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Weight-Loss Surgeries Skyrocketing

Study found number of procedures quadrupled between 1998 and 2002

TUESDAY, July 12, 2005 (HealthDay News) -- The number of Americans who had weight-loss surgery quadrupled between 1998 and 2002, new research shows.

Not surprisingly, the total price tag for the procedures also climbed, according to the government study, which appears in the July 12 issue of Health Affairs. During the same period, hospital costs swelled more than six-fold, going from $157 million a year to $948 million a year. The average cost per surgery rose by about 13 percent, from $11,705 to $13,215.

Those costs are likely to go even higher. Although 71,733 surgeries were performed in 2002, compared to 13,386 in 1998, only 0.6 percent of about 11.5 million morbidly obese individuals who could have been candidates for the procedure actually had it.

"There's no question that it's on the rise," said Dr. Shawn Garber, chief of bariatric surgery at Mercy Medical Center in Rockville Centre, in New York. "The incidence of obesity is on the rise, which is a good part of it. This, combined with public awareness from different celebrities such as Al Roker, has brought more attention to the surgery."

Also, more procedures are being performed via laproscopy, with smaller incisions and quicker recovery, making them more appealing to patients.

The current obesity epidemic has left almost one-third of the U.S. population obese (with a body mass index or BMI of 30 or greater), and close to 5 percent are morbidly obese (with a BMI of 40 or higher).

According to the study, to be considered eligible for weight-loss (bariatric) surgery, an individual must have a BMI greater than 40 or greater than 35 with attendant complications such as type 2 diabetes. About 395,000 Americans aged 65 to 69 will be medically eligible for the surgery this year, a number that could increase to 475,000 in 2010.

There are two main types of bariatric surgery: to reduce the size of the stomach and/or to bypass part of the intestines. Many patients are also opting for weight-loss drugs, but this usually results in fewer pounds shed.

Studies of people who have had surgery for obesity, on the other hand, found that, with gastric bypass, patients lost 61.6 percent to 70.1 percent of their excess weight. As a result, 76.8 percent of individuals saw their diabetes disappear.

"It's good that we have this option because right now there really aren't other options," Garber said. "The success rate for medical programs is 5 percent, and there are no good drugs on the market. These people are suffering from medical problems like diabetes and sleep apnea, and they need to do something."

"Obviously, we want to have people not becoming obese," added study co-author Dr. Claudia Steiner, a senior research physician at the Agency for Healthcare Research and Quality (AHRQ). "But this particular intervention has been shown to work."

The current study, which provides the first national estimates on this subject, was based on data from the Nationwide Inpatient Sample, which draws information from 37 states.

Much of the overall increase in bariatric surgery was attributable to a 900 percent rise in operations in people aged 55 to 64. This group accounted for 11 percent of all weight-loss surgeries in 2002. Patients 18 to 55 years old accounted for 88 percent. Adolescents and the elderly made up the rest, according to the study.

Roux-en-Y gastric bypass operations, which reduce the size of the stomach while also bypassing part of the intestines, accounted for about 85 percent of weight-loss procedures. Women accounted for 84 percent of all surgeries in 2002, the study found.

The largest increase in average cost was seen in surgeries covered by Medicaid: an increase of 17.7 percent despite declining hospital days. The escalating costs are clearly a concern for Medicaid and for private insurers, which cover 83 percent to 84 percent of the people who opt for this type of surgery, Steiner said.

The alternative, however, is equally grim.

"Obesity is associated with other health conditions such as diabetes and hypertension, and those chronic conditions clearly increase the risk of cardiovascular disease and early death," Steiner said.

While increasing costs in bariatric surgery seem driven by the fact that more people are having the procedure, that is not the case in the rest of the health-care arena.

Another study in the same issue of Health Affairs found that higher prices for prescription drugs, hospital stays, doctor visits and other health services were pushing up costs, not malpractice claims or greater access to health-care services.

According to the study, health spending accounted for 14.6 percent of the U.S. gross domestic product (GDP) in 2002. That year, only Switzerland and Germany spent more than 10 percent of their GDP on health care.

The AHRQ also reported in its latest Medical Expenditure Panel Survey that Americans spent nearly $151 billion in 2002 on outpatient prescription drugs alone, roughly 2.5 times more than the $65 billion spent in 1996. Here were the top 10 drugs, ranked by expense:

  • Lipitor: $5.9 billion
  • Zocor: $4.4 billion
  • Prevacid: $3 billion
  • Prilosec: $2.6 billion
  • Celebrex: $2.4 billion
  • Paxil: $2.2 billion
  • Pravachol: $2.1 billion
  • Zoloft: $2.1 billion
  • Claritin: $2.1 billion
  • Norvasc: $2.1 billion

More information

The National Institute of Diabetes and Digestive and Kidney Diseases has more on surgery for obesity.

SOURCES: Claudia Steiner, M.D., senior research physician, Agency for Healthcare Research and Quality, Rockville, Md.; Shawn Garber, M.D., chief, bariatric surgery, Mercy Medical Center, Rockville Centre, New York; July 12, 2005, Health Affairs
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