Weight-Loss Surgery’s Health Benefits Found to Have Costs

Obese people who have weight-loss surgery gain at least six years of health benefits that include fewer diabetes cases and lower cholesterol and blood pressure. Even so, their medical costs didn’t drop.

While the advantages linked to diminished fat were found to be durable over six years in a study published today, a second report tied the surgery to complications such as gallstones and anemia that raised how much patients spent over the same time. The research was included in an obesity theme issue of the Journal of the American Medical Association.

More than 500 million people worldwide are obese, according to the World Health Organization. Other research in the journal found that children with high levels of bisphenol A, a chemical in consumer products, were twice as likely to be obese and that some types of body fat are more dangerous than others. The surgery findings suggest the procedures are underused, said Philip Schauer, at the Cleveland Clinic in Ohio.

“Despite the somewhat overwhelmingly positive study results, surgery rates haven’t changed,” with about 1 percent of those who qualify getting an operation, said Schauer, director of the clinic’s Bariatric and Metabolic Institute. “We’re not anywhere close to coming up with effective prevention strategies.”

Schauer, interviewed by telephone, wasn’t involved in either of the surgery studies.

$66 Billion Cost

The journal’s theme issue coincides with a report today by two public-health foundations that said obesity will continue to rise in the U.S., potentially adding $66 billion in expenses to the nation’s health-care bill. The Obesity Society, based in Silver Spring, Maryland, is also set to hold its annual meeting starting Sept. 20 in San Antonio.

By 2030, more than 60 percent of adults in 13 states may be obese, with all states having obesity rates of more than 44 percent under current trends, according to the report from the Trust for America’s Health and Robert Wood Johnson Foundation.

A person with a body mass index of at least 30 is considered obese, according to the National Institutes of Health in Bethesda, Maryland. The BMI is calculated using height and weight. A man who is six-foot tall who weighed more than 220 pounds would be considered obese using the formula.

Growing Faster

The number of severely obese people in the U.S. is growing faster than those with moderate obesity, according to Ted Adams from the University of Utah School of Medicine in Salt Lake City, who led the study on weight-loss surgery’s long-term health benefits.

Drug therapy and lifestyle changes have been largely ineffective, so the weight-loss surgery investigators examined the results of the procedure in 1,156 volunteers. The patients who underwent gastric bypass surgery lost an average of 28 percent of their body weight, while those who didn’t get surgery stayed the same or even gained a few pounds, the study found.

Almost two-thirds of the surgery patients saw their blood sugar return to normal levels, while hypertension, cholesterol and triglyceride all declined.

Researchers were surprised by the results of a separate study that weighed cost benefits from the surgery, said Martin Neovius from the Karolinska Institute in Sweden, the lead author. The study tracked 2,010 adults who underwent weight loss surgery between 1987 and 2001, and compared their results to similar people who didn’t get surgery.

54 Days

The researchers found that surgery patients spent 54 days in the hospital in the two decades after their operations, compared with 40 days for those in the comparison group. For the first six years, they were hospitalized an average of 1.7 days each year, compared with 1.1 days for their overweight peers who didn’t have surgery, and had more doctor visits for things other than routine care.

The operation did reduce the amount of money patients spent on drug costs after the first six years. Surgery patients spent $930 annually, compared with $1,123 for the comparison group, in years seven to 20, the study found. The biggest difference was in lower spending for diabetes and heart disease drugs.

“Based on our findings, bariatric surgery appears to result in greater health benefits than conventional obesity treatment, but at a higher cost over the time of the study,” the researchers concluded. “A formal cost-effectiveness analysis is needed to quantify” the exact costs associated with surgery, they said.

Underlying Conditions

Scientists are also trying to understand obesity’s underlying conditions and how people’s conditions may differ. For example, not all body fat is equally dangerous, according to another study reported in the journal. Obese adults with belly fat may have a higher risk of developing diabetes than those with fat in other places, the research showed.

Those with higher levels of abdominal visceral fat, which surrounds internal organs, had a higher risk of developing diabetes and pre-diabetes than those with excess belly fat underneath the skin, the study showed. The researchers used magnetic resonance imaging (MRIs), and x-rays to determine where the fat was stored in the body.

Those who gained weight during the study, who were resistant to insulin and had a family history of diabetes were also more likely to develop the disease, the authors said.

“It’s very interesting that two people with the same body weight, both obese, may have different distribution of fats and may be at very different risks for development of diabetes,” said James de Lemos, a professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas, in a Sept. 14 telephone interview. “There’s a lot of variability.”

De Lemos said they will next look at whether fat distribution raises risk of heart attacks and strokes. Future trials should also study whether specific weight loss programs might change the distribution of the body’s fat, he said.

Environmental Causes

Scientists are also searching for environmental causes behind the epidemic, which affects 17 percent of American children and adolescents, according to the Atlanta-based CDC.

In a study by researchers from New York University, children with high levels of bisphenol A, a chemical found in consumer products, were more than twice as likely to be obese than those with low levels. The findings suggest that the chemical, which is found in soda bottles and cans, may increase the risk of obesity in children.

The U.S. Food and Drug Administration in July ruled that baby bottles and other cups intended to be used by children can no longer contain BPA.

The ban was issued primarily because the use by companies of plastic containing the chemical had already been abandoned. BPA is used to harden plastic and make canned food watertight. For decades it was used in the manufacture of plastic food containers, baby bottles and sippy cups.

“This study raises further concern about the need for regulatory action,” said Leonardo Trasande, lead researcher on the BPA study and an associate professor of pediatrics and environmental medicine at New York University.

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