You have been an immense inspiration and to say that I have shared many of your thoughts, dreams and fears would be an understatement. I am rendered almost, almost mind you , speechless at how helpful I have found you to be. — John T.
What a gift you are! As you talk about your experience, your honesty and gut level feelings make this new lifestyle achievable for me. Thank you so much for your experience, strength and hope. — Tammy D.
You are so honest, true and to the core — I love it. You provide an enlightening reminder that, although food is a big part of our lives — it's not the only part of it. I feel blessed — Terri
Through Thick and Thin #36 (December 15, 2003)
The Times They Are A' Changing
or All The News (About Us) That's Fit To Print
It's a Brave New World out there for us WLSers! Have you noticed, as I have, that there seems to be a dramatic increase in the number of news stories about obesity and WLS? We're not imagining or projecting. They really ARE talking about "us" and our issues more and more every day. And for the most part, that's good news.
The alarming worldwide increase in obesity - and the stunning increase in the number of morbidly obese people choosing Weight Loss Surgery - really has captured media attention and fancy. The North American Association for the Study of Obesity recently documented a phenomenal increase in the number of US & International (English-speaking) obesity-related articles for the last 3+ years.
It's getting harder and harder to keep up with the flood of information. Since it's "all about us", I thought that you might find it interesting and useful if I shared with you excerpts from some of the more important news stories you may have missed. This makes for a long newsletter, but I think the experiment is worth it. Let me know if you want me to continue being your eyes and ears in my ongoing WLS Media Watch...
Preface: According to the December 8, 2003 issue of Newsweek, the incidence of diabetes increased 27% in the last five years. The Centers for Disease Control and Prevention estimates that 17 million American adults have already been diagnosed with diabetes, and 12 million adults are developing the disease... Morbidly obese individuals are at high risk for diabetes. More than 65% of Americans are overweight or obese, a rate that has doubled in the last 20 years. Obesity rates vary from about 14% in Colorado to almost 26% in MississippiÉ Bariatric surgery is flourishing. Fueled by tabloid reports of spectacular celebrity slimdowns, more than 100,000 drastically overweight people are expected to undergo Weight Loss Surgery this year, double the number that had WLS in 2001. (See "Getting Rid of Extra Pounds", by Peg Tyre, at pgs. 62-74, Newsweek 12.08.03)
Item: There has been a +178% change since 2000 in the number of U.S. surgeries performed each year to treat morbid obesity. (Sources: Harper's Index, Nov. 2003; American Society for Bariatric Surgery, Gainesville, FL)
Commentary: We WLSers are pioneers in our own right. Of course, we owe our tools and successes to the courage and sacrifices of earlier generations of WLS patients, who offered up their bodies on the surgical table for the advancement of the science BEFORE the procedures were refined, perfected, insured and officially sanctioned. Nevertheless, I find myself pleased that WE are leading the vanguard and lighting the path for what I expect will be MILLIONS of Brothers and Sisters of the Scale. (More than 10 million Americans, 4.7 percent of the population, are eligible for the procedure, according to the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.) Honestly, did you ever figure that you would pioneer on the wild frontiers of WLS?
Item: Debate widens: Is obesity a disease? (source: Rob Stein, Washington Post)
The rising number of Americans who are seriously overweight has triggered intense debate among scientists, advocacy groups, federal agencies, insurance companies and drug makers about whether obesity should be declared a "disease," a move that could open up insurance coverage to millions who need treatment for weight problems and could speed approval of diet drugs.
Proponents argue that new scientific understanding has clearly established that obesity is a discreet medical condition that independently affects health. Classifying obesity as a disease would have a profound impact by helping to destigmatize the condition, experts say. But equally important, the move would immediately remove economic and regulatory hurdles to prevention and treatment, they say.
The move to classify obesity as a disease appears to be accelerating. The IRS ruled last year that, for tax purposes, obesity is a disease, allowing Americans to claim a deduction for some health expenses related to obesity. The federal agency in charge of Medicaid and Medicare is conducting a review to determine whether it, too, should consider obesity a disease. That would mean that the poor, elderly and infirm would be covered for some weight-control therapies without first having another illness diagnosed, such as diabetes. That decision would pressure private insurers to follow suit, and they are resisting.
The Food and Drug Administration is reviewing how it judges new weight-loss drugs. As part of that review, the agency will consider whether it should evaluate diet drugs more like it assesses treatments for diabetes and cardiovascular disease, which could help new medications gain approval more quickly.
