As obesity reaches epidemic proportions in the United States, Milwaukee-area hospitals report a dramatic increase in patients undergoing what doctors call the “weight-loss program of last resort” — bariatric surgery.
THE STOMACH-SHRINKING procedure is meant only for extremely obese people who are at a severely high risk of developing serious health problems. Nevertheless, demand is soaring as hospitals and physicians report that more people are morbidly obese, more physicians want to do the surgery, more hospitals are opening programs and improved technology has made bariatric surgery less formidable to patients.
In many cases, private insurance plans are covering the surgery.
In Wisconsin, the total number of surgeries to treat obesity nearly doubled between 2001 and 2002, according to the Wisconsin Hospital Association, Madison. If current trends continue, numbers for 2003 will most certainly surpass 2002.
“There is a great need for bariatric surgery,” said Dr. Joseph Regan, the surgeon who performs bariatric procedures at Columbia St. Mary’s Hospital in Milwaukee. “The number of people in the United States considered morbidly or severely obese is only getting worse.”
The prevalence of obesity among U.S. adults climbed from 19.8 percent to 20.9 percent between 2000 and 2001, according to the U.S. Department of Health & Human Services. The total direct and indirect costs attributed to people being overweight or obese added up to about $117 billion in 2000, according to the U.S. Food & Drug Administration.
Columbia St. Mary’s is the latest Milwaukee hospital to open a bariatric surgery center. The hospital, which performed its first bariatric surgery in late August, recruited Regan to run the program. Regan recently completed a year-long fellowship in laparoscopic and bariatric surgery at Mount Sinai Medical Center in New York City.
The hospital anticipates treating about 100 cases in the program’s first year, said Karol Marciano, executive vice president at Columbia St. Mary’s.
In the past two years, Milwaukee-area hospitals have invested more than $1 million combined to reconfigure hospital rooms and surgery suites to accommodate bariatric patients’ larger size. Among the alterations: wider doorways, larger beds and wheelchairs, special equipment to lift overweight patients, and more comfortable furnishings.
Milwaukee-area hospitals with bariatric surgery programs include Aurora Sinai Medical Center, St. Luke’s Medical Center, Elmbrook Memorial, St. Francis, Froedtert Hospital and Columbia-St. Mary’s. All reported increases in bariatric surgeries over the last year.
Nationwide, a few pediatric hospitals have even begun using bariatric surgery on morbidly obese adolescents, though Children’s Hospital of Wisconsin, Wauwatosa, is not one of them.
However, the hospital has a formal review process that would consider a morbidly obese adolescent whose health did not improve after participating in the hospital’s “optimal medical management program” for at least six months, said Dr. Tom Sato, a pediatric surgeon at Children’s Hospital.
Although some local hospitals have been using surgery to treat weight loss for many years, the increased interest in bariatrics also results from better technology that allows procedures to be done with laparoscopic, or minimally invasive, surgery.
Area hospitals are using one, or more, of three forms of bariatric surgery.
The Roux-en-Y gastric bypass, the most frequently performed procedure, involves stapling the upper stomach to create a small pouch which is then attached to part of the intestines.
Vertical banded gastroplasty involves stapling and dividing the upper stomach to form a small pouch that shrinks the stomach and the amount of food it can hold. VGB can be performed laparoscopically.
The newest procedure is the LAP-BANDA® System, performed through laparascopic surgery. An adjustable elastic band is placed around the upper part of the stomach, creating a small pouch to restrict food passage.
Bariatric surgery is not a solution for all obese patients, providers cautioned.
Surgical candidates meet strict weight and other health requirements. They must have serious health complications or be at very high risk to develop problems such as diabetes, congestive heart failure or stroke. They also must undergo a barrage of medical and psychological tests as well as prove that they have failed at other weight loss attempts.
In addition, insurance plans have their own requirements before they will approve coverage for a procedure. Generally, though, insurance plans will cover bariatric surgery unless the employer asks that it be excluded from the benefit plan, Wisconsin insurance industry representatives said.
“Bariatric surgery is not a quick fix,” said Linda Scalzo, vice president of patient care at Elmbrook Memorial Hospital in Brookfield, which opened its bariatric surgery program 20 months ago.
“Just like any weight loss program, there are many adjustments to lifestyle that patients must make after the surgery,” Scalzo said.
Follow-up care and attention to the patient in the days and months after surgery is critically important to a successful case, said Dr. James Wallace, a bariatric surgeon at Froedtert Hospital, Wauwatosa.
Because the stomach becomes so much smaller, patients must make major changes in their eating and diet habits.
“You can’t learn that in one day. It requires a lot of coaching,” Wallace said.
Copyright 2003 American City Business Journals Inc.