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Study Questions Cost Savings of Weight-Loss Surgery (About Time)

February 28, 2013

TRIGGER WARNING: Weight loss surgery talk ahead.

Well, well, well, it’s about damned time someone did a study on the cost savings of WLS and here it is. There are some conclusions drawn, toward the end of the article with which I do not agree, but we’ll get to that in a bit.

Bariatric surgery did not reduce healthcare costs over the long term when surgery patients were compared with matched obese patients who did not have surgery, a review of almost 30,000 cases showed.

Right, because everyone knows that being fat raises health care costs over the moon, is bankrupting our country, and making health care more expensive for everyone (/sarcasm).

Surgical patients had lower healthcare costs in the first year after surgery, averaging about $1,000 lower per case, according to Jonathan P. Weiner, DrPH, of the Johns Hopkins School of Public Health, and co-authors. During the next 2 years, bariatric surgery was associated with significantly higher healthcare costs. In years 4 through 6, costs stabilized but remained higher in the surgery cohort for 2 of the 3 years.

“Bariatric surgery does not reduce overall healthcare costs in the long term,” the authors concluded. “Also, there is no evidence that any one type of surgery is more likely to reduce long-term healthcare costs.

The medical profession has been doing bariatric surgery of one sort or another on fat people for over 40 years and they’re just now looking at whether it actually saves money in the long run? After all these years of saying that the costs of obesity are skyrocketing and “we need to do something to curb them immediately,” you’re just now looking into whether it’s actually cost effective? Really?

“To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.”

As evidence has accumulated to support the health benefits of bariatric surgery, the number of procedures has increased dramatically, reaching 220,000 annually as of 2009. Additionally, numerous studies have suggested that bariatric surgery reduces healthcare costs by improving patients’ health and well-being.

Future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings. Excuse me while I catch my breath, I’m laughing so hard at this one. Like the complications from all kinds of WLS have never been documented and no one (in the medical profession) knows how debilitating those complications can be, or how they impact their patients’ health or quality of life. (sarcasm)Yep, surgeons and doctors don’t know any of that and they need studies to tell them that information. Because “everyone knows” that being fat is going to “cause” all kinds of VFHTs and fat people will die if they don’t get thin (and really, who gives a shit if they die from the surgery that’s supposed to end those VFHTs and make them thin?). (/sarcasm)

Fuck you very much, asshats. What future studies should concentrate on is whether those health “improvements” that are supposed to happen after WLS actually do happen and if they’re actually sustained for life (because we know the weight loss sure as hell isn’t sustained in most cases). And do those health “improvements” come at the cost of quality of life — is it really worth it to be thin if you’re malnourished, vomiting after every meal, losing hair, restricted on the types/textures of foods you can eat, have neurological problems, etc?

In particular, laparoscopic bariatric procedures have won favor because of their association with shorter hospital stays and fewer complication rates as compared with open procedures. However, questions have persisted about the potential return on investment, the most cost-efficient surgical procedures, and whether cost savings are sustained over time.

Fewer complications? Really? Ask all the patients who have lapbands how few complications they have and whether those complications have an adverse impact on their lives. Like band problems, blood clots, bowel function changes, bowel perforations, esophageal dilation, food trapping, gallstones, gastroesophageal reflux disease (GERD), hiatal hernia, indigestion (dyspepsia), intolerance to certain foods, nausea and vomiting, pneumonia, port problems, and pouch dilation are just a snap to deal with and no big deal (oh, and it doesn’t cost any more money to deal with these complications than it would to deal with being fat either, amirite?).

I’m not even getting into the complications that surround WLS other than lapband, I’ve listed them before and they’re more extensive and more debilitating, in a lot of cases, than the complications from lapbanding. So yeah, by all means, look at the cost “savings” of WLS over treating the diseases “caused” by being fat. I’m not holding my breath waiting for y’all to tell me that WLS just saves tons of money.

To address some of the unresolved issues, Weiner and colleagues analyzed claims data provided by seven Blue Cross/Blue Shield healthcare plans with total enrollment of 18 million. The authors identified 29,820 plan members who underwent bariatric surgery during 2002 through 2008. Each patient was matched with another plan member who had one or more diagnoses associated with obesity but did not have weight-loss surgery.