For ages, obesity has been regarded as a personal moral failing, a behavioral issue that's easily fixed by people who have sufficient willpower to do so," said Morgan Downey, executive director of the American Obesity Association, a Washington-based advocacy group. "The modern scientific understanding of obesity is that it is a complex disease in its own right." That understanding has led many major medical authorities, including the National Institutes of Health and the World Health Organization, to conclude that obesity should be called a disease entity.
"Obesity is a disease," said Arthur Frank of George Washington University. "Obesity is a disease where there's a disregulation of eating, just like diabetes is a disease where the system of controlling blood sugar is not functioning properly."
The insurance industry argues that it is more appropriate for employers to pay for weight-loss treatments through employee assistance programs. "It's really going to require a whole host of responses, and not simply, "Let's have the insurance companies pay for it,' " said Larry Akey, a spokesman for the Health Insurance Association of America.
Commentary: It's about time! Each of us can play a vital role in helping to solidify, encourage and nail down what is presently merely an emerging trend. If we educate and inform our circles and communities, and demand action from our elected representatives, denial of insurance coverage may soon become as outdated as our wardrobes after we've used WLS to take off our excess weight. I encourage you to become a WLS advocate on this issue in solidarity with all those who are still suffering, and without hope, because they are blamed and damned for their overweight, rather than supported and assisted in their quest to regain their health.
Related Item: Hospitals Pressured by Soaring Demand for Obesity Surgery
(Source: 8.29.03 New York Times article by Milt Freudenheim)
Doctors and hospitals across the country are scrambling to satisfy the booming demand for surgery that shrinks the stomachs of severely obese people.
Dozens of hospitals are adding special operating suites for the procedure, called bariatric surgery, which attracted wide notice after public figures like Al Roker of "Today" on NBC, Sharon Osbourne of "The Osbournes" on MTV and Representative Jerrold Nadler, a Manhattan Democrat, had it done. Some bariatric surgeons are fully scheduled 12 months in advance, and hundreds of doctors have jumped into the field recently and started to advertise their availability.
Bariatric procedures - meant for obese people who are at extremely high risk of severe health problems, as defined by a National Institutes of Health consensus - surged more than 40 percent last year, to 80,000. This year, the number is expected to climb to 120,000, according to Frost & Sullivan, a consulting firm. Spending on bariatrics is approaching $3 billion a year, at an average cost of $25,000 for each procedure. With the number of people eligible for the procedures growing by an estimated 10 to 12 percent a year, bariatric surgery can be profitable for hospitals - and even more so for surgeons. But the costs are a major concern for insurance companies and employer health plans. Surgeons say that some insurers routinely delay approvals.
"The companies throw up roadblocks," said Dr. James Rosser, a surgeon at Beth Israel Medical Center in Manhattan. "They keep requesting more information. Patients are left to really hound the insurance companies to get the approvals."
Doctors and patients, meanwhile, are putting pressure on insurers to lower the body-size threshold for paying for the operation for people who have advanced problems with diabetes and other weight-related diseases. That could triple the number of people potentially eligible for the operation to more than 30 million, a panel of medical advisers to the national Blue Cross and Blue Shield association was told recently. One group having trouble winning access to treatment is the poor, among whom obesity is an especially acute concern. Doctors say that Medicaid programs in many states have been reluctant to pay for the procedures. At the University of California at Davis, for example, Medi-Cal patients face a 12-year wait for bariatric surgery, said Dr. Bruce M. Wolfe, a bariatric surgeon and professor of surgery. Medi-Cal reimburses Davis for the procedure at less than a third of the hospital's cost. "Basically they're not getting access to the care," he said. "They will suffer the consequences of untreated obesity."
The procedure is approved for patients at the upper end of the body mass index, a measure of weight in relation to height. Under National Institutes of Health guidelines, widely followed by health plans, candidates must first try diet and exercise regimens. More than 10 million Americans, 4.7 percent of the population, are eligible for the procedure, according to the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.
In addition to the average cost of $25,000 for the surgery and associated services, lifelong follow-up is strongly recommended, adding to costs. "They need support groups, follow-up by nurses, exercise programs," Dr. Wittgrove said. Insurance companies often do not pay for these programs or for counseling, Dr. Rosser added.
For some patients, overall costs can be much more, up to $100,000, said Helen Darling, president of the Washington Business Group on Health. Her organization, which represents large employers, recently opened a campaign to encourage overweight workers to slim down.
A spokesman for that campaign, Dr. Vincent Kerr, director of health care management at the Ford Motor Company, estimates that obese workers cost employers $12 billion annually in medical bills, reduced productivity, increased absenteeism and higher insurance premiums.
