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Surgical treatment was usually recommended only for people with a BMI over 40 or a BMI between 35 and 40 with comorbidities. [77] In 2010, 370,000 were performed in the United States. [78] The costs of the procedure for the health plan ranged from $15,000 to $26,000, of which the surgeon’s fee was $2,500 - $6,000. With costs in a well-run program running at $7,000 to $10,000, this could be a profitable operation for a hospital. [79]
Surgical complications could be as high as 10% or more, but the death rate was relatively low. A 2011 study found that length of hospitalization was shortened and mortality rates decreased at hospitals that perform at least 100 bariatric surgeries each year. [80] A 2009 article reported that over 10 years, those that underwent surgery sustained a mean weight reduction of 43 pounds, compared to those in the control group who experienced a mean weight gain of 3 pounds. Both men and women had lowered incidents of first-time cancers post-surgery. [81] In addition, bariatric surgery resolved incidence of type-2 diabetes in 92% of patients and dramatically improved or resolved rates of dyslipidemias in 70-95% of patients, and hypertension in 87-95% of patients, respectively, resulting in a 40% decreased relative risk of death from obesity-related causes compared to control patients. [82] Other dietary programs could not match that success rate. But, deaths not caused by disease, such as accidents and suicide, increased by 58 percent in the group that had undergone gastric bypass surgery. [83]
Several hundred hospitals established surgical obesity treatment programs with an average waiting time of eight months. [84] The Massachusetts General Hospital weight loss clinic, for example, accepted 1,000 new patients per year but within the MGH system there were approximately 50,000 obese patients. [85] One bariatric surgeon’s appointment schedule was backed up for two and a half years. [86]
Forest Health Service A privately held company operated nine bariatric treatment centers, in Michigan, Ohio, and Pennsylvania. The freestanding facility in Pennsylvania had four operating rooms and 53 beds. [87] By 2009 it had performed 35,000 surgeries. [88]
A physician noted that primary care physicians lacked the knowledge or skills for the treatment of these patients prior to and after surgery. [89] A bariatric surgeon observed that “No other specialty takes the kind of effort and time as this specialty. You are married to the patient for life.” [90]
Some were offering carrots or sticks to alter unhealthy behavior. An example of a stick was a North Carolina State program which offered only 70% percentile insurance coverage to those with a BMI of over 40, dropping to 35 in the future. An Alabama state employee program used a carrot approach with reductions in their insurance payments of up to $55 of their $70 monthly fee for healthy behaviors. [91]
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