Obesity surgery helps, but it’s not a cure-all

“Today” show weatherman Al Roker and singer Carnie Wilson are likely to have a lot more company in the once-exclusive ranks of those who undergo weight-loss surgery to treat obesity. But such surgery is not a cure for obesity.

“It’s a tool designed to help you help yourself, not a free ride,” says surgeon Harvey Sugerman, past president of the American Society of Bariatric Surgery and professor emeritus at Virginia Commonwealth University.

A recent Medicare decision expands coverage for gastric bypass and other weight-loss surgery to people with a body mass index of 35 or greater -- about 60 pounds or more overweight -- who also have at least one weight-related medical problem, such as diabetes, sleep apnea or heart disease.

In 2005, about 170,000 people had weight-loss surgery, according to the American Society of Bariatric Surgery. Medicare paid for 6,000 of those procedures. Ninety percent of them were performed on people 65 years and younger and disabled by their weight and other medical problems, according to the federal Centers for Medicare and Medicaid Services.

Because private insurers generally follow Medicare’s lead, the expanded coverage is expected to increase weight-loss surgery significantly throughout the country.

Some people worry that the expanded coverage sends the wrong message. “Insurance companies won’t cover the medical care of obesity treatment, but they’re willing to pay for surgical intervention,” says Dr. Arthur Frank, director of George Washington University Weight Management Program. “That’s outrageous. It drives people into surgery ... and may create the wrong incentives.”

Here are some of the caveats to keep in mind about gastric bypass and other weight-loss surgery, which has a mortality risk of about 0.5% to 2%, or about the same risk as a hip or knee replacement.

* Surgery gives a jump-start. The procedures promote weight loss in two ways: either by diverting food from the stomach to a lower part of the digestive tract where nutrients can’t be absorbed, or by reducing stomach size so that less food can be consumed. Overeating after surgery can result in vomiting or “dumping,” a condition that lasts about 30 minutes and is characterized by lightheadedness, nausea, flushing and sometimes diarrhea.

“But you can always beat the system by drinking milkshakes or eating ice cream,” says Frank, who notes that the same healthy habits prescribed for weight loss -- eating less and moving more -- are still required after surgery.

That may be particularly challenging since people who become morbidly obese usually have difficulty controlling what they eat and they often don’t exercise. “Lots of people go into this with unrealistic expectations that the surgery will take care of it all and this will be it,” says Ronna Saunders, director of the Center for Behavioral Change in Richmond, Va., who counsels people after surgery.

* Plan on taking vitamin and mineral supplements for life. The digestive tract is altered so that enough key vitamins and minerals can’t be absorbed from food alone. After surgery, “all menstruating women need iron supplements,” Sugerman says. “All patients need vitamin B-12 daily by mouth or monthly by injection.” Also required: a daily multivitamin and at least 500 milligrams of calcium a day.

* Expect to lose -- and regain. During the first two years after surgery, an average of 60% of excess pounds is lost, which often improves health by reversing Type II diabetes, reducing blood pressure and lessening joint pain. But those who undergo weight-loss surgery almost never achieve an ideal body weight and still remain slightly obese or at least overweight.

The weight also invariably creeps back, as weatherman Roker has found. He shed more than 100 pounds after surgery, but in January began a diet on the show to lose 20 of the pounds he’s regained. “Typically you’ll get three to five years of benefit in terms of weight loss,” George Washington’s Frank says. “But the weight almost invariably adds back.”

* Prepare to pay. Weight-loss surgery averages $20,000 plus long-term medical follow-up. Private insurers take a cue from the Centers for Medicare and Medicaid Services, which pays just $10,000 for hospital costs plus $1,000 to $1,700 for the surgeon. (The patient picks up 20% of the doctor’s fee.) Follow-up medical, psychological, diet and exercise treatments are extra and can run thousands of dollars.

* Find additional help. Large weight loss “requires physical and emotional adjustment,” says clinical psychologist Melissa Kalarchian, who studies people after weight-loss surgery at the Western Psychiatric Institute and Clinic in Pittsburgh.