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Bariatric Surgery and the Obesity Battle

Tinker Ready, April 11, 2014
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This article appears in the April 2014 issue of HealthLeaders magazine.

Mounting concern over obesity in America has put the spotlight on bariatric surgery. Interest in this approach to weight-loss spiked between 2000 and 2004. The number of inpatient surgeries then began to decline from a high of 130,158 in 2004, according to the Agency for Health Quality Research.

Still, many hospitals and health systems find it important to offer the service for patients who cannot lose weight through diet and lifestyle changes.

Bariatric programs can be high volume or low volume, with annual surgeries ranging from a handful to more than 800. Community hospitals offer the service, as do academic medical centers. Some service lines try nonsurgical approaches first, putting patients on medical weight management programs. Others begin educating patients about surgery from the start.

Many bariatric programs share one key element—they are built around multidisciplinary teams that include surgeons, nurses, nutritionists, endocrinologists, psychologists, and other specialists. These teams are at the core of the thorough presurgery prep and follow-up treatment considered vital to the success of bariatric surgery.

Some hospitals see the potential for growth. Weight-loss surgery is becoming more accepted, and indications for the procedure are shifting. And there is a large unmet need for care, according to the American Society for Metabolic and Bariatric Surgery. The group says that though 15 million people are classified as morbidly obese, only 1% of the clinically eligible population is treated through bariatric surgery.

For now, programs are dealing with declining demand, changes in certification rules, and complex, spotty insurance coverage. But last year, the American Medical Association declared obesity a disease. And data is accumulating on the health benefits of bariatric surgery as a treatment for diabetes and heart disease. So bariatric surgery programs are likely to continue to mature and evolve.

Bariatric surgery reduces a patient's risk of cancer, cardiac disease, and diabetes, says Daniel B. Jones, MD, chief of minimally invasive and bariatric surgery at Beth Israel Deaconess Medical Center in Boston.

"We get real results for most people," says Jones. "We're getting them off insulin when they are diabetic, getting them off breathing machines when they have sleep apnea. We get them walking or skiing. The list goes on and on. We can make an impact by getting 100 pounds off somebody."

Still, like other centers, BIDMC saw a drop in volume after 2008, when the hospital performed 288 procedures. By 2010, the number was down to 267 and the hospital made some changes. The program made it easier to schedule appointments and improved both its application process and education programs. The 649-bed teaching hospital started its program 15 years ago.

Across the river in Cambridge, Mass., Mount Auburn Hospital's program is only three years old. Mount Auburn contracts for two surgeons from the TuftsUniversity Medical School–affiliated New England Medical Center. They offer the surgery as part of a two-track weight-management program. The procedures take place at the 220-bed hospital. Patients can get follow-up care either in Cambridge or at a satellite center in suburban Waltham, Mass.

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