Neapolitan Lighthouse

Is COVID a Spark for Growth in Obesity Care?

We have plenty of reasons to think that COVID might be a spark for growth in obesity care. First of all, untreated obesity leaves a person more vulnerable to bad outcomes with COVID. More data is suggesting that effective obesity care might reduce those risks. And then we have anecdotal reports telling us that uptake of obesity care may indeed be growing. But so far, the evidence is fragmentary.

A Big Reduction in Risk

Getting a number on the effect of obesity treatment on COVID risk is a difficult and imprecise exercise. But that has not stopped people from trying. A year ago, Ali Aminian and colleagues published a study showing the risk of hospitalization for COVID was two-thirds lower for patients with a history of bariatric surgery.

At about the same time, French researchers found the risk of severe COVID symptoms was cut in half for people who had bariatric surgery. The risk of death was 75 percent lower.

More recently, another group of researchers in France found similar results. They reported an 85 percent reduction in severe outcomes and death for patients who had bariatric surgery well before contracting COVID-19.

To be sure, all of these data are observational. An RCT of bariatric surgery to reduce the severity of a subsequent COVID-19 infection is unlikely to ever happen. But these findings certainly line up with the observation that obesity is an important risk factor for severe symptoms and death with COVID-19. So it’s not a big stretch to think that highly effective treatment for obesity – such as bariatric surgery – would cut the risks.

Growth in Bariatric Surgery

Getting a handle on the impact of COVID on bariatric surgery utilization is even harder. That’s because so many things are in flux right now.

For one thing, surges in the pandemic forced a stop in bariatric surgery – especially early on. But even during those surges, many people started working through the process that leads up to bariatric surgery, says Heather Sarten:

“It was about being at home – and not having anything else to do. People finally slowed down enough to realize that their health matters, that they needed to do something about it and not let their health take a back seat.

“There is so much work that goes into preparing for bariatric surgery.

“As soon as we opened up and were able to do surgery again, we were jam packed.”

Because the prep work could mostly be done remotely, many people were ready to go when programs opened up. Consistent with this, Optum reported 26 percent growth in bariatric surgery program enrollment during the summer of 2020.

Access to Care

One thing that is helping is Medicaid expansion. Amresh Hanchate and colleagues report that utilization of bariatric surgery grew among non-Hispanic White persons in Medicaid programs following the expansion. But we note that this did nothing for the utilization of surgery by Black and Hispanic persons.

So, perhaps we are seeing more access to obesity care. But much work lies ahead to ensure that our systems for providing this care serves the needs of diverse populations.

Click here, here, and here for studies on bariatric surgery and COVID risk. For perspective on the uptake of bariatric surgery in the pandemic, click here and here. For the study of Medicaid expansion and bariatric surgery, click here.

Neapolitan Lighthouse, painting by Ivan Aivazovsky / WikiArt

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November 29, 2021