Weight-Loss Surgery: Dangerous or a Cure for High Health Care Costs?

7 years ago

What do you know about obesity surgery? Is it just the lazy man's answer to weight loss?  Or is it an effective treatment for people who are dangerously obese?  A new study suggests that weight-loss surgery may not only save lives, but could also contribute to a considerable savings in overall health-care costs.

From Reuters -- Report Says Obesity Surgery Can Save Health Costs ...

[T]he financial toll of unemployment, welfare payments, hospital costs and prescriptions caused by obesity could be cut drastically if more patients had weight-loss surgery.

Could surgery become the recommended treatment for obesity as a way to cut health-care costs? Should it?

Color me skeptical. We all know how easily these studies can be manipulated to reflect a desired outcome.  And considering where the funding for this one came from, there doesn't seem much doubt that the desired outcome was achieved.

The report was written by an independent consultancy called the Office of Health Economics and funded by the health firms Allergan and Covidien, both of whom make medical equipment used in weight-loss, or so-called "bariatric," surgery.

I'm not saying that there isn't a place for these types of surgeries, I just question whether we should be using them more frequently simply because they "may" reduce health care costs.

I remember years ago when people first started getting surgery to treat obesity (I knew it as stomach stapling), it seemed like such a drastic option for weight loss.  I couldn't imagine how the benefits of such a surgery could really outweigh the risks, and I'm not sure they did.

Stomach Stapling (also known as gastric bypass surgery) is ...

[A] restrictive operation for weight control. Both a band and staples are used to create a small stomach pouch. In the bottom of the pouch is an approximate one-centimeter hole through which the pouch contents can flow into the remainder of the stomach and thence onto the remainder of the gastrointestinal tract.

VBG is known in the medical community as a very serious and dangerous procedure. It has been classified by the AMA as a "severely dangerous" operation.

But today, weight-loss surgery can be much different, and many believe it to be much safer, when using a less invasive procedure known as an Adjustable Gastric Band ...

[G]astric banding is the least invasive surgery of its kind. Gastric banding is performed using laparoscopic surgery and usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. Because no part of the stomach is stapled or removed and the patient’s intestines are not re-routed, he or she can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they are able to stay in the patient’s body without causing harm.

Although there have been huge strides in the safety of these types of surgeries, I still think eating healthy and getting exercise is the best way to go.  But when that's not working, and obesity is contributing to additional life-threatening health issues, surgery should be looked at as a possible solution.  With the staggering rise in obesity, I can definitely see that there is a real need for these types of procedures, and I just hope they continue to find ways to make them safer.

Even though these surgeries are "safer" than they used to be, they are not without risk ...

Any major surgery involves the potential for complications—adverse events which increase risk, hospital stay, and mortality. Some complications are common to all abdominal operations, while some are specific to bariatric surgery. A person who chooses to undergo bariatric surgery should know about these risks.

In experienced hands, the overall complication rate of this type of surgery ranges from seven percent for laparoscopic procedures to 14.5 percent for operations through open incisions during the 30 days following surgery. Mortality for this study was zero percent in 401 laparoscopic cases, and 0.6 percent in 955 open procedures. Similar mortality rates -— 30-day mortality of 0.11 percent and 90-day mortality of 0.3 percent -— have been recorded in the U.S. Centers of Excellence program, the results from 33,117 operations at 106 centers.

Mortality is affected by complications, which in turn are affected by pre-existing risk factors, such as degree of obesity, heart disease, obstructive sleep apnea, diabetes mellitus, and history of prior pulmonary embolism. It is also affected by the experience of the operating surgeon: The "learning curve" for laparoscopic bariatric surgery is estimated to be about 100 cases. Unfortunately, the way a surgeon becomes experienced in dealing with problems is by encountering those problems over time.

See a list of complications from gastric bypass surgery here.

This is a video from a woman who lost a family friend because of gastric bypass ...

There is no question that weight loss surgery can be dangerous and shouldn't be done unless a person's life is already in danger due to complications of obesity.  I really hope this type of surgery doesn't just become the "quick-fix" for obesity, I think in the long-run that could have dire consequences.

What do you think?  Would you consider surgery for weight loss?  Have you?  Should health care costs be a consideration in whether obesity surgeries become more acceptable?  Let us know your thoughts in comments.

Contributing Editor Catherine Morgan
Also at Catherine-Morgan.com

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