The two groups had comparable healthcare costs in the year prior to date of the surgical patients’ procedures: $8,850 in the surgical cohort and $9,590 for the comparison group. The standardized cost of surgery was $29,517, including the surgery and 30-day follow-up period.

In the first year after surgery, healthcare costs averaged $8,905 in the surgery cohort and $9,908 in the comparison group. During year 2, total healthcare costs in the surgical cohort peaked at $9,908, whereas costs in the comparison group decreased to $9,264. Costs in the surgery cohort exceeded those of the comparison group for 3 of the next 4 years:

Year 3 — $9,211 versus $9,041
Year 4 — $9,051 versus $9,232
Year 5 — $9,386 versus $8,966
Year 6 — $9,259 versus $8,714

Bariatric surgery patients had lower costs for prescriptions and clinic visits but higher costs for inpatient care compared with the comparison group.

And this just covers the costs paid out by the insurance company. It doesn’t look at out-of-pocket costs incurred and paid for by patients (and believe me, those supplements that WLS survivors end up taking to just have some semblance of “health” are not cheap). Does this make anyone else wonder what the costs would be if they looked at them 10 years out, 15 years out, 20 years out? I’m thinking they don’t get less, and probably get much higher as time goes on.

In a critique of the study, JAMA deputy editor Edward H. Livingston, MD, said bariatric surgery clearly benefits a subgroup of patients who have a complication or condition known to improve dramatically with weight loss, such as diabetes and osteoarthritis. Reducing body mass index should not be the exclusive indication for the surgery.

Right, because WLS “cures” type 2 diabetes. It doesn’t, it puts T2D into remission for a period of time, and then blood glucose starts to rise again because WLS doesn’t deal with the underlying cause of T2D — the body’s inability to use glucose properly.

And we all know that only fat people get arthritis and the only way to “cure” it is to become less fat (excuse me while I LMFAO over this one). Why in the hell do doctors think WLS is going to “cure” a disease in fat people, but don’t recommend that same “cure” for those thin people who have the same fucking disease? I mean, if it’s a “cure” for the disease, shouldn’t everyone be lining up for it? (I’m not even getting into the stupidity of the rationale behind “but fat is going to kill you, it’s for your own good”.)

“Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive,” Livingston wrote. “In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients.

“Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success.”

“Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive,” Livingston wrote. Ya think? Dramatic short-term weight loss followed by debilitating complications and weight regain are “far less than impressive” outcomes. Do tell, Dr Livingston, do fucking tell.

As for that “overwhelming probability of long-term success”? Why don’t you hold your breath waiting for that to happen? If we’re lucky, you’ll turn blue and pass out (and maybe that will enlighten you to the fact that “it ain’t happening, dude.”).

The findings are informative but do not necessarily reflect the current practices and economics of bariatric surgery, according to Jaime Ponce, MD, president of the American Society of Metabolic and Bariatric Surgery. In particular, the study reflected a predominance of open procedures, even in the last year of the study period. Since that time, laparoscopic procedures have become predominant.

“We know that open surgery requires a longer follow-up to see the economic benefits of bariatric surgery,” said Ponce, of Memorial Hospital in Chattanooga, Tenn. “Even in the last year of the study, a large number of open surgeries were performed. Today about 90% of bariatric surgery procedures are performed laparoscopically.”

Right, Dr Ponce, and those complications of lapband that I listed earlier — were the result of laparascopic lapbanding. But I suppose those complications aren’t expensive to deal with, so costs aren’t a factor? Yeah, right.

The following statement is the one that really pisses me off and I’ll explain why, after you read the comment.

Ponce also noted that the study did not take into account the economic impact of the indirect benefits of bariatric surgery, such as improved employability, improvement in overall health, resolution of diabetes and other metabolic disturbances, and better quality of life.

Improved employability? WTfuckingF? Fat people need to change because employers are such bigoted asshats that they think we can’t do the job? Fuck you, Dr. Ponce, marginalized groups do not have to change to meet some “ideal” in order to have the rights that everyone else has.

