Fact Sheet: Why it makes sense to provide treatment for obesity through bariatric surgery.
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Obesity is widespread, deadly and expensive
- 34% of Americans are affected by obesity(1) with 5.7% affected by severe obesity (more than 100 pounds overweight).2
- Approximately 75% of individuals affected by severe obesity have at least one co-morbid condition (diabetes, hypertension, sleep apnea, etc.) which significantly increases the risk of premature death. 3
- Life expectancy for a 20 year-old male affected by severe obesity is 13 years shorter than a normal weight male of the same age. 4
- Annual direct medical expenditures attributable to obesity are $147 billion. 5
Obesity disproportionately affects minority and poor populations
- African-Americans are disproportionately affected by obesity. Caucasians make up 75% of the U.S. population, but only 64% of individuals affected by severe obesity. In contrast, African-Americans make up 12% of the population but 23% of individuals affected by severe obesity. 6
- Poor populations (those making less than $20,000 annually) show a similar increase in likelihood of being affected by severe obesity. 5
Bariatric surgery is a life-saving procedure as it is proven to increase life expectancy
- Christou study compared patients affected by severe obesity who were treated with surgery versus those who were not. It found an 89% reduction in the risk of death throughout five years in the surgery group. In other words, those who received surgery were nine times less likely to die over the next five years.7
- New England Journal of Medicine Study comparing 15,000 plus individuals affected by severe obesity found a 40% lower risk of death over 7 years in surgery patients for all causes. The study found a 52% lower risk of death from obesity related illnesses including a 92% lower risk of death from diabetes.8
Bariatric surgery can resolve potentially fatal co-morbid conditions
- A meta-analysis study including more than 22,000 patients showed the following effects of surgery on co-morbidities:
- Diabetes was completely resolved in 76.8% of patients.
- High cholesterol was resolved or improved in more than 70% of patients.
- High blood pressure was resolved in 61.7% of patients.
- Sleep apnea was resolved in 85.7% of patients. 9
- Other studies have shown even higher (82%) resolution of diabetes 10 and “profound improvement in obstructive sleep apnea.” 11
Weight-loss post-surgery is extensive and durable
- A long term study following patients for up to 14 years after surgery found that 89% of weight-loss was maintained. 12
The risk-benefit tradeoff for bariatric surgery is favorable
- The mortality rate for bariatric surgery varies by surgeon. Experienced surgeons have mortality rates ranging from .02%-.5% (averaging the rate for all types of procedures). 13 14 The risks of not receiving surgery is far higher as demonstrated by the Christou study where those who did not receive surgery were almost nine times more likely to die. 15
Coverage for bariatric surgery makes economic sense
- Downstream savings associated with bariatric surgery are estimated to offset the costs in 2 years (laparoscopic procedure) to 4 years (open procedure). 16
- Post-surgery drug costs for diabetic and anti-hypertensive medications decrease dramatically. Potteiger study found a 77.3% savings. 17
1 Center for Disease Control, National Health and Nutrition Examination Survey (NHANES)
2 CDC. Prevalence of overweight, obesity, and extreme obesity among adults: United States, Trends 1976–80 through 2005–2006. Hyattsville, MD: US Department of Health and Human Services, National Center for Health Statistics, CDC; 2008.
3 Must A, Spadano J, Coakley EH, Field E, Colditz G, Dietz WH. The Disease Burned Associated with Overweight and Obesity. JAMA, 1999;282:1523-1529.
4 Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003 Jan 8;289(2):187-93.
5 Finkelstein EA, Fiebelkorn, IC, Wang G. State-Level Estimates of Annual Medical Expenditures Attributable to Obesity. Obesity Research 2004 Jan;12(1):18-24.
6 Livingston EH, Ko CY. Socioeconomic Characteristics of the Population Eligible for Obesity Surgery. Surgery 2004, Vol. 135, No. 3, pp. 288-296
7 Christou NV, Sampalis JS, Liberman M. Surgery Decreases Long-Term Mortality, Morbidity, and health Care Use in Morbidly Obese Patients. Annals of Surgery 2004, Vol. 240, No. 3, pp. 416-424.
8 Adams TD, et al. Long-Term Mortality after Gastric Bypass Surgery. New England Journal of Medicine 2007:357:753-761
9 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery – A Systematic Review of the Literature and Meta-analysis. JAMA, 2004:292:1724-1737
10 Pories WJ, Swanson MS, MacDonald KG, et al. Who Would Have Thought It? – An Operation Proves to be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Annals of Surgery 1995, Vol. 222, No. 3, pp. 339-352
11 Rasheid S, Banasiak M, Gallagher SF, et al. Gastric Bypass is an Effective Treatment for Obstructive Sleep Apnea in Patients with Clinically Significant Obesity. Obesity Surgery 2003, 13, pp.58-61
12 Pories WJ, Swanson MS, MacDonald KG, et al. Who Would Have Thought It? – An Operation Proves to be the Most Effective Therapy for Adult-Onset Diabetes Mellitus. Annals of Surgery 1995, Vol. 222, No. 3, pp. 339-352
13 Buchwald H, Avidor Y, Braunwald E, et al. Bariatric Surgery – A Systematic Review of the Literature and Meta-analysis. JAMA, 2004:292:1724-1737
14 Pratt G, ASMBS Center of Excellence Course, January 2009, Surgical Review Corporation BOLD Database
15 Christou NV, Sampalis JS, Liberman M. Surgery Decreases Long-Term Mortality, Morbidity, and health Care Use in Morbidly Obese Patients. Annals of Surgery 2004, Vol. 240, No. 3, pp. 416-424.
16 Cremieux PY, Buchwald H, et al. A Study on the Economic Impact of Bariatric Surgery. The American Journal of Managed Care 2008, 14, No. 9, pp. 589-596.
17 Potteiger CE, Paragi PR, Inverso NA, et al. Bariatric Surgery: Shedding the Monetary Weight of Prescription Costs in the Managed Care Arena. Obesity Surgery 2004, 14, pp. 725-73