Precept Employee Benefits Blog

There is no question that obesity is a major health problem in the US, and that it can create severe complications, from diabetes to strokes and heart disease.  Many people try to diet and fail, and pharmaceutical approaches have been hazardous – remember the phenylpropanolamine (PPA) diet suppressants pulled from the market because they caused strokes and the fen-phen diet drugs that caused heart disease?

Given these alternatives, surgery has become increasingly popular as an alternative, and it is being promoted on billboards, in television ads and on the web. What’s the problem? The surgery often fails, it has bad complications, and it is expensive. It can kill you. And it is growing in popularity, with more than 120,000 performed in 2004. 

Take the procedure: disconnect 95% of the stomach and an important piece of your small intestine and hook up the remaining stomach “pouch” to the intestine.

If that sounds drastic, it is. Mortality rates vary, probably averaging about 2%, but may be almost 5% for older patients. The mortality rate may be even higher if the surgeon is new to the procedure – and surgeons looking to boost their income have been taking weekend courses. If the patient survives, there’s an even greater chance that there will be leakage. Visualize stomach and intestinal contents leaking into the abdomen of a high-risk, post-operative patient, and you can imagine the complications, infections and dangerous, prolonged hospital course that follows.

Yes, there are dramatic testimonials from those who have survived the procedure and avoided complications, those that have lost hundreds of pounds and reversed their diabetes and high blood pressure. The failed surgeries, those whose initial weight loss was regained, don’t get the same publicity, and this number may be as high as 40% of those who have the surgery. Add long-term problems with hernias, ulcers, gallstones, malnutrition, and “dumping syndrome,” and it seems fair to ask whether the surgery should be performed at all.

For these reasons, many employers simply do not cover obesity surgery in their medical plans. Those employers that choose to cover it may require:

• Clear documentation of failure of other approaches to weight loss
• The use of centers of excellence that have lower mortality and complication rates
•  A higher employee copayment than for other surgical procedures

With a price tag that may run as high as $25,000, gastric bypass surgery should not be for everyone.