As one of Glenn's first coaching clients, I can attest to his ability. He was very honest in his approach and gently challenged me in areas where I needed to make changes. His encouragement and sensitive approach to coaching comes out of his own personal history and journey of change. The hard choices he has made in his own life allows Glenn to impact lives in a profound way, offering not only inspiration, but HOPE. He is a changed person who now affects others in healthy and positive ways. He is a delight to talk to and I felt completely safe in being vulnerable to discuss my issues and questions concerning Gastric Bypass Surgery.
— Heather Labbe
Waiting for surgery in Maine
Seven Rational Reasons
To Require Universal Insurance
Coverage of
Weight Loss Surgery (WLS) so that morbid obesity
need not be a death sentence for millions without resources
by Glenn
Goldberg, J.D., R.C., VBG WLS 10.24.02 360/195
1. Americans are suffering from an epidemic of obesity that
devastates countless lives and families with incalculable suffering
and expense, and then kills people prematurely. Obesity is
also a causative factor in many other costly and debilitating medical
conditions.
According to the 12.08.03 issue of Newsweek,
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
Mississippi. Morbid (i.e. life-threatening) obesity is often
defined as weighing 100 pounds or more over a person’s ideal weight.
Newsweek also reported that the incidence of diabetes increased
27% in the last five years. The Centers for Disease Control
and Prevention estimate that 17 million American adults have
already been diagnosed with
diabetes, and 12 million adults are developing the disease.
Morbidly obese individuals are at particularly high risk for
diabetes.
In the July, 2003 issue of ObesityHelp magazine, www.obesityhelp.com
founder Eric Klein estimated that the average costs associated
with morbid obesity (e.g. medications, hospitalizations, etc.)
are about $6,000 a year.
At this rate, a Weight Loss Surgery can pay for itself in about
four years, and start generating significant savings in five
years!
More than 10 million Americans, 4.7 percent of the population,
are medically eligible for Weight Loss Surgery, according to
the National Institute of Diabetes and Digestive and Kidney
Diseases of the National
Institutes of Health. More than 100,000 very overweight people
are expected to undergo Weight Loss Surgery this year, double
the number that had WLS
in 2001, but largely because of insurance exclusions for the
procedure, that represents only 1% of the number of people
who are medically eligible.
Morbid obesity is an independent risk factor for premature
death, with the risk rising as a person’s BMI (body mass index) increases.
A BMI greater than 40 -- or greater than 35 with associated
medical problems -- means that a person has clinically severe
or morbid obesity, which is
associated with diabetes, heart disease, high blood pressure,
high cholesterol, heartburn, gallstones, arthritis, urinary
stress incontinence, infertility,
and some types of cancer. People with a BMI of 30 have a relative
risk of dying early that is 1.3 times greater than normal weight
individuals. By the time the BMI reaches 40, the risk is almost 3 times
as great. At
50, the risk of dying prematurely multiplies exponentially.
2.
Mandating insurance coverage for WLS is the fair, equitable
and right thing to do, because obesity is a disease. The disease
of morbid obesity need not and should not be a death sentence
for so many individuals
without insurance coverage or resources.
Weight Loss Surgery is a medical (not a moral) condition requiring
a medical intervention (not moral judgments.) Smokers aren’t denied
insurance coverage for appropriate surgical treatment when they develop
lung cancer, and patients with heart disease are covered for indicated
surgery regardless of their lifestyles. This raises fundamental issues
of fairness and discrimination in health care policy on the basis of weight
and appearance. Classifying obesity as a disease would not only lessen
the severe social stigmas associated with the condition; it would also
immediately remove presently insurmountable economic and regulatory hurdles
to prevention and treatment. Declaring obesity as a “disease'' could
open up insurance coverage to the estimated 10 million Americans
who need treatment for their morbid obesity.
“
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,'' says Morgan Downey, executive director of the American Obesity
Association. “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 classified as a disease.
3. Mandatory WLS coverage at equitable compensation rates would
encourage and help the American Society of Bariatric Surgeons
(ASBS) to elevate their training, research and quality assurance
programs.
Hundreds of doctors have jumped into the bariatric field recently
and started to advertise their availability as WLS surgeons,
even though they may not have the expertise and experience
required to perform the
procedures safely and effectively. Universal WLS coverage,
and the increased resources that would generate, will encourage
the most highly qualified
bariatric surgeons to impose stringent ASBS certification requirements
that will protect patient safety and promote quality medical
treatment and care.
4. WLS is proven effective and reasonably safe (especially
compared to alternatives).
Numerous studies suggest that Weight Loss Surgery is the ONLY
treatment that reliably produces significant and sustained
weight loss. According to Dr. Bruce Wolfe, a bariatric surgeon
and Professor of Surgery
at the University of CA at Davis, "Morbid obesity is life-threatening,
and surgery is the only treatment that works." Surgical treatment
for clinically severe obesity has been endorsed by the National
Institutes of Health, the World Health Organization, Shape-Up America,
the American
Heart Association, the American Dietetic Association, and the
American Obesity Association. WISH Bariatric Centers have reported that
their patients
lose as much as 70 percent of their excess weight within one
to two years after surgery. Other studies show that more than 92% of American
WLS patients
achieve and maintain long-term weight loss.
