "But a portion of those costs could be saved if they paid for bariatric surgery for a wider range of obese patients."
Among the many strategies for treating obesity, including dieting, exercising and medications, only bariatric surgery has been shown to be effective in maintaining a healthy weight over the long term. But surgery also is the most expensive strategy. Cost estimates range from $20,000-$25,000 for the initial surgery and don't include follow-up care.
In the United States, the upper limit for a medical procedure to be considered cost effective is $50,000 per quality-adjusted life year (QALY), a measure of the true value of treatment in terms of a person's quality and length of life. The assumption is that most people would be willing to pay up to $50,000 for an additional year of healthy life. Any amount less than that is considered cost effective.
Chang and her colleagues analyzed data from 170 studies looking at the effectiveness of bariatric surgery. The analysis only included studies that measured at least one outcome of interest such as weight loss, quality of life, complications and medical cost information.
They used this data to estimate and simulate the life expectancies and quality of life of people who underwent surgery versus people who did not. This simulation data then informed their cost-effectiveness analysis.
For the super obese, people with a body mass index (BMI) of 50 or greater (for example, a person who weighs 350 pounds and stands 5 feet 10 inches tall), the cost per quality-adjusted life year is actually negative. This means that, over a lifetime, the cost of bariatric surgery is less than the health-care costs associated with not having the procedure.
For the severely obese, people with BMIs of 40-50, the cost per QALY is about $1,900 for those with obesity-related disease and about $3,800 for those who are otherwise healthy. And for the moderately obese, people with BMIs of 35-40, the cost per QALY is about $2,400 for those with related medical problems and $3,900 for those who are healthy. While costs increase for healthier, less obese patients, all amounts are well below the $50,000 threshold.
"Other similar studies have found higher costs associated with bariatric surgery because they did not take the lifetime medical costs of the obesity-related diseases into consideration," Chang says.
This work also differs from previous cost analyses because it draws data from a much larger number of studies. While Chang says bariatric surgery in general is worth the high price tag, she points out that the analysis does not differentiate between types of bariatric surgery, such as lap band and gastric bypass.
"We did not intend to compare different types of weight loss surgery, but to generalize its effects and costs," she says. "Based on our analysis, bariatric surgery should be an option that is universally available to all obese people."
This work was supported by the Barnes-Jewish Hospital Foundation and the American Cancer Society Clinical Research Professorship.

Wednesday, May 4, 2011

Obesity Coverage

Rising rates of obesity among the 50 million Americans with arthritis are cause for concern because excess weight is associated with increased problems for arthritis patients, a new study says.
In people with arthritis, obesity is associated with disease progression, reduced activity, disability, poorer quality of life, total joint replacement and poor outcomes after joint replacement.
For the study, U.S. Centers for Disease Control and Prevention researchers analyzed Behavioral Risk Factor Surveillance System data from 2003 to 2009 and found that obesity prevalence among adults with arthritis was 54 percent higher than among adults without arthritis.
During that time period, obesity prevalence among U.S. adults with arthritis increased significantly in 14 states and Puerto Rico, decreased in the District of Columbia and remained about the same elsewhere.
The number of states in which more than 30 percent of adults with arthritis were obese increased from 38 (including D.C.) in 2003 to 48 in 2009. The number of states in which more than 40 percent of adults with arthritis were obese increased from zero in 2005 to seven in 2007 and 12 in 2009, the investigators found.
The median state obesity prevalence among adults with arthritis rose from 33.2 percent in 2003 to 35.2 percent in 2009. In 2003, prevalence ranged from 40.1 percent in Ohio to 25.1 percent in Colorado. In 2009, prevalence ranged from 43.5 percent in Louisiana to 26.9 percent in Colorado.
The findings highlight the urgent need to expand programs to prevent obesity among arthritis patients and to promote treatment and management of the disease, the researchers said.
The study appears in the April 29 issue of the Morbidity and Mortality Weekly Report, published by the CDC.
In the United States, about 50 million adults have arthritis and about 72.5 million adults are obese. Estimated annual medical costs are $128 billion for arthritis and $147 billion for obesity.

