June 22, 2015

Learning the benefits and costs of surgery for obesity



Dr. David Arterburn has new studies on the costs, care variation, and effect on life expectancy of bariatric surgery. The results could guide obesity care.

Bariatric surgery such as gastric banding or bypass can improve the health of some people with obesity. Scientists including Group Health Research Institute’s David Arterburn, MD, MPH, have shown that bariatric surgery can positively affect weight loss and weight-related conditions such as diabetes. However, the procedures are expensive and can lead to postsurgical complications, nutritional deficiency, and other harms. The effectiveness of bariatric surgery could be improved if we knew more about which patients are helped most by the treatment, and which surgery types and postsurgery care results in the best outcomes. Three recent studies by nationwide collaborative groups that included Dr. Arterburn could help health systems develop best practices for bariatric surgery.

  1. The newest study, in JAMA Surgery, compared two common bariatric procedures (Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding) for outcomes important to patients and health care systems: time in the hospital, emergency visits, and costs. Insurance claims information on nearly 10,000 patients showed that patients undergoing Roux-en-Y gastric bypass initially had more emergency visits and hospitalization. Both procedures reduced patients' overall and prescription drug costs for at least three years after surgery, but Roux-en-Y gastric bypass patients had lower costs than adjustable gastric banding patients. Some people have worried that bariatric surgery increases a person's health care costs; this study found that it might actually decrease costs in some populations over the long term.
  2. Improving life expectancy is of primary importance to patients, health care systems, and society. A study in the journal Annals of Surgery used computer modeling to estimate the effect of bariatric surgery on life expectancy. The results showed that life expectancy is expected to increase for most patients with diabetes and clinically severe obesity (body mass index [BMI] greater than 35 kg/m2) who undergo the surgery. For example, in the modeling, life expectancy was improved by nearly 7 years for a 45-year-old woman with diabetes. However, for people with BMI greater than 60 kg/m2, the study suggested that surgery could lead to a possible decrease in life expectancy because, on average, the surgical risks were higher than the potential life expectancy benefits. These initial results could guide future research on identifying patients who will benefit the most from bariatric surgery.
  3. Variation in the way that care is delivered is a major health care concern in general, because it can mean that patients are not getting the best treatments for their conditions or circumstances. A study in American Journal of Managed Care found wide variation in how patient care is managed after bariatric surgery. Postsurgical care elements such as nutritional counseling, support groups, and exercise education might improve the ability of surgery to affect weight loss, overall health, quality of life, and other issues important to patients. However, the paper concluded, we need more carefully planned studies to help us develop the best presurgery and postsurgery care management strategies for patients with severe obesity.

“Our research shows that although we know a lot about who can benefit from bariatric surgery,” says Dr. Arterburn, “we still need to learn more about when surgery is the best option, which procedure is best, who benefits most, and what follow-up care around surgery optimizes health results for patients.”


by Chris Tachibana