Marie Gahler, Senior Manager, Weight and Nutrition Education Services
According to a study published in the July issue of Archives of Surgery, among obese veterans, bariatric surgery (predominantly gastric bypass) is not associated with lower healthcare expenditures in the three years following the operation. This is in direct contrast to an earlier observational analysis that focused on younger, primarily female, patients, which showed that bariatric surgery reduces overall healthcare costs in the two to five years following surgery. Some limitations with this study need to be considered.
If current trends continue, by 2030, 42 percent of American adults will be obese and 11 percent, or 33 million people, will be severely obese. Today, 15 million adults in the U.S. are severely obese, incurring healthcare costs that are almost eight times higher than non-obese adults. In response, many employers and health plans now cover bariatric surgery, which is proving to be the most effective treatment option for severely obese adults. Some say this new study could slow the acceptance of bariatric surgery as a solution for the severely obese an outcome that would be detrimental to obesity treatment overall.
Many recent studies have shown a return-on-investment (ROI) within about 24 months following bypass surgery. This has been true in studies not only on the US but in Canada and Western European countries as well. Prescription drug costs are reduced by more than $200 a year following surgery. Studies on disability pension payouts on males age 19 and older following surgery show a significantly lower number of days for those who had surgery verse those whose who did not.
We should also consider the measure of the medical benefits associated with bariatric surgery, a treatment method considered to be our most effective for the severely obese: the weight lost through bariatric surgery can prevent or improve costly chronic conditions like diabetes, heart disease, high blood pressure, cancer, and sleep apnea. Studies show overall mortality is reduced by 89% at 5 years post-surgery and quality of life measures reveal a 95% improvement. A resolution of more than 80% is seem in metabolic syndrome, asthma, cardiovascular disease, type II diabetes, polycystic ovarian syndrome and venous statis disease.
It is important to note that the new studys focus on older patients may limit our understanding of the cost of bariatric surgery as a whole: older patients are more inclined to be sickly and therefore incur greater healthcare costs, no matter what their weight (obese elderly arguably incur more than non-obese elderly). Also, the data for the new study came at a time before less-invasive surgery methods were available. Today patients spend less time in the hospital and experience fewer complications, both of which result in money saved. In addition, this two fold study failed to control for the higher death rate among on the control group. Almost twice as many individual in the control group died during the study period and thus were not consuming health care resources.
In the end, bariatric surgery is an investment not only for those who pay for the surgery, but for the patients themselves. Bariatric patients must make great behavioral changes and change the way they think about food and exercise for the rest of their lives. The sacrifices they make to achieve better health in the short-term, however, can potentially result in lasting results that will drastically improve their health and eventually, lower healthcare costs as well.
Marie Gahler has more than 25 years experience in treating obesity and weight related health behaviors and continues to be inspired by the ef