Many Americans are critically overweight, meaning they have other medical conditions that have been diagnosed as a result of their obesity or morbid obesity status. In 2013, nearly 160,000 patients in the U.S. had bariatric surgery – about the same number that had it in 2004. According to the American Society for Metabolic and Bariatric Surgery, that is only about 1% of 18 million adults who qualify for the surgery.
Surgeons believe that the low surgery number is not only because of economic problems, but the social stigma of having to have surgery to treat a weight problem. However, many feel that insurance coverage is the biggest reason. According to AP, two-thirds of all health plans that are sponsored by employers don’t cover weight loss surgery. Those that do cover bariatric surgery require special diets and psychological evaluation prior to having a procedure scheduled and included. Only 24 states actually required insurers cover weight loss surgery. When this system is involved, most plans require that the patient pay up to 50% out of pocket, which can be tens of thousands of dollars alone.
Ultimately, insurers believe that bariatric surgery should only be administered to those as a last resort. However, new guidelines from the American Heart Association, Obesity Society and the American College of Cardiology in November 2013 call for doctors to address obesity head on and to calculate a patient’s body mass index (BMI) yearly.
“All major surgeries are risky. This one is life altering, and if there is an approach that’s less invasive and less dangerous for the patient, you want to try that one first,” says, Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an insurance industry trade group.
Roughly one-third of all American adults are obese – defined as a BMI of more than 30. Weight loss surgery is recommended for those with body mass index readings of over 40 and over 35 for those with risk factors for high blood pressure, high cholesterol, diabetes and heart disease.
According to the study, states where obesity is the highest such as in Mississippi and Arkansas, only 25% of employers covered weight loss surgery. The study reports that insurance companies mention that they are following federal guidelines for bariatric surgery by recommending the procedure to only carefully select patients who have failed other methods of losing weight for a period of time.
The problem lies that some patients believe that weight loss surgery is a cost-effective way to treat obesity, while others believe that educating kids and teens on healthy eating is more effective. Others talk about the safety of the procedure. In 1998, one in 100 died from the procedure, while today just 1 in 1,000 do.
Ultimately for those that take medications to control conditions that are affected by weight issues, the surgery is a must.