NJ Gov Christie Has Lap-Band Surgery

May 7th, 2013 No comments »

New Jersey Governor Chris Christie has had lap-band surgery, according to a report in today’s Politico. Christie’s weight has long been an opportunity for fat-bashing humor and has been considered an obstacle to a potential Presidential run. However, Christie, who had the operation on his 50th birthday, said that he had the operation to be healthier for his wife and children.

 

New study indicates bariatric surgery improves pancreatic beta-cell function

February 28th, 2013 1 comment »

Philip Schauer and colleagues have found that gastric bypass surgery but not intensive medical care or sleeve gastrectomy significantly increased insulin sensitivity and pancreatic beta-cell function even though weight loss was similar. The study randomized 60 subjects and followed them for two years. Pancreatic beta cells store and release insulin and their loss of function is a key feature in the progression to type 2 diabetes. The study is published in the March edition of Diabetes Care.

 

Morbid Obesity Continues to Increase

October 3rd, 2012 No comments »

Severe or morbid obesity (BMI >40) continues to grow. A new analysis estimates, after adjusting for self-report biases, that, in 2010,  15.5 million adult Americans or 6.6% of the population had an actual BMI >40 kg m−2. The prevalence of clinically severe obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.   PubMed: Morbid Obesity Continues to Rise in the US. To put this number in perspective, 15.5 million is the in-between the population of the 4th and 5th largest states by population, Florida and Illinois. Or, it is roughly equal to the populations of Nebraska, Idaho, Hawaii, Maine, New Hampshire, Rhode Island, Montana, Delaware, South Dakota, Alaska, North Dakota, Vermont, Washington, DC, and Wyoming, combined. It is also about equal to the total US population that use Twitter and the total Asian-American population.

Eric Finkelstein et al have projected that morbid obesity will increase 130% over the next 2 decades. PubMed: Obesity and Severe Obesity Forecasts through 2030

What is significant, to my mind, is that unlike any other chronic disease I can think of, we have an effective treatment for the most severe cases…bariatric surgery. We could (and should) employ a strategy to bring this intervention to this population which we know can benefit from it. This is the same population which has the highest mortality, morbidity and health care costs and health care utilization. What am I missing?

 

New Technology for Bariatric Surgery

September 14th, 2012 No comments »

The Geisinger Health System has released a new iPhone app to assist patients to determine how much weight they would lose from bariatric surgery. The free app, called “Get-2-Goal” and available at the App Store, allows the patient to enter their age, weight and height and calculate personalized expected weight loss based on national averages of persons with similar characteristics. Post-surgery, the app allows the patient to track weight loss over time, generate motivational content, and email their physician. Christopher Still, D.O., Director of the Geisinger Obesity Institute stated, “The most useful function of this app is that it ensures patients are fully informed and have realistic expectations after their procedure.” The app was developed in collaboration with Bucknell University.

 

Challenging Insurance Denials of Care

August 14th, 2012 No comments »

My old friend Walt Lindstrom has a new site for those needing to challenge denials of insurance coverage for obesity treatment. Check it out at http://wlsappeals.com/

 

Texas Grapples with Costs of Bariatric Surgery

June 24th, 2012 No comments »

The New York Times reports on the issue of Texas, which has one of the highest rates of obesity in the country, grappling with the costs of bariatric surgery in Medicare and Medicaid. NYT:Spending for Weigh Loss Surgery Increases in Texas

No doubt this scenario will be played out in many states in the coming years. I’ve always said, “Obesity is too expensive to treat and it is too expensive not to treat.” This article bears this out. The tipping point for me is that at least with treating, we are reducing suffering for some humans. Predictably, at the end of the article a professor is cited as saying that the state could reach many more people with less expensive lifestyle interventions and improve their health enough to save far more dollars than bariatric surgeries do. This would be true if any lifestyle intervention was shown to achieve bariatric surgery’s long term, significant weight loss, with a reduction in co-morbidities, such as type 2 diabetes. But the professor’s statement is still, after millions of dollars of research on lifestyle changes, only a hypothesis, yet to be established.

 

Improvements Seen in Obesity Reimbursement

May 13th, 2012 No comments »

A Washington Post article by Judith Graham points out the progress made in getting insurers and physicians to screen patients for obesity and reimburse for counseling and treatment. I can add that at one of the recent FDA Advisory Committee meetings, an FDA health officer presented data indicating that about half of prescription drugs for obesity were paid for by insurance plans now. WaPo: BMI as vital sign

In addition, conversations with health plan representatives indicate that they are getting more requests from employers for riders covering obesity interventions, including bariatric surgery. These are considerable improvements from a few years ago.

 

Bariatric Surgery Improves Disability Outcomes

March 14th, 2012 No comments »

A study just published in the International Journal of Obesity looks at disability rates of men and women who have had bariatric surgery compared to non-surgical controls. The study, from the Swedish Obesity Study, followed subjects for 19 years and found a significant decline in days lost due to disability in men but not in women. International Journal of Obesity – Abstract of article: Effects of bariatric surgery on disability pension in Swedish obese subjects