New Procedure Estimates for Bariatric Surgery:
What the Numbers Reveal

Published in May 2014 Issue             

Between 2011 and 2013, the number of bariatric surgeries performed in the United States grew by nearly 15 percent, according to new estimates from the American Society for Metabolic and Bariatric Surgery (ASMBS). The biggest jump occurred between 2011 and 2012, while the number of procedures grew only slightly between 2012 and 2013.

Jaime Ponce, MD

“The good news is cases are growing again. The bad news is, this still represents less than 1 percent of the eligible patient population for surgery,” said Jaime Ponce, MD, immediate past president of the ASMBS, who was part of the ASMBS task force that calculated the
new estimates.

Bariatric Surgery By the Numbers: A New Top Procedure Emerges in 2013

A look at the numbers reveal the rapid rise of sleeve gastrectomy, which became the most common method of bariatric surgery in America in 2013, outpacing gastric bands by three to one, and surpassing gastric bypass, the perennial number one.

Last year, sleeve gastrectomy accounted for 42.1 percent of the 179,000 procedures, followed by gastric bypass (34.2%), gastric band (14%) and Biliopancreatic Diversion with Duodenal Switch (1%). Revisions were about 6 percent
of operations.

In 2011, gastric bypass and gastric band each accounted for more than one-third of procedures, while sleeve gastrectomy was less than 20 percent. Since then, gastric bypass numbers have been relatively steady, sleeve gastrectomy has surged and gastric band procedures, in relation to other procedures, have dropped precipitously. “I think there was some pent up demand for sleeve gastrectomy as surgeons and potential patients waited for the data and better coverage,” said Dr. Ponce. “That happened in 2012 and we saw a near doubling of the number of gastric sleeves.”

That same year, based on studies showing consistent weight loss and improvement of obesity-related conditions, the ASMBS updated its 2009 position statement on sleeve gastrectomy. The updated statement said “substantial comparative and long-term data have now been published in peer-reviewed studies demonstrating durable weight loss, improved medical co-morbidities, long-term patient satisfaction, and improved quality of life after SG (sleeve gastrectomy). The ASMBS therefore recognizes SG as an acceptable option as a primary bariatric procedure and as a first-stage procedure in high-risk patients as a part of a planned staged approach.”

National insurance coverage of the procedure, where bariatric surgery was covered,
soon followed.

How the Estimates were Derived

The new bariatric procedure numbers were based on an analysis of BOLD, ASC/MBSAQIP and National Inpatient Sample databases, and an estimation of outpatient procedures. Estimates prior to 2011 were based on surveys of surgeons and industry sources.

“We believe these clinical databases enable us to provide a more reliable estimate,” said Dr. Ponce. “We could see very clearly the number of procedures being performed at accredited centers because that is a requirement of accreditation. We were then able to use a formula to account for non-accredited centers and outpatient surgeries, which gave us our
final estimates.”

Beyond the Numbers

Between 2011 and 2013, more than a half million people in the U.S. had some form of bariatric surgery. This seems like a lot of people, but taken year by year, the number of patients having procedures represents only about 1 percent of the estimated 18 million-plus adults who could qualify for the surgery.

Ninh Nguyen, MD

“The penetration of bariatric surgery is still a drop in the bucket compared to the number of people who could benefit,” said Ninh T. Nguyen, MD, president of the ASMBS. “It’s really quite astonishing that the most effective treatment for severe obesity and related conditions is the least utilized. We’re making progress, but as a nation and a community we have a lot more work to do to tear down the barriers
to treatment.”

Bariatric surgeons and obesity health professionals point to a combination of factors that have served to limit the number of people who have surgery. Lack of adequate insurance coverage, the economic downturn and a bias toward treating the consequences of obesity over the source, top the list.

Nearly two-thirds of employer-sponsored health plans do not cover bariatric surgery. More than half of the State Health Exchanges under the Affordable Care Act currently exclude bariatric surgery as a covered benefit. Of the insurers that do offer coverage, many have a long list of requirements that delay or deter patients or require patients to pay up to 50 percent of the cost.

John Morton, MD

"Obesity is one of the biggest preventable and treatable public health threats we face, yet we are only treating the tip of the iceberg, but the tide is turning,” said John Morton, MD, president-elect of the ASMBS. “Groundbreaking studies and major medical groups support metabolic and bariatric surgery, major guidelines urge doctors to refer patients for surgery and there is greater acceptance of obesity as a disease. There is more of a climate to seriously address obesity with proven treatments like surgery, and less of a climate for policies and medical decisions based on discrimination, bias and anecdotal information or experience. This is good for metabolic and bariatric surgery and it’s good for patients.”