Published February 12, 2017             

The following is a summary/brief analysis of the obesity and surgery stories making news this week:

Intragastric Balloon Gets ASMBS ‘Stamp-of-Approval’…Following Bariatric Surgery, Indiana Man Needs Excess Skin Removal but Insurance Won’t Pay…Metabolic Surgery Thwarts Type 2 Diabetes Complications…CNN: Weight Loss Surgery Works…Chile’s “War” on Obesity…Obesity Increases Health Care Costs but Varies by State… Parents Communicate Differently to Children with Obesity

Metabolic and Bariatric Surgery in the News…

ASMBS Announces Addition of Intragastric Balloon to Approved Procedures and Devices (MedPage Today, News-Medical, Bariatric News)

On Monday, February 5th, the American Society for Metabolic and Bariatric Surgery (ASMBS) announced it had added the intragastric balloon to its list of approved procedures and devices following an extensive analysis of safety and effectiveness data, and public comment from ASMBS members. Intragastric balloons were first approved by the FDA in 2015 for the treatment of obesity in patients with BMIs between 30 and 40. Since its approval, the ASMBS estimates that only 5,000 intragastric balloons have been implanted, representing less than 3 percent of the 216,000 bariatric procedures performed in the U.S. in 2016. “Intragastric balloon procedures may fill a treatment gap between medication and weight loss surgery and should be considered a standard intervention in the continuum of care for patients with obesity,” said Samer Mattar, MD, ASMBS President. “However, insurance coverage for this procedure is currently non-existent. It is our hope that our approval and the body of evidence that supports the appropriate use of the device will change that and more people will have access to a new treatment option for obesity.”

Surgery Helped Him Lose Almost 500 Pounds. Now Insurance Won't Help Remove Excess Skin. (The Indianaoplis Star)

Story profiles Stanley Hollar, who at his peak weight weighed 700 pounds but was able to lose nearly 500 pounds in the two years following bariatric surgery. Hollar now carries around pounds of excess skin as a result of his successful weight loss, and is trying to raise funds to cover the costs of skin removal surgery since Medicare, along with most insurance carriers, decline coverage for post-bariatric skin removal surgery, deeming it cosmetic. Most patients over the age of 30 who have bariatric surgery can expect some loose skin which can cause health problems such as rashes, according to Samer Mattar, MD, director of Swedish Weight Loss Services in Seattle and president of the ASMBS. As a bariatric surgeon, Dr. Mattar sees little difference between skin removal surgery and breast reconstruction for women who undergo mastectomies. "Why would you exclude them from having this very beneficial coverage? It's a form of discrimination and bias against poor people who have suffered all their life. They are finally making very courageous, momentous decisions and this is part of the continuum of care," said Dr. Mattar, who explained he works to get his patients coverage by documenting the health toll and various complications excess skin takes and even sending pictures of a patient to their insurer. He also refers patients to a dermatologist, suggesting that instead of treating the skin irritation with an over-the-counter cream, patients incur the cost of a doctor's visit and a prescription medicine to provide more proof that the problem is not a solely a cosmetic one. In some cases, insurers do cover treating an underlying medical condition that arises from excess skin, said Cathryn Donaldson, communications director for America's Health Insurance Plans, a trade association for health insurers. However, many patients cannot even afford bariatric surgery even if their insurer technically covers it, according to Dr. Scott Kahan, spokesperson for the Obesity Society, as high co-pays and deductibles can put the potentially life-saving operation out of reach. The only way to change insurance coverage lies through legislation, added Mattar. Without that, he said, insurers will have no incentive to amend their policies.

Metabolic Surgery Prevents T2D Microvascular Complications (MedPage Today)

Metabolic surgery was superior to usual medical treatment for the prevention of microvascular complications in type 2 diabetes, according to a study published in the British Journal of Surgery. The meta-analysis of more than 17,500 patients found the incidence of microvascular complications in patients who have obesity and diabetes was significantly lower with metabolic surgery. "Current standard treatment for T2DM involves lifestyle modifications and medical treatment, although these have no influence on cardiovascular complications despite improved glycemic control and weight loss," the researchers from the University of Heidelberg in Germany wrote. "Strong evidence indicates that bariatric surgery is superior to medical treatment regarding weight loss, glycemic control and
remission of diabetes."