Improvement in overall health? Yeah, those complications are an improvement all right, in spite of the increased costs of health care after WLS.

Resolution of diabetes and other metabolic disturbances? Yeah, for a short period of time, and then you end up treating those diseases all over again.

Better quality of life? Right, living with complications like vomiting, GERD, chronic diarrhea/constipation, etc. is just such a wonderful improvement of one’s quality of life.

What fucking world are you living in, Dr. Ponce? The evidence is out there, but it doesn’t gibe with what the medical community has been recommending to fat people for over 50 years now, so you’re putting your fingers in your ears and only hearing what you want to hear, which isn’t that this is a horrible solution to a problem that doesn’t fucking exist.

I have a suggestion for all the doctors who think that WLS is the solution — try looking at your fat patients as people first, treating their problems the same way you’d treat the same problems in a thinner person, and STFU about WLS. That would go a very long way toward improving the lives of your fat patients.


14 Comments leave one →
  1. February 28, 2013 10:46 am

    I haven’t had a chance to read the study yet, but I’m surprised by the pre-surgery numbers. Other studies have found people who go on to have BS tend to have higher costs prior to surgery and don’t pick up on the obvious confounding factor that fat people who are sick (e.g. with diabetes etc) are likely to access more healthcare in the years leading up to their surgery than fat people who aren’t sick. Probably because they don’t believe such a population exists! So the fact that the numbers here are about the same is interesting.

    • vesta44 permalink
      February 28, 2013 11:39 am

      One of the things I forgot to comment on was that finding about costs before surgery. How many of those who had the surgery had no comorbidities, and only qualified for the surgery because their BMI was over 50? How many of those people, with no comorbidities, were told that their weight was going to kill them sooner or later, and were scared into having the surgery? How many of them were very fat and wanted to lose weight so people would just STFU and leave them alone? Because I can guarantee you that there are a lot of fat people with no comorbidities (high blood pressure, type 2 diabetes, heart disease, etc) who are scared into having bariatric surgery and come to regret it.

    • Amber permalink
      March 2, 2013 7:09 am

      “The authors identified 29,820 plan members who underwent bariatric surgery during 2002 through 2008. Each patient was matched with another plan member who had one or more diagnoses associated with obesity but did not have weight-loss surgery”

      From the sounds of this quote, the surgery cohort could have been a mix of those with and without a comorbidity, but they don’t specify; whereas the ‘control’ cohort had AT LEAST one comorbidity. Even with this (potentially) stacked deck, the non surgery group had lower healthcare costs long term.

  2. pyctsi permalink
    February 28, 2013 12:35 pm

    The way they are saving money is by killing people off, some of whom were is pretty good health before they were scared into such a drastic procedure.

  3. February 28, 2013 3:32 pm

    Are they tracking all health care expenses for patients or just ones they consider to be affected by obesity?

  4. Nymeria permalink
    February 28, 2013 4:14 pm

    Did they mention the per year health costs of non – obese patients?

  5. The Real Cie permalink
    February 28, 2013 8:19 pm

    I read something by a person who had the surgery. She said you lose a lot of weight in the first month BECAUSE YOU CAN’T EAT ANYTHING BUT LIQUIDS! Duh, derrr! She then went on to describe the horrific complications she’s experienced thereafter, and the fact that she gained the weight back and now she can’t eat normally, nor will she ever be able to again.
    So if one is really hell bent on losing a shit ton of weight, the thing to do is to go on one of those (not healthy) low calorie liquid diets. Yeah, you’ll lose the weight and when you eat normally again, you’ll gain it back. But at least you’ll still have your proper digestive system in place.
    Weight loss surgery: the one thing that can make yo yo dieting seem like a good thing.
    Note: I am NOT advocating going on a low calorie liquid diet. I’m pointing out that this is the component which causes the initial weight loss.

