Weight loss surgery does not lower health costs over the
long run for people who are obese, according to a new study.
Some researchers had suggested that the initial costs of
surgery may pay off down the road, when people who've dropped the extra weight
need fewer medications and less care in general.
The new report joins
other recent studies challenging that "No way does this study say you
shouldn't do bariatric surgery," said Jonathan Weiner from the Johns
Hopkins Bloomberg School of Public Health in Baltimore, who led the new
But, he added,
"We need to view this as the serious, expensive surgery that it is, that
for some people can almost save their lives, but for others is a more complex
How the study was
According to the American Society for Metabolic and
Bariatric Surgery, about 200 000 people have weight loss surgery every year.
Surgery is typically recommended for people with a body mass index (BMI) - a
measure of weight in relation to height - of at least 40, or at least 35 if
they also have co-occurring health problems such as diabetes or severe sleep
eight-inch person weighing 119.2kg has a BMI of 40, for example. For their
study, Weiner and his colleagues tracked health insurance claims for almost 30 000
people who underwent weight loss surgery between 2002 and 2008.
They compared those with claims from an equal number of
obese people who had a similar set of health problems but didn't get surgery. As
expected, the surgery group had a higher up-front cost of care, with the
average procedure running about $29,500 (R 262 356).
In each of the six years after that, health care costs were
either the same among people who had or hadn't had surgery or slightly higher
in the bariatric surgery group, according to findings published in JAMA Surgery.
Costs involved in the
Average annual claims ranged between $8,700 (R 77 636) and
$9,900 (R 88 344) per patient. Weiner's team did see a drop in medication costs
for surgery patients in the years following their procedures. But those people
also received more inpatient care during that span - cancelling out any
financial benefits tied to weight loss surgery.
One limitation of the study was that only a small proportion
of the patients - less than seven percent - were tracked for a full six years.
Others had their procedures more recently.
The study was partially funded by surgical product
manufacturers and pharmaceutical companies, including Johnson & Johnson and
Pfizer. Claims data came from BlueCross BlueShield.
It's clear that surgery can help people lose weight and
sometimes even cures diabetes, Weiner told Reuters Health.
But it might not be
worthwhile, or cost-effective, for everyone who is obese. That means policymakers
and companies will have to decide who should get insurance coverage for the
procedure and who shouldn't.
that bariatric surgery is not reducing overall health care costs, in at least a
three- to six-year time frame," said Matthew Maciejewski, who has studied
that topic at the Center for Health Services Research in Primary Care at the
Durham VA Medical Center in North Carolina, but wasn't involved in the new
"What is unknown is whether there's some subgroup of
patients who seem to have cost reductions," he told Reuters Health. In the
meantime, whether or not to have weight loss surgery is still a personal
decision for people who are very obese, Weiner said."Every patient needs
to talk it through with their doctor," he said. "It obviously
shouldn't be taken lightly, but shouldn't be avoided either."