Published in April Issue             

In just the last few weeks, the benefits of bariatric surgery were featured in stories by some of the top news outlets in the country, while an experimental procedure called bariatric arteriale embolization (BAE) was touted as a potential alternative to gastric bypass.

Millions of readers and viewers learned bariatric surgery could reduce pain and lead to better mobility, what to ask if they’re considering a procedure, eight things they need to know about having weight-loss surgery, and early findings from a study about BAE that was presented at the Society of Interventional Radiology’s annual meeting.

The AP, one of the world’s largest news organizations, described in its “The Big Story,” that while “finances and fear” may keep many patients with severe obesity from having bariatric surgery, weight-loss surgery is steadily becoming more popular. The reason: surgical techniques and insurance coverage have improved as the number of people with obesity has risen dramatically over the years. Another reason is mounting research that shows the benefits of bariatric surgery go far beyond appearance. The story said, “bariatric surgery reverses or improves dozens of disorders, including expensive, life-threatening ones such as Type 2 diabetes.” But the benefits do not stop there. Other research shows “eliminating those conditions reduces patient care costs by 30 percent within five years, and insurers recover their costs within two to four years by averting hospitalizations and other medical expenses.”

The story featured comments from American Society for Metabolic and Bariatric Surgery (ASMBS) president Raul J. Rosenthal, MD and one of his sleeve gastrectomy patients, who went from 289 pounds to 157 pounds over the course of 15 months. She says since the procedure, her confidence has improved, “she’ll now wear a bathing suit and has gotten engaged.” Perhaps even more importantly, her blood sugar is normal again and she is off diabetes medications.

The story goes on to explain the differences between the various bariatric procedures with Dr. Rosenthal providing an overall commentary. “This is safe surgery,”
Dr. Rosenthal concluded.

John M. Morton, MD, immediate past president of ASMBS commented on the insurance aspects of bariatric surgery. He says Medicare has covered bariatric surgery for two decades and Aetna, Cigna, UnitedHealthcare and Blue Cross now cover it, but many smaller insurers do not.

He points out that big employers offer it but few small ones do. Further, only 23 states have health care exchanges that cover bariatric surgery, and Medicaid pays so little that few surgeons accept that coverage.

Researchers published their findings on bariatric surgery and its impact on pain and mobility in JAMA. They reported that many patients with severe obesity had less pain and greater mobility in the first few years after weight-loss surgery.

Wendy King, MD

Lead study author Wendy King, a public health researcher at University of Pittsburgh and researchers followed more than 2,200 bariatric surgery patients, and after one year 58 percent reported less pain and 77 percent said they had better physical function. After three years, the proportion of patients still reporting improvements in pain and physical function dropped to 49 percent and 70 percent, respectively.

However, patients did report consistent improvements in walking ability at one and three years, and those who had knee and hip problems before surgery reported lasting pain reductions and increased mobility around these joints. Preliminary findings of this study were presented at ObesityWeek 2015.

In the Reuters story, Dr. King said the amount of weight lost after surgery, rather than the type of surgery, was “consistently related to improvements in pain and function.”

The study focused on patients who had gastric bypass or gastric banding. Researchers reported that overall, reductions in weight and symptoms of depression were associated with more improvements in pain and mobility.

Dr. Morton commented, “Clearly patients who have obesity and joint disease are patients with chronic disease. These patients likely need to have follow up and access to care for needed services like physical therapy. Dr. Morton was not involved in the study.

Prevention magazine, in its “8 Things You Need to About…” series featured bariatric surgery. They report “good news: For lots of Americans weight loss (bariatric) surgery is a safe and effective way to drop weight, send diabetes packing, and otherwise dodge the dangers of severe obesity.”

Raul Rosenthal, MD

ASMBS’ Dr. Rosenthal said, “Obesity is an epidemic in the United States and considering obesity's close ties to diabetes, heart disease, and cancer, the numbers are even more frightening.”

The “8 Things” cited by Prevention include discussion about: shrinking the stomach, patient selection, different methods to consider, deciding which procedure to have, insurance coverage varies, people generally return to their normal lives and recover within a week, the procedures are low risk, and that surgery is not a magic bullet, but requires work after surgery to succeed.

NBC News reported on the preliminary findings of a 7-patient study on BAE that was presented at Society of Interventional Radiology annual meeting. The story featured one of the patients, who within the first three months of the procedure lost 30 pounds. She said she had what is considered an experimental procedure because she was “apprehensive about undergoing a surgical procedure and recovery.”

They described BAE as an alternative to gastric bypass. In the procedure, interventional radiologists thread a catheter through the wrist or groin to gain access to specific blood vessels in the stomach. “Once they zero in on their target, they inject microscopic beads to block the blood supply to this spot where the body's ‘hunger hormone’ ghrelin is produced.” The decrease in blood flow leads to a reported 80 percent decrease in hunger. It is noted that the same kind of beads have been safely used in heart and uterine procedures for decades.

Clifford Weiss, director of interventional radiology research and Bioengineering Innovation and Design at the Johns Hopkins School of Medicine who presented the findings said the procedure has been “specially designed to be an outpatient procedure that will take less than an hour with very little recovery time need, plus a very high safety profile.”