The National Institutes of Health, meanwhile, says that the annual costs of treating obesity-related conditions - including diabetes, heart disease, osteoarthritis and breast and colon cancers - are at least $120 billion.
Bariatric specialists say the surgery reduces those costs in the long run. Patients with Type 2 diabetes, which the N.I.H. said accounted for $98 billion of obesity-related costs, have normal sugar counts within a few days after the stomach bypass procedure, without medication, Dr. Wittgrove said.
A recent study by the Blue Cross and Blue Shield association "confirmed that surgery is far more effective than diet and exercise in treating morbid obese patients," said Naomi Aronson, executive director of the association's technology evaluation center.
Health insurers will cover the cost only for patients who meet a long list of preconditions, partly based on N.I.H. criteria. Aetna, for example, requires that candidates for the procedure have spent six months in a diet and exercise program supervised by a physician.
"Insurance companies, unfortunately are somewhat schizophrenic about this procedure," Dr. Wittgrove said. "Some authorize it quite easily and are patient-friendly. They seem to get the fact that they are going to save money over all." But, he added, "other insurance companies want to put hurdles in front of patients rather than facilitate treatment."
Some of the most active hospitals for bariatric procedures are in California, New York and Boston. But a number of hospitals in Indiana are adding bariatric facilities. And in Florida, "just in the last six months in my neighborhood in Coral Gables, six surgeons have begun to advertise bariatric surgery," said Dr. Eneida O. Roldan, a physician who is chairwoman of the American Board of Bariatric Medicine, an accrediting group.
Hospitals in New York State reported 4,670 procedures last year, up 50 percent from 2001 and more than double the 1,981 in 2000, said Karen Heller, a senior health care economist at the Greater New York Hospital Association.
In California, Kaiser Permanente, the big health maintenance organization, is tripling its bariatric surgery capacity in the San Francisco area. "There has been a tremendous increase in demand in the last four years," said Dr. Michelle Caughey, physician in chief of Kaiser's South San Francisco Medical Center, which treats 420 bariatric cases a year. Kaiser recently added two centers nearby. Combined, they expect to handle more than 1,200 cases by the end of next year, she said.
New centers like Kaiser's are big customers for special equipment. They buy beds four feet wide that can support "patients of size," who may weigh up to 1,000 pounds, said Lynne Sly, vice president at Kinetic Concepts, a bed manufacturer in San Antonio. With extras like built-in scales, the special beds can cost more than $20,000, or $170 a day to rent.
Sales of these beds and accessories have been growing 21 percent a year, another indicator of the trends in obesity surgery, said Dhiraj Ajmani, an analyst at Frost & Sullivan, the consultants.
Dr. Wolfe at U.C. Davis said that bariatric procedures were only "profitable by a small margin" for hospitals. Complications are frequent, and the procedures often require extra employees in the operating room, he said. But with demand so strong from patients, many bariatric surgeons are thriving, Dr. Wolfe added.
"Morbid obesity is life-threatening, and surgery is the only treatment that works," he said. "The hospitals don't have much choice but to respond."
Commentary: As this article amply demonstrates, WLS = BIG $$$. I don't have any problems with these incredibly skilled bariatric surgeons commanding top dollars for their extraordinary services. I have huge problems with surgeons jumping into the field of bariatric surgery without the knowledge, skills, training, experience or commitment necessary to perform the surgery safely and effectively. (A friend's aunt recently died from WLS performed by a newcomer who was not adequately prepared to deal with complications.)
I expect that this will become a growing problem, and it makes it more important than ever before that prospective WLS patients thoroughly and carefully check out their surgeons before selecting one. It's vital to understand that surgeons can join the American Society for Bariatric Surgery, our most prestigious national organization of bariatric surgeons, without necessarily having appropriate training, skill, experience or certification. This also places a responsibility on us to help newbies select their surgeons wisely by sharing our recommendations and teaching them the importance of choosing a doctor will a comprehensive aftercare program.
Item: Study Shows Depth of Obesity Stigma (source: 10.14.03 article by Daniel Q. Haney, Associated Press Medical Editor)
FORT LAUDERDALE, Fla. - While it is no surprise that people often have a low opinion of the overweight, a new study finds that just standing next to a large person can be bad for one's image. The experiment, conducted in England, demonstrates the depths of stigmatization endured by heavy people: It even rubs off on their friends.
Trying to combat discrimination against the overweight is a topic of discussion at this week's meeting in Fort Lauderdale of the North American Association for the Study of Obesity, the field's top professional organization. Even here, though, another study suggests that obesity specialists themselves may harbor subtle, if unintentional, negative attitudes toward their patients.
"Weight stigma is powerful, pervasive and destructive," said Marlene Schwartz, a Yale psychologist.
