Guarding the Floodgates Against Obesity Care

Last week we met a brave physician guarding the floodgates of demand for obesity care. He told us:

“If all the patients that need bariatric surgery demanded it,
they would bankrupt our health system.”

This is a jarring perspective from a primary care physician in leadership at a large, nonprofit health plan. He confirmed that they are quite successful guarding the floodgates against all the people who need medical and surgical obesity care. He told us:

Fortunately, we have enough hurdles for those obese people that few of them make it through to get bariatric surgery. We don’t need to be spending all that money on surgery and drugs when exercise works so well. But if a patient with severe obesity demands the surgery, they’re eventually going to get it.

Such talk is nonsense. Those hurdles are keeping people with severe obesity in a poor state of health and costing the health plan money.

Craig et al: Estimated Mortality After RYGB vs Controls

Though we can’t argue with the benefits of exercise, it’s not, by itself, a magic cure for severe obesity. Exercise therapy can lead to better health outcomes for people who have surgery, but it’s not a substitute. For instance, it won’t reliably reverse type 2 diabetes by itself. Bariatric surgery will.

For people who need it, bariatric surgery is life saving. Data from the Geisinger Health System at ObesityWeek proved that once again.

So we are left to wonder. Is a doctor who takes pride in discouraging people from a life saving procedure really a healer? Is the health plan that fears people who need obesity care already bankrupt?

Click here for more on the survival benefits of bariatric surgery,  here for more on the benefits in type 2 diabetes, and here for the study from Geisinger. Click here for more on the benefits of exercise in bariatric surgery patients.

Flood, photograph © maryaben / flickr

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November 13, 2016

6 Responses to “Guarding the Floodgates Against Obesity Care”

  1. November 14, 2016 at 10:27 am, Allen Browne said:

    Unfortunately, the world we live in:
    short-term economic gain wins over improved health and long term economic survival
    perceived economic disaster sold by a women molesting huckster wins over kindness and intelligence presented by a woman who got poor advice on how to do email.

    Deep breath

    Enjoy the “Beaver Moon”. “King Tide” here on the Maine coast.


  2. November 14, 2016 at 11:09 pm, TPRichatdson said:

    A doctor is supposed to take the oath to “do no harm”. Or is that just in the movies? To deny someone care they need is the equivalent of harm. When did medicine become more about money than patients? The epitome of harm.

    • November 15, 2016 at 5:17 am, Ted said:

      I agree wholeheartedly.

  3. November 21, 2016 at 1:06 am, Michael said:

    A patient with severe obesity has their right foot amputated due to inadequately controlled type 2 diabetes. Their doctor never mentioned bariatric surgery as an option to bring their t2d into remission.

    If the person had bariatric surgery which successfully controlled their t2d and prevented the vascular damage, they would probably still have 2 feet.

    Was the doctor negligent?

    • November 21, 2016 at 4:25 am, Ted said:

      An excellent question, Michael. I wonder how much longer bias will triumph over good medical judgement.

  4. November 21, 2016 at 5:03 pm, Michael said:

    Thx Ted,

    Mark Twain once said “Nothing focuses the mind like the prospect of a good hanging”.

    Bias will only triumph as long as the lawyers allow it to. It will be the lawyers that open the floodgates to reasonable access to effective treatments. As soon as just one patient successfully sues their doctor for negligence, there will be miraculous improvements in delivery of, or referral to, appropriate care.

    Given the weight of evidence in favor of the patient and that there must be over a hundred preventable amputations due to t2d in the US every day, I’m staggered that such a case hasn’t already been brought.