Weight Loss Interventions that Work: Surgery (CNN)

CNN reports there are three proven levels of intervention for weight loss: lifestyle changes, medications, and bariatric surgery. Bariatric surgery is an option, according to the story, for people with severe obesity who have not been able to lose an adequate amount of weight with lifestyle changes or weight loss drugs, or have serious health issues related to obesity. “You consider surgery when other therapies for obesity fail," said Sue Cummings, a registered dietitian. People who have bariatric surgery lose 15 to 35 percent of their starting weight, and improve many health conditions related to obesity, including type 2 diabetes and hypertension. It’s noted that with gastric bypass, improvement in diabetes occurs within days of surgery and is independent of weight loss, due to hormonal changes that enhance insulin's response to nutrients. A full risk-benefit analysis should be performed for every patients and if the benefits outweigh the risks “surgery is the most effective therapy," Cummings said, "data show an increased life expectancy due to the remission and/or resolution of over 190 medical conditions associated with obesity, such as type 2 diabetes, heart disease, sleep apnea, high blood pressure, kidney failure and more."

Obesity in the News…

In Sweeping War on Obesity, Chile Slays Tony the Tiger (The New York Times)

With three-quarters of its adult citizens and over half of 6-year-old children having overweight or obesity, the Chilean government is “waging war” on unhealthy foods with a mass of marketing restrictions, mandatory packaging redesigns and labeling rules aimed at transforming the eating habits of 18 million people. Nutrition experts say the measures are the world’s most ambitious attempt to remake a country’s food culture, and could be a model for how to turn the tide on a global obesity epidemic that researchers say contributes to four million premature deaths a year. Since the law was enacted two years ago, it has forced the removal of iconic cartoon characters from sugary cereal boxes, banned the sale of candy that use trinkets to lure young consumers, prohibited the sale of junk food in Chilean schools, and forbids junk food from being advertised to young audiences. Beverages high in sugar include an 18 percent tax, which is among the steepest soda taxes in the world. The “linchpin of the initiative” is a new labeling system that requires packaged food companies to prominently display black warning logos in the shape of a stop sign on items high in sugar, salt, calories or saturated fat. According to AB Chile, a food industry association, more than 1,500 items, or 20 percent of all products sold in Chile, have been reformulated in response to the law. Obesity rates in Chile have yet to fall, and experts say it could take years to significantly modify the way people eat.

Obesity Drives US Health Care Costs Up by 29 Percent, Varies by State
(Medical Xpress)

The percent of U.S. national medical expenditures devoted to treating obesity-related illness in adults rose from 6.13 percent in 2001 to 7.91 percent in 2015, and increase of 29 percent, according to recent research published in Clinical Chemistry. By analyzing data from the Medical Expenditure Panel Survey, a nationally representative survey of Americans' health care utilization and costs, researchers estimated the percent of health care costs that were associated with adult obesity for the most populous states. The researchers found large differences among states; Arizona, California, Florida, New York and Pennsylvania devote five to six percent of total medical expenditures on treating obesity-related illness, whereas North Carolina, Ohio and Wisconsin spent more than 12 percent of all health care dollars on obesity-related illness. Previous estimates of the health care costs of obesity by state were based on assumptions about how national costs should be apportioned to different states.

Can the Way you Speak Contribute to Obesity? (The Chicago Crusader)

Researchers from the University of Michigan note a difference in the communication between parents of children with obesity and parents of those of normal weight. The study published in the Journal of Nutrition Education and Behavior found that when children with obesity were offered cupcakes, their parents made direct commands, like “Only eat one.” Parents whose children did not have obesity had a more subtle, guiding approach, saying things like “That’s too much – you haven’t had dinner.” “Most people recognize that being ‘overly-permissive’ is not healthy. But being ‘overly-restrictive’ (i.e., not allowing ANY sweets or treats), has been shown to contribute to unhealthy eating habits, and more importantly, an unhealthy relationship with food and eating [which] can lead to overeating and obesity,” said Dr. Matthew Smiley, a pediatrician and medical director of the Healthy Active Living Program at Advocate Children’s Hospital in Chicago. “Unfortunately, many people believe that childhood obesity is caused by ‘bad parenting,’ or that the children and their parents are ‘lazy,’ and that’s why they struggle with their weight,” said Dr. Smiley. “This study shows how many parents of obese children are trying to monitor their kids’ habits, but struggle with the best way to approach it.”