Written by: Tracy B. McManamon, 2017
Affordable Weight Loss Surgery – Are you eligible?
Obesity still remains America’s biggest health challenge and from the look of things, it will continue being a burden unless an effective intervention is instituted. Why so?
Currently, there are about 78 million Americans who are obese, a number that has significantly increased since a decade ago.
Moreover, at the moment the most appropriate intervention for persisting obesity is weight loss surgery. Persisting obesity in this context means that the condition has been refractory to any diet changes, lifestyle modification and other healthy and safe weight loss programs. In this case, surgery is considered if the patient meets a certain criteria. Keeping this in mind, there seems to be a lot of hope from people suffering from obesity because weight loss surgery is associated with effective positive results. However, that is not the case because only a few eligible patients are able to get weight loss surgery.
According to the American Society for Metabolic and Bariatric Surgery, in 2013 a meager 160,000 obese patients in the U.S. went through weight loss surgery. This represents around 1% of the approximately 18 million adults that are eligible for the surgery.
Contrastingly, as the figures on obesity escalate, the number of weight loss surgeries being done every year remains at a plateau. The biggest reason behind this stalemate is that many overweight Americans cannot afford to undergo weight loss surgery because many health insurance plans do not cover this. Lack of insurance coverage is considered the biggest hurdle although other factors like economic deterioration and the stigma associated with seeking surgery to treat obesity are contributory factors.
What exactly does it mean when health insurance companies take such a position when it comes to covering weight loss surgeries? In simple terms, about two thirds of patients fail to get coverage from their health insurance and must pay from their own pocket for this surgery. On average, one surgery costs between $15,000 and $25,000. In some cases the insurance company may cover the surgery but only after the patient meets certain stringent requirements. These can be intense ranging from special diets to psychological evaluations. This trend is also seen outside the private sector where only 24 states have made it compulsory for health insurers to cover weight loss surgery for their patients. Unfortunately even with this coverage, patients are still required to pay up to half of the total cost out of their own pockets.
Insurers justify their actions by saying that weight loss surgery is considered as a last resort since it is invasive, life-altering and ‘risky’.
According to the trade group; America’s Health Insurance Plans, health insurance companies are obediently following federal guidelines that recommend surgery only for patients who have been selectively picked out. Using this stance, health insurance companies undertake patients in need of coverage through a selection process. Their aim is to rule out causes like mental and eating disorders that could be contributing to poor weight management. Patients have to go through a period of dieting supervised by their doctor for six months to one year. In addition, patients must take inventory of their eating habits in a journal and also have regular check-ups with their doctor. Most patients fail to maintain all these demanding requirements and opt to pull out. Insurers thus use this program to reduce the number of patients they have to provide coverage for.
Important to note though is that with advancements made in the field of medicine, weight loss surgery has been deemed safe unlike ten years ago when the practice was new to the industry.
This earlier belief changed with time and by November 2013 a strong recommendation was sent out encouraging doctors to recommend surgery to patients suffering from serious health issues due to obesity. The guideline was put forward by the American Heart Association, the Obesity Society and the American College of Cardiology. It recommends that doctors should determine their patient’s body mass index (BMI) every year in order to aggressively manage obesity.
Weight loss surgery is therefore recommended for patients whose BMI is 40 or if it is 35 and the patient has other concurrent chronic illnesses like diabetes and hypertension. Also known as bariatric surgery, weight loss surgery is available in different forms. Gastric bypass is a type of weight loss surgery that involves bypassing part of the stomach and joining it to the small bowels. It aids in weight loss by ensuring the patient’s stomach holds little food and that lesser calories are absorbed from the small intestines. Gastric band surgery is another different type that involves placement of a ring on the upper part of the stomach to decrease its size.
Most recent studies have proven the efficacy of weight loss surgery.
From these studies, after three years gastric bypass surgery leads to loss of about 30% of extra weight while gastric band surgery leads to loss of 17% of this weight. Such weight loss is significant compared to only 2%-8% that is lost after lifestyle change and diet modification.
Despite such efficacious results of weight loss surgery, doctors supporting weight loss surgery argue that it is not the most economical long term solution for obesity in America. They propose that the best approach is preventative medicine. This entails educating adolescents and children from a young age about a healthy lifestyle; appropriate diet and regular exercise.
The latest trend for affordable weight loss surgery is now in the Caribbean, with US Board Certified Physicians. Give me a call at 877-549-1212, to see if this option is right for you.