The recent decision by the Travis County commissioners to deny county employees access to weight-loss surgery benefits is going to cost county residents millions of dollars.
Obesity is a major health problem in the United States, and no one is immune from its effects. More than two-thirds of U.S. adults are overweight and 30 percent are obese. Obesity is demonstrated to cause a host of other medical problems, such as diabetes, heart disease, cancer and early death from vital organ failure. Rates of severe obesity in the year 2000 were about double the rates for 1990, and the growth trend continues to accelerate.
The direct medical cost of morbid obesity is $75 billion per year, which does not include the lost productivity and missed work that leads to inefficient business. Employers nationwide, like Travis County, are already paying to treat the symptoms of obesity in the form of diabetes, hypertension, joint problems and myriad other health problems caused or exacerbated by obesity. For example, medical care for diabetes costs about $10,000 per patient each year, and surgical replacement of a knee joint costs about $15,000. The Centers for Disease Control has estimated the cost of obesity to a firm with 1,000 employees at $285,000 per year. Travis County has 5,000 employees.
The CDC has attributed 400,000 deaths per year to obesity. This is second to tobacco, which is responsible for 435,000 deaths per year. The CDC expects obesity to overtake tobacco with a predicted 500,000 deaths next year.
The National Institutes of Health has thoroughly reviewed the role of weight-loss surgery in the treatment of obesity. The U.S. government and the Center for Medicare Services have reviewed the NIH recommendations along with the costs of obesity to society and have determined that it is cost effective to pay for weight-loss surgery. The government has also acknowledged that a preoperative waiting period only increases costs to the taxpayers and risks to the patient by delaying appropriate care.
Obesity is a medical illness. It is not a lifestyle choice and those who argue that people who are obese need to "stop eating" do not understand the biological basis of obesity. It tends to run in families and is associated with other disease processes such as diabetes, high blood pressure, sleep apnea and acid reflux. Patients who suffer from obesity and its related co-morbidities rarely find long-term success with medical management alone. In fact, less than 1 percent of patients who are morbidly obese are able to lose to a healthy weight and keep that weight off long-term. In contrast, more than 85 percent of surgical patients are able to accomplish this goal.
Another common myth is that patients regain all their weight after surgery. This is not true. Surgery is a powerful tool that enables patients to re-learn good eating habits. Patients who have sustained long-term follow-up in a comprehensive bariatric program have been shown to sustain healthy weights up to 20 years after surgery.
Unfortunately, there is a lot of prejudice against obesity, as evidenced by the hundreds of comments posted online recently regarding the Travis County commissioners’ proposal to explore weight-loss surgery for a test group of employees. It is vital that we as a society recognize obesity as a medical illness, but it is also a societal problem. There are no warning labels on unhealthy foods. Schools are decreasing the required time for physical education. Fast food is available at every corner. Our children are primarily entertaining themselves with video games or computer activities instead of outdoor exercise. This is our culture now, and we have to address this problem on all fronts.
When dealing with a disease process, the first step is always prevention. We as a society need to acknowledge the problem and implement measures to prevent the disease. We also need to provide the best treatment available to those already suffering. Denying obese patients access to these life-saving procedures is akin to denying treatment to patients with lung cancer because they smoked. Weight-loss surgery works when performed by an experienced surgeon with an appropriate aftercare program to help the patient learn healthy eating and exercise habits, including support groups to ensure long-term success. It is the only proven, long-term treatment for obesity and its related co-morbidities.
Seger is treasurer of the Texas Association of Bariatric Surgeons and a partner at New Dimensions Weight Loss Surgery in San Antonio.
