Fact Sheet: Why it makes sense to provide treatment for obesity through bariatric surgery. (Click here for a PDF version of the OAC Weight-loss surgery coverage fact sheet.)

Reason

Evidence/Details

Obesity is widespread, deadly and expensive

• 30.5% of Americans are obese with 4.7% morbidly obese (more than 100 pounds overweight). 1

• Approximately 75% of the morbidly obese have at least one co-morbid condition (diabetes, hypertension, sleep apnea, etc.) which significantly increases the risk of premature death. 2

• Life expectancy for a 20 year-old morbidly obese male is 13 years shorter than a normal weight male of the same age. 3

• Annual direct medical expenditures attributable to obesity are $75 billion. 4

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 the morbidly obese population. In contrast, African-Americans make up 12% of the population but 23% of the morbidly obese population. 5

• Poor populations (those making less than $20,000 annually) show a similar increase in likelihood of being morbidly obese. 5

Bariatric surgery is a life-saving procedure as it is proven to increase life expectancy

• Christou study compared morbidly obese patients 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. 6

• MacDonald study in North Carolina found 68% reduction in risk of death after mean follow-up time of six years. 7

Bariatric surgery resolves 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

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

Coverage for bariatric surgery makes economic sense

• Upfront costs of bariatric surgery are paid off in three and a half years due to hospitalization cost savings. 14

• Post surgery drug costs for diabetic and anti-hypertensive medications decrease dramatically. Potteiger study found a 77.3% savings. 15

Sources

1 Flegal KM, Carroll MD, Ogden CI, Johnson CL. Prevalence and Trends in Obesity Among US Adults, 1999-2000. 2002;288;1723-1727.

2 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.

3 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.

4 Finkelstein EA, Fiebelkorn, IC, Wang G. State-Level Estimates of Annual Medical Expenditures Attributable to Obesity. Obesity Research 2004 Jan;12(1):18-24.

5 Livingston EH, Ko CY. Socioeconomic Characteristics of the Population Eligible for Obesity Surgery. Surgery 2004, Vol. 135, No. 3, pp. 288-296

6 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.

7 MacDonald K, Long S., Swanson M, et al. The Gastric Bypass Operation Reduces the Progression and Mortality of Non-Insulin Dependent Diabetes Mellitus. Journal of Gastrointestinal Surgery 1997, Vol. 1, No. 3, pp. 213-220.

8 Flum DR , Dellinger EP. Impact of Gastric Bypass on Survival: A Population-Based Analysis. Journal of the American College of Surgeons 2004, Vol. 199, No. 4,pp. 543-551.

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 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.

14 Sampalis JS, Liberman M, Auger S, Christou NV. The Impact of Weight Reduction Surgery on Health-Care Costs in Morbidly Obese Patients. Obesity Surgery 2004, 14, pp. 939-947.

15 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. 725-730