December 1, 2013
John DiTraglia MD
Obesity or bariatric surgery probably works better than diet and exercise for long-term weight loss and cure of type 2 diabetes. We still say “probably” because even thought the evidence is overwhelming, people still have a problem with issues of will power and blame and whether this kind of surgery is a mortal sin in the Catholic Church.
If it works, is it worth it? This is another fraught question. Is it worth $25,000 to lose 30 percent of your weight and cure your diabetes? Does it have to save money in the long run? That is the question the insurance companies ask. Annual health care costs for obese patients are estimated to be 3 to 10 grand per year. If those costs totally disappeared after surgery it could still take many years on average to break even.
A recent report in JAMA surgery used insurance data on 29,820 BlueCross BlueShield members who got bariatric surgery between Jan. 1, 2002 and Dec. 31, 2008 to investigate these questions. They found that compared to a comparison group of obese persons not undergoing surgery, bariatric surgery did not reduce or increase health care costs over the first six years.
Maybe in the longer term it would save money. The lack of cost savings does not mean that these surgeries are not cost effective, that’s a different question. Also, remember, there are several kinds of bariatric surgery, gastric bypass, gastric banding that were studied here and sleeve gastrectomy that was not studied in this report. Finally, if we could figure out how these surgeries really work - which has little or nothing to do with keeping you from eating or keeping you from absorbing what you do eat - maybe we could do this much cheaper.
1. Weiner JP et al. Impact of bariatric surgery on health care costs of obese persons: A 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA Surg. 2013:148(6):555-62.
2.Maciejewski ML, Arterburn DE. Clinical Review and Education. Cost-effectiveness of bariatric surgery. JAMA 2013;310(7):742-3.