  6. vesta44 permalink
    February 28, 2013 10:58 pm

    I didn’t have the surgery they’re talking about in this research, mine was a VBG (stomach stapling). My surgery was recommended because I had arthritis in my knees and my NP told me that no surgeon would replace my knees at my then-weight of 350 lbs (she lied). My blood pressure was normal, my blood sugar was normal, and my cholesterol was normal. I did have back problems that didn’t allow me to walk more than a couple of blocks at a time without my back screaming at me. She said that losing weight would end that problem and would assure me that a surgeon would replace my knees. The only reason I was approved for WLS was because my BMI then was 53.2. What upset me at the time was that they weighed me when I got to the hospital and said I weighed 370 lbs. Now, this is two days after I’d been weighed at the dr’s office and weighed 350 lbs, and had drank a gallon of Go-Lightly (Go Lightly my ass, you drink a gallon of that shit and you’re spending the next 24 hours on the toilet, shitting your brains out). Then, they weighed me just before I was discharged – lo and behold, according to them, 4 days after surgery, I had lost 70 lbs and only weighed 300 lbs (funny thing about that – I wore the same clothes home that I wore to the hospital and they didn’t fit any differently after surgery than they did before surgery).
    Trigger warning for graphic descriptions of bodily functions
    I went home with instructions to eat pureed foods for a month (baby food works great for that and one of the smallest jars is more than enough for a meal). Then I was told I could eat mashed and ground foods for another month. If I tolerated those, then I could go back to eating regular foods (yeah, right). I tried that and ended up spending a lot of my time after meals in the bathroom, worshiping the porcelain throne and selling a lot of Buicks (my husband’s term for barfing because if you draw out the word “Buick”, that’s exactly what it sounds like).
    About a year after surgery, I found out one of the lovely side effects of WLS, and I found it out after dining out at a Chinese buffet. It had been a half an hour since we’d eaten and we were walking from the buffet to the mall a couple of blocks away. All of a sudden, I had an urgent need to defecate. I tried to hold it until I could get to the bathroom at the grocery store, which was only 100 feet away. No dice. Explosive diarrhea waits for no one and doesn’t care if there’s a bathroom close or not. I ended up having to send my friend to a store to buy me some new pants while I walked into the grocery store smelling like shit, and having my pants full of it. Cleaning up in a bathroom stall isn’t easy, nor is cleaning the stall itself so the store employees don’t realize what’s happened (as if they couldn’t tell when I walked in). I later found out that this is called “dumping syndrome” and happens when too much sugar, too many carbs, and/or too much fat hits your system. For me, not only are all of those things triggers for dumping, so are fruits/vegetables and dairy products. What really sucks about this syndrome? Is that it isn’t always triggered by those foods – sometimes I can eat any/all of them and nothing happens. Sometimes I can eat only one of them and it’s triggered. An adventure in dining pleasure that I wouldn’t wish on anyone.
    Fifteen years out from my surgery and I’m still having problems with dumping, even though I try to avoid things that trigger it – not always easy to do when you’re traveling and have to dine out. I’ve made it a policy when I go places to know where the bathrooms are located, and when we travel, I make sure that I stop at most rest areas, whether I think I need to go or not (I also do not eat when I’m driving, and I wait at least 30 to 60 minutes after eating before we get back on the road). The really sad thing about this is that this is a common side effect of WLS that no one tells you about, and isn’t counted as a cost of the surgery (and it’s an expensive one, I don’t know how many pairs of underwear/slacks I’ve had to throw away because of this). There is nothing that can fix this, and the only thing I’ve found that helps is the Prilosec I take for GERD (also a side effect of WLS).
    I also have migraines, fibromyalgia, worsening back problems, worsening arthritis, venous insufficiency in my lower legs,and nerve damage from this surgery. Now, I could deal with that if that “70” lbs I lost (and the additional 30 lbs I lost after I got home) had stayed lost. If I weighed 270 lbs now, I would deal with the dumping, the migraines, the fibro – all of that. But lo and behold, like most people who’ve had WLS, not only did I regain every fucking pound I lost, I gained an additional 40 lbs (and I’ve gained another 15 or 20 lbs since I’ve had my thyroid removed). So not only do I have these nasty fucking side effects from WLS, I’m also 50 to 70 lbs fatter than I was before the surgery. I’ve complained to my doctors and the only things they (think they) can recommend are more diets or having my VBG converted to RnY. Yeah, right, you had your one opportunity to kill me, why the hell would I give you another one?
    The point of all this lengthy explanation is to say that I probably see doctors less now than I ever did before this surgery. But every one of my ailments that are a side effect of this damned WLS are attributed to “obesity”. When I look at the sheet the clinic gives me when I leave, the very first diagnosis on that fucking sheet is “OBESITY”, even if what I went in about was a fucking busted toe or a nail fungus that isn’t going away. And that damned busted toe or nail fungus isn’t caused by being fat, but obesity is still the initial diagnosis, so that nail fungus is probably considered one of the related costs of “after-WLS” care. And why is that? Because insurance companies decide what coding is used on billing in order to pay doctors, and they’ve decided that “obesity” tops the list of codes, and if there isn’t room for any other diagnostic code, “obesity” trumps them all (they code from the top down on the list, and “obesity” is the very first one on the list of diagnostic codes).
    I think it’s safe to say that the “health costs of obesity” are probably inflated precisely because of the way insurance companies demand the diagnostic codes have to be listed on billing submissions. As for the true costs of after-WLS care, I don’t think we’ll ever know what they are because there isn’t a code for that. There isn’t a code for “former WLS survivor who couldn’t maintain weight loss and has a fuckton of complications as a result of WLS”.
    Sorry this got so wordy, but I want people to know what their chances are of being successful at losing weight and maintaining that weight loss after WLS without serious complications (slim and none and slim just left town).