Obesity Coverage

Men who are both obese and tall face a much higher risk for developing potentially fatal blood clots, though overall the risk remains quite small, according to a new study.
The researchers report that extra weight and extra inches together seem to raise the risk more than either alone.
"Tall and obese men had more than a fivefold higher risk, compared to short and lean men," said the study's co-author, Sigrid K. Braekkan, who warns the vertically and horizontally gifted to avoid sitting in one place for too long.
Women also face a higher risk if they're both obese and tall, but just being tall alone doesn't seem to be a problem, the study found.
The clots lead to a condition known as deep vein thrombosis, which may be best known as an affliction that strikes passengers on long plane flights who don't have much chance to move around. Immobilization of the legs can contribute to the condition.
Other causes include injury and a genetic condition that makes people's blood more likely to clot. "And there are some people who seem to get clots when they don't have any clear, obvious risk factors," said Dr. Victor Tapson, director of the Center for Pulmonary Vascular Disease at Duke University.
Though the clots start in the leg, they can move to the lung, where they may cause a deadly pulmonary embolism. Venous thromboembolism is the term used to describe the two conditions -- deep vein thrombosis and pulmonary embolism -- together.
In the new study, published online April 28 in Arteriosclerosis, Thrombosis and Vascular Biology, researchers collected data on 26,714 people from 1994 to 2007, including 461 reports of venous thromboembolism.
Obese and tall men -- those at least six feet tall -- had more than five times the risk for a clot, compared with normal-weight men shorter than 5 feet 7 inches. The risk was three times higher for women who were obese and at least 5 feet 6 inches than for normal-weight women shorter than 5 feet 3 inches.
The higher risk for tall people appears to be related to their circulatory system. "The distance for blood to return to the heart and lungs is longer," Braekkan said. "Since the blood must be pumped upwards against the force of gravity by the calf-muscle pump, the longer distance may cause reduced flow in the legs and, thereby, higher risk of clotting."
He said that obesity causes pressure in the abdomen that may hinder the ability of the calf-muscle pump to send blood back up into the body.
The study found, however, that the risk for developing blood clots remained low, even for the tall and obese.
But what should obese and tall people do to lower their risk even more? Until pounds can be shed, the best thing to do is to avoid situations where you're not moving for long periods of time, Tapson said.
Even in the cramped space of a plane, try "just moving your legs, shifting your legs, going up and down on your toes and flexing your feet back and forth to keep your calf muscles stimulated," he said. It's also a good idea to keep hydrated (and alcohol doesn't help on that front). Some people use elastic socks, although Tapson said they may be troublesome if they crimp the legs.

Source:April 28 (HealthDay News)

Bariatric Surgery Coverage

The Morning Blend (KTNV-TV)
4/26 – Dr. James Atkinson of the Gastric Band Institute in Las Vegas encourages patients to proactively engage in dialogue with their physicians to request a referral to a bariatric specialist.  Dr. Atkinson also discussed different procedures for weight loss surgery.

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Good Day Columbus

Dr. Marc Michalsky of Nationwide Children’s Hospital discussed the practice of performing the sleeve gastrectomy in patients as young as 13 years old.  Dr. Michalsky also discussed associated risks and potentials benefits of bariatric surgery among this age group.

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Bariatric Surgery Coverage

4/22 – Robert MacMillan of the Centennial Medical Center used a REALIZE-branded gastric band display to describe different surgical options for weight loss, including the band, sleeve and duodenal switch.  The clip also features “Obesity Online” event speaker Pamela Davis who discusses her personal experience with surgery.

Source:Better Nashville (WSMV-TV)

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US Study Probes How Surgery Makes Diabetes Disappear

Weight loss surgery appears to change the body's metabolism in a way that dieting alone cannot, helping to explain why diabetes often disappears after the surgery even before much weight is lost, U.S. researchers said on Wednesday.
Understanding how gastric bypass affects metabolism could shed light on treatments for type 2 diabetes, a global epidemic strongly linked with obesity and too little exercise.
Weight loss surgery is becoming increasingly popular as obese people struggle to lose weight and avoid the health complications that accompany the extra pounds -- including diabetes, heart disease, joint pain and some cancers.
In research conducted at Columbia University in New York and Duke University in North Carolina, researchers studied two small groups of severely obese diabetic patients who either had gastric bypass surgery or went on strict diets.
Both groups lost about 20 pounds.
For the study, the teams measured metabolites -- chemical byproducts of foods in the body.
They found that unlike dieting, gastric bypass changes a person's metabolism by significantly reducing levels of circulating amino acids -- compounds linked with obesity, diabetes and insulin resistance.
"What we were trying to do is cast a very wide net," said Christopher Newgard of Duke, who worked on the study published in Science Translational Medicine.
"What we caught is a very clear difference between bariatric surgery and dietary intervention."
He said patients in the surgery group had lower levels of molecules known as branch chain amino acids.
"These dropped much more precipitously in people having bariatric surgery than people having the dietary intervention," he said.
People in the gastric bypass arm of the study underwent a surgery known as Roux-en-Y, in which doctors surgically reduce the size of the stomach to prevent people from eating too.
Newgard said it is not clear why reducing stomach size might have this effect, but it is clear that bariatric surgery results in significant metabolic changes.
The team is now looking to discover ways to develop drugs that could replicate this effect.
Newgard said the results might not apply to Allergan's (AGN.N) Lap-Band weight-loss device, in which doctors insert an adjustable silicone band around the upper part of the stomach but do not surgically reduce the size of the stomach.
Up to a third of U.S. adults could suffer from diabetes by 2050, according to the U.S. Centers for Disease Control and Prevention

Source is by Reuters, 4/27

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