While there are risks inherent in any surgery, the rates of
death (0.5 - 1%) or complications (5-8%) from Weight Loss Surgery
are comparable to those for most other major surgeries. The
risks to the health and life
of a morbidly obese individual from NOT losing their excess
weight seem to be far greater than the risks of death or complications
from having
WLS.
Bariatric surgery techniques and technologies have been refined
and improved, and they can save lives – if patients can afford to
have the surgery. The barriers created by insurance policy
exclusions prevent most patients who need surgery from having it. Consequently,
they effectively
impose a death sentence upon millions of morbidly obese Americans.
5. Weight Loss Surgery is extremely cost-effective. Denial
of WLS coverage today will exponentially multiply our nation’s future
health care costs.
Dr. Vincent Kerr, director of health care management at HYPERLINK "http://www.nytimes.com/redirect/marketwatch/redirect.ctx?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=F" 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 reports
that the annual costs of treating obesity-related conditions -- including
diabetes, heart disease, osteoarthritis and breast and colon cancers --
are at least $120 billion. (According to Frost & Sullivan, a consulting
firm, spending on bariatrics is now approaching $3 billion
a year, at an average cost of $25,000 for each procedure.)
According to an 8.29.03 article by Milt Freudenheim in the
New York Times, bariatric specialists say that the surgery
reduces overall health care costs in the long run. Patients
with Type 2 diabetes, which
the National Institutes of Health said accounted for $98 billion
of obesity-related costs, have normal sugar counts within a
few days after the stomach bypass
procedure, without medication. A recent study by the Blue Cross
and Blue Shield Association confirmed that “surgery is far more effective
than diet and exercise in treating morbidly obese patients," according
to Naomi Aronson, executive director of the association's technology
evaluation center.
If Eric Klein is right in his calculations, the financial “break
even” point for bariatric surgery may be as short as four years post-op.
6. Insurance exclusions for WLS disproportionately hurts our
poorest and most vulnerable Americans.
Obesity is an especially acute concern for poor people (due
in part to government food subsidy policies that support and
promote the least nutritious, highest calorie foods.) Millions
of low- and middle-income
people don’t have and can’t afford private insurance, and Medicare
and Medicaid -- the government’s health care plans for older/disabled
and impoverished patients -- have been reluctant to pay for bariatric procedures.
At the University of California at Davis, for example, Medi-Cal patients
face a 12-year wait for bariatric surgery, according to Dr. Bruce M. Wolfe,
a bariatric surgeon there. Aggravating the dismal situation, Medi-Cal reimburses
Davis for the procedure at less than a third of the hospital's cost. "Basically
[poor people] are not getting access to the care," he said. "They
will suffer the consequences of untreated obesity."
7. For many morbidly obese people, Weight Loss Surgery may
be their ONLY realistic hope for a long and healthy life.
Research has identified several genes (and their corresponding
hormones such as leptin) that seem to be at least partially
responsible for obesity. These genes help regulate appetite
and metabolism. We now
have credible evidence that obesity is at least partially biological
in its origins, offsetting the prevalent misconception that
it is primarily a behavioral or psychological disorder. Obesity
is a disease which needs
a cure, rather than a character defect within the individual
that warrants condemnation and requires correction.
Perhaps because of their genetic endowment, people prone to
obesity seem to gain excessive weight easily, while finding
it difficult or impossible to lose it. That’s why diets almost always fail and
why WLS is currently the only viable weight loss option for many morbidly
obese people, according to endocrinologist David Cummings of the Veterans
Affairs Puget Sound Health Care System. Most people can lose no more than
5-10% off their "natural" body weight by exercising and eating
wisely. Decades of diet studies show that more than 90% of people who lose
weight by dieting gain it all back within 5 years. "There are exceptions,
but when you are speaking of general rules, the only people who are able
to lose more than 10 percent of their body weight and keep it off are people
who have had gastric-bypass or other bariatric surgery," according
to Cummings.
Our community of Weight Loss Surgery patients and their families
and friends faces a difficult, but surmountable, challenge
to create a society where each person is judged by the quality
of their character,
not their weight on the scale, and receives quality and appropriate
medical treatment for their medical needs. WE already know
that covering the costs
of surgery is smart, saves money in the long run, and contributes
to our creating a nation that is compassionate, caring and
supportive to people
struggling with obesity. Our job now is to convince the rest
of America that Universal WLS Insurance Coverage – in both private and governmental
health insurance programs – is an idea whose time has finally come.
Each of us has a vital role to play in helping to encourage,
solidify 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 are without hope,
because they are blamed and judged for their excess weight,
rather than supported and
assisted in their quest to regain their health. In my next
newsletter, the first of the new year, I will describe a scenario
whereby we can mobilize
our community and realize this dream.
Through Thick
