Dry Land Fish

Perspectives from the misplaced.

When Cutting the Fat May Not Mean Cutting the Fat

A recent study suggests bariatric procedures don't save money.

I was flipping through the channels and stopped when I heard the stars of daytime televisions, The Doctors, talking about how shocked they were at a recent study that suggests that bariatric surgeries do not, in fact, save money in the long term. Of course they were surprised. They, like so many other people, had been assuming that bariatric surgeries were the “cure” that would save both lives and money. The six-year follow-up study of patients receiving bariatric surgeries that was recently published in JAMA Surgery does not, however, paint such a simple picture.

With more and more insurance companies covering the costs of bariatric procedures—at least in part because they’re thought to be cost effective—the authors of the study set out to ascertain whether or not these procedures did, in fact, deliver a savings. They discovered that—regardless of the type of procedure—patients who underwent a bariatric surgery had fewer prescription and office visit costs during the six-year follow-up than obese patients who didn’t undergo a bariatric procedure. However, the bariatric surgery group had more claims for inpatient procedures. Overall, the costs of the two groups were strikingly similar, meaning no real cost savings came out of bariatric surgeries.

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In the end, the study’s authors conclude that “future studies should focus on the potential benefit of health and well-being of persons undergoing the procedure rather than on cost savings.” Given that the average cost of a bariatric surgery in the U.S. was about $28,000 in 2005 when their study began, and given that in 2009, the authors estimate that there were roughly 220,000 bariatric procedures performed, that’s about $6 billion (yes, B, billion) spent on procedures that didn’t ultimately save money.

Not only does this particular study suggest that there’s a reason to be skeptical of the economic benefits of such procedures, but there are narratives that suggest that we ought to also look askance at the ethics of these procedures in terms of outcomes and how the surgery will and won’t change people's lives. Jen Larsen’s memoir, Stranger Here: How Weight-loss Surgery Transformed My Body and Messed with My Head, is one in a series of accounts by adults who underwent bariatric procedures only to find that they didn’t have a perfect life on the other side. Dani Hart’s I Want to Live: Gastric Bypass Reversal came out in 2002 and chronicled the horrors of her unexpected life after surgery. The web is filled with these kinds of accounts, accounts by adults who are miserable after their surgeries, forced to be obsessed with food and calorie counting in order not to develop serious malnutrition, and who often say they had no idea what life after their procedures would really involve. Yet, these accounts get almost no serious attention.

When these accounts do come to light, they’re often pointed out as the exceptions rather than the rule. The same thing happened yesterday on The Doctors, as Dr. Andrew Ordon rushed to say that he had many patients who had undergone bariatric procedures and were really happy with their results. In light of the recent study from JAMA Surgery, if people insist on continuing to have conversations about the costs of obesity, it seems to me that they need to also figure in the human costs of these kinds of procedures and think through why they’re really being performed. Because the economic argument doesn’t hold up.

 

Dr. April M. Herndon has a Ph.D. in American Studies and is an Associate Professor of English at Winona State University.

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