At 202 pounds, Steffany Sears knew she was fat, but not fat enough to qualify for traditional weight-loss surgery.
Desperate for help, the Gold Bar, Wash., woman did what seemed the only logical thing: She gorged herself on chips and cookies, pizza and fried chicken so she’d gain at least eight pounds more.
“I would have eaten myself stupid,” recalled Sears, 34, who was turned down by her insurance company for the $20,000 procedure. “I know friends who would have done that, too.”
In the end, she actually qualified to participate in a clinical trial that led the federal Food and Drug Administration this spring to lower the bar for obesity in people eligible for one form of weight-loss surgery, Allergan’s Lap-Band stomach-shrinking device. Because she had a body mass index, or BMI, of between 30 and 35, the target range of the new rule, she even got the treatment for free, instead of having to take out a second mortgage on her house.
Today, at 5-foot-6, she weighs 143 pounds. "I felt like I'd won the lottery, really, with my life," said Sears, a native of England.
But Sears’ experience highlights what dieters and doctors alike say is a growing dilemma. Spurred by strict insurance policies that limit surgery to high BMIs of 35 or 40, some obese people are actually striving to gain weight -- in order to lose it.
Web sites devoted to weight-loss surgery are full of advice and anecdotes from would-be losers who claim they ate piles of bananas, chowed down on burgers and curly fries or swilled gallons of water to nudge the scale to the correct heights.
“That happens all the time,” said Dr. Robert Michaelson of Northwest Weight Loss Surgery in Everett, Wash., who was a clinical investigator for the FDA trial. “I’ve seen people come in with ankle weights on.”
Sometimes, it works. Elizabeth Marks, 32, of San Diego, Calif., was turned down for surgery once by her insurance company for being less than 100 pounds overweight, but accepted after she gained more.
“I just had two weeks of eating all the junk I could,” Mark said.
In general, a person who is 5-foot-6 and weighs 220 pounds has a BMI of 35. At 250, the BMI climbs to 40.
Weight-loss doctors definitely discourage patients from gaining more and instead urge them to pursue non-surgical options, or to find other ways to pay for the surgery. One good reason? Some insurers regard the practice as fraud.
“I tell them go home. You don’t qualify,” said Dr. Namir Katkhouda, a bariatric surgeon at the University of Southern California who has performed 2,000 procedures. “They come back six months later and their problems are much worse.”
The dilemma has been exacerbated by the recent FDA decision, which approved the use of Lap-Band in patients with BMIs as low as 30 with at least one weight-related disease, such as high blood pressure or diabetes. The agency left the BMI level at 40 for heavy but otherwise healthy people.
The move opened the door to an additional 27 million people eligible to access surgery and prompted experts to predict a sudden rush toward lower BMI procedures. So far, despite great interest, that hasn’t happened, said Dr. Robin Blackstone, president of the American Society for Metabolic and Bariatric Surgery.
“The insurance hasn’t expanded to embrace that indication,” she said, noting that less than 1 percent of those eligible for bariatric surgery actually get it. In 2009, nearly 63,000 Lap-Band devices were implanted in the U.S., according to estimates from the Agency for Healthcare Research and Quality.
Insurers prefer that people try other less-drastic weight-loss options, including medically supervised programs, said Susan Pisano, a spokeswoman for America’s Health Insurance Plans.
“Many, if not most, insurers look to less invasive, less-risky approaches before they move on to the more invasive, more life-threatening approaches,” Pisano said.
As far as Sears is concerned, the January 2008 surgery changed her life; she says she doesn’t regret gaining a little to lose a lot.
“I would do it again, now that I’ve tasted what it feels like to be normal and not overweight,” said Sears.