Rising Need for Advanced Obesity Treatment

November 16, 2012 — Rapidly increasing numbers of people with extreme obesity are creating a new level of treatment complexity for managing this disease. Severe obesity (defined by BMI of 40 or greater) has grown at an astounding rate over the last two decades, according to a study published Sept. 18 in the International Journal of Obesity. The authors report that in 2000, 3.9% of U.S. adults had a BMI of 40 or greater, and by 2010 the figure grew to 6.55%.

Severe obesity is complex for physicians to treat, health experts say. Patients have often tried and failed many ways to manage obesity, such as WeightWatchers, on their own. Complications of severe obesity and the altered metabolic state of patients with severe obesity add to the complexity.

Dr. Roland Sturm, the study’s lead researcher, notes that while medical costs for patients with moderate obesity are 25% higher than normal-weight, severe obesity is twice as expensive.

Jaime Ponce, MD, president of the American Society for Metabolic and Bariatric Surgery, said. “Unfortunately, 95% of them will fail on weight-loss methods that are not surgery. So, if you let that patient continue to go on those terms, they are going to continue to be overweight, and these numbers are going to increase.”

Bariatric surgery can result in weight loss of 30% to 60%, studies show. A randomized trial published March 26 in The New England Journal of Medicine found that 75% of patients with diabetes who underwent bariatric surgery achieved glycemic control within two years. None of the patients in the medical treatment comparison group achieved glycemic control in the study of 72 patients. Yet fewer than 1% of patients deemed eligible for some kind of bariatric or weight-loss surgery — those with a BMI of 40 or more, or above 35 with serious weight-related illnesses — have undergone the procedure.

Regardless of the treatment approach, bariatric surgery or other approaches, physicians are challenged in addressing severe obesity. Just one example is that weight-related complications such as joint and back pain make adhering to an exercise regimen especially difficult in patients with severe obesity.

Read the American Medical News summary article here. The study in the International Journal of Obesity can be found here.