In the English study, psychologist Jason Halford and colleagues from the University of Liverpool tested 144 female students' reactions to two prom photos. One showed a dapper, thin young fellow standing next to a svelte ringlet-haired woman. The other was the same photo altered to show the guy arm-in-arm with a very large, nicely dressed woman.
The volunteers took a quick look at one or the other of the pictures and then were asked their opinion of the man. They rated him from 1 to 5 on 50 negative adjectives - called the "fat phobia scale" - that people often use to describe obese people.
The man with the big woman was rated 22 percent more negatively than the same fellow with the thin companion. When seen with the large woman, he was more likely to be described as miserable, self-indulgent, passive, shapeless, depressed, weak, insignificant and insecure.
"It shows that people project negative attitudes associated with obesity not only on the obese but all those who associate with them," Halford said.
The study also found that students who were themselves overweight were more likely than usual to rate the man harshly when pictured with the obese partner.
At the same obesity meeting two years ago, researchers give a word quiz, called an implicit association test, to about 200 obesity professionals. The test, intended to measure bias, asks people to quickly link up words like "lazy," "stupid" and "worthless" on command with obese or thin people.
The results, described at this year's meeting, showed that obesity professionals were more apt to link the negative words with overweight people, even when trying not to.
"These are unconscious attitudes," said Heather Chambliss of the Cooper Institute in Dallas.
Carol Johnson of Milwaukee, a large woman who heads a support organization called Largely Positive, told the conference that overweight people are often discriminated against by doctors, who ascribe all their problems to weight and sometimes withhold standard treatments, like blood pressure pills, that they freely prescribe to thin patients.
"Society wants no fatties," Johnson said. Rebecca Puhl of Yale said bias against the large begins early in life. Studies show that even preschoolers are more likely to describe overweight playmates as mean, ugly or stupid. She said overweight people are less likely to get into college, less likely to get hired and more likely to get fired.
"Expressing negative attitudes toward obese people has become an acceptable form of bias," she said.
Commentary:I guess we weren't delusional after all when we felt the harsh, biting judgments and condemnation of so many other residents of Thin America!Sadly, fat people were among the harshest critics of other overweight folks. I've always known that discrimination against obese individuals was both widespread and pernicious, but I was stunned to learn that negative judgments about my weight and appearance might have affected other people's judgments about my friends and associates. We still have lots of work to do to create a world where each person is judged by the quality of their character, not their weight on the scale.
BATON ROUGE, La. - Forty fat government employees will get stomach bypass surgery in a $1 million experiment to see whether it keeps insurance payments down over the long run by preventing other health problems.
The first job will be choosing the 40 from more than 1,000 people on the state's health plan who expressed interest in the surgery. The participants will be monitored for three years.
A few states require insurance companies to cover the operation, which clips the stomach to a fraction of its original size and bypasses part of the intestine. This makes people feel full much more quickly, and digest less of what they eat.
The resulting weight loss can head off long-term illness related to being overweight. The operation is generally considered only for people who are "morbidly obese" - at least 100 pounds overweight.
The Louisiana Legislature refused to require coverage of the operation after insurers objected that it would cost too much. The state health plan alone would spend an estimated $25 million in its first year if it had to cover all requests immediately, Executive Director A. Kip Wall told lawmakers this summer.
"The biggest obstacle is, for lack of a better term, pent-up demand," he said Tuesday.
Wall said the $25 million estimate was based on a quoted price of $25,000 per operation and the more than 1,000 letters his office got after sending a notice about the proposed test a year ago to the 250,000 people covered by the plan. Nationwide, prices range up to $40,000 per operation.
Commentary: This is what we need to make our case for WLS and its insurance coverage: careful, long-term studies of the cost-effectiveness of Weight Loss Surgery. WE already know that covering the costs of our surgery is smart, saves money in the long run, and contributes to our creating a society that is kind, caring and supportive to people struggling with obesity. These kinds of studies will help us convince everyone else.
Through Thick
Bariatric procedures - meant for obese people who are at extremely high risk of severe health problems, as defined by a National Institutes of Health consensus - surged more than 40 percent last year, to 80,000. This year, the number is expected to climb to 120,000, according to Frost & Sullivan, a consulting firm. Spending on bariatrics is approaching $3 billion a year, at an average cost of $25,000 for each procedure. With the number of people eligible for the procedures growing by an estimated 10 to 12 percent a year, bariatric surgery can be profitable for hospitals - and even more so for surgeons. But the costs are a major concern for insurance companies and employer health plans. Surgeons say that some insurers routinely delay approvals.