    • vesta44 permalink
      February 28, 2013 11:07 pm

      Oh, I did find out (on my own, mind you, no doctor told me this) that besides the Prilosec helping with the dumping, not drinking anything 30 minutes before and 30 minutes after you eat can help, as can eating very slowly – in other words, take tiny bites, chew them thoroughly, and take at least 30 to 45 minutes to finish your meal (ever tried doing that when you’re not eating alone?). Yeah, not easy to do when you have very few teeth left because they’re rotting out of your head (another lovely side effect of WLS that no one tells you about).

    • The Real Cie permalink
      March 4, 2013 1:59 am

      I’m always glad when people tell the true story about what WLS does. You could be saving someone’s life!

  7. Elizabeth permalink
    March 2, 2013 1:34 pm

    vesta, thank you for outlining your post-surgery life in detail.

    What I would like to add to the discussion is that your enteric nervous system resides in your gut. The ENS is larger than the CNS and controls basic bodily functions, such as heart rhythm. Medical personnel know the ENS exists, but most doctors have NO RESPECT for the gut. And bariatric surgeons are at the top of that list. No one who understands what the gut does and its essential role in bodily health would ever mess with it unnecessarily. Due to medical negligence I ended up with peritonitis and bowel obstruction, and when they opened me up my intestines flew out. Despite this, despite a hernia which is my small intestine pooching out, I still have an amazingly healthy digestion. And believe me, I am very thankful.

  8. April 5, 2013 9:57 pm

    Thank you all for keeping it real. I’ve been approved for WLS and frankly scared witless. When I ask questions, I get a sugar coated answer. With all due respect for those of you who have had the surgery, after reading these comments, I have dutifully decided that I will no longer go through with this procedure! God love you all.

    • April 5, 2013 10:51 pm

      Hi Sheri,
      I’m glad you have reconsidered. If you don’t know where to go next, check out Health at Every Size by Dr. Linda Bacon. If you want to get healthy, focus on your behaviors, like improving your diet and getting more exercise by finding something that you love (water aerobics is awesome for larger bodies… well, any anyone who hates muscle pain). HAES is a great alternative if you’ve spent a lifetime yo-yo dieting. If you have any questions, just let us know.


    • Elizabeth permalink
      April 6, 2013 12:20 pm

      Hey, Sheri, I was pressured by a surgeon I saw to have WLS, but, like you, I was nervous about it. Fortunately, I read stuff online and people said they couldn’t even take their vitamins after having lapband surgery. That freaked me out because I have supplemented for years and I know it’s one reason I’m so healthy despite mechanical problems (injured spine, etc).

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