Access to bariatric surgery remains difficult for many with obesity

LOS ANGELES — It is estimated that some 20 million Americans have a BMI of more than 40 kg/m², yet less than 1% of eligible patients with obesity undergo bariatric surgery, according to a presenter at ObesityWeek.

Lloyd Stegemann, MD, FACS, FASMBS, of the Better Weigh Center in Corpus Christi, Texas, said several factors might explain why more people with obesity do not consider bariatric surgery as an option, including barriers to access, and patient or even physician mindsets regarding the procedure.

Lloyd Stegemann

“More than 1 in 20 people have class 3 obesity, and if we look at the numbers, people who are overweight are staying overweight,” Stegemann said during a presentation on access to surgical care. “If we look at the bariatric surgery numbers over the past 5 years, those numbers stay relatively stable, despite more people moving into surgery eligibility.”

On the patient side, there remains a lack of knowledge regarding the safety and effectiveness of bariatric surgery, Stegemann said. Despite what he called “tremendous” safety data, misinformation remains that bariatric surgery is dangerous, whereas some see the procedure as a lazy alternative.

“A lot of people just aren’t interested in surgery,” he said. “Many still believe, ‘I can do it on my own. I don’t want to take the easy way out.’”

There also remains a lack of bariatric surgeons with a quality program in many parts of the country, Stegemann said, making access to the procedure difficult for many who need it. For some patients, their own physicians may talk them out of considering it.

“When we look at physician factors there are still a lot of physicians out there saying ... ‘Do not have this done,’” he said. “Many are uncomfortable talking about weight issues, let alone talking about bariatric surgery. And many are not up to date with the latest obesity treatment options.”

Insurance barriers also make treatment difficult, Stegemann said. Only 22 states cover bariatric surgery under the Affordable Care Act, and for many companies, bariatric surgery is an “add-on” procedure that many do not consider.

Even when insurance plans do cover the procedure, hurdles remain, he said.

“One of the things we’ve learned is just because it’s a covered benefit, doesn’t mean it’s a covered benefit,” Stegemann said, calling some of the benefit designs “discriminatory.”

Some insurance plans require a 2-year or 5-year weight history of a BMI more than 40 kg/m² or require patients to undergo 3-, 6- or 12-month medically supervised diets before any surgery, despite what Stegemann called “zero evidence that these preoperative diets can predict long-term success.”

For others, a high out-of-pocket insurance cost, a separate “bariatric” deductible in their health plan or no coverage for pre- or postoperative care can make the option of surgery available only on paper, Stegemann said.

Fixing the problem, he said, goes beyond any legislative action.

“As a society, many bariatric surgeons fail to get involved,” Stegemann said. “They’re not taking active participation in advocacy efforts, and that hurts us. Until we create a substantial movement by individuals affected by obesity, I don’t think this needle will move. It’s getting people affected by this motivated and active to see change.” – by Regina Schaffer

Reference:

Stegemann L. Remaining barriers in access to surgical care. Presented at: ObesityWeek; Nov. 2-6, 2015; Los Angeles.

Disclosure: Stegemann reports no relevant financial disclosures.