One thing that keeps the cost of health care sky high is surgical procedures that used to be deemed “elective”…these operations were not life saving needs, rather, cosmetic needs. Gastric bypass was one such procedure. In rare cases it would be used as a last resort for those who could not manage their weight in other ways. In the past few years this surgery has become more and more popular; it’s a fast fix for those who are overweight. Since it’s popularity has increased, old fashioned dieting and exercise as a way to lose weight has lost it’s popularity. Insurance companies are starting to step back on paying for these procedures.

Tufts Health Plan next month will start denying gastric-bypass and stomach-banding procedures to some obese patients and require others to enter a yearlong diet and counseling program before undergoing the potentially lifesaving surgery.

Tufts, the third-largest health insurance company in Massachusetts, said limiting the number of such surgeries could save the company millions of dollars and ultimately improve patients’ health. While insurers routinely reject patients for certain procedures or restrict access to medical care, Tufts is adopting more stringent criteria for the procedures than the state’s two largest insurers, Blue Cross Blue Shield of Massachusetts and Harvard Pilgrim Health Care.

These surgeries are quick fixes. There is nothing wrong with asking potential patients to take a year of dieting, exercise, and other steps to avoid the surgery. Side effects of diets and exercise are much less life threatening than the effects a gastric bypass can have on a person.

Doctors condemned the new policy, which takes effect March 6, saying Tufts is ignoring a growing body of clinical evidence that shows that such operations help those who have exhausted other methods to lose weight. Delaying surgery worsens conditions such as diabetes and heart disease that are often complications of pronounced weight gain, they said.

“This is Draconian,” said Dr. Philip Schauer , president of the American Society for Bariatric Surgery and director of bariatric surgery at the Cleveland Clinic. “This flies in the face of the medical evidence. These policies sentence a patient to a life of dealing with obesity without the possibility of parole.”

Doctors condemned the policy? I doubt that. Doctors who specialize in obese patients, who make profit from the weight of people, may be critical of this policy. But doctors in general prefer to see patients make life style changes and avoid surgical procedures altogether. Sentencing an obese person to a lifetime of obesity? No. It’s a year. One year. Those who follow a decent diet normally drop 2-3 lbs a week; over one year this is around 100lbs. As the weight drops, so will the blood pressure and risks of heart problems. Diabetes can be managed quite well now- weight problem or not.

The popularity of the procedures has made them a target for health plans seeking to control costs. Last year, 177,600 weight- related surgeries were performed nationally, compared with 36,700 in 2000, according to the American Society for Bariatric Surgery. But these surgeries carry significant risks — one in 200 patients undergoing gastric bypasses dies from complications, according to a study published in October 2004 by the Journal of the American Medical Society.

Gastric bypass surgery costs about $20,000, while the stomach banding procedure can cost less than $10,000.

It’s not so much the popularity here. It’s side effects that have an impact on a person’s health. It’s an expensive risk to take. There are some people who have metabolic disorders that render dieting useless. Others are on meds which to an extent, effect weight. These people should be allowed to consider a gastric bypass, and for years, these people have had good luck with the procedure. But not without documented proof of the failure of other means first (such as dieting). I read recently that teenagers have been subjected to the banding procedure, after a trial of 6 months of diet. 6 months? And who will really CARE to even bother going on a diet or exercising when they know an operation will “fix” their weight issues anyway?

A person with a body mass index greater than 25 is considered overweight and a BMI of more than 40 is classified as severely obese. Under guidelines sent to Tufts doctors last month, all patients would have to complete a yearlong “lifestyle management” program called iCanChange before being eligible for bariatric surgery. At the end of the program, those with a BMI of less than 40 would not be eligible for the procedures. Patients with an index between 40 and 50 would only be eligible for stomach banding, which is less expensive and not as invasive as stomach bypass surgery, unless they also suffered from medical conditions like diabetes or high blood pressure.

Dr. Allen J. Hinkle , Tufts’ chief medical officer, said the new standards will lower risks to patients and save Tufts Health Plan money. The insurer spent $10 million on the operations last year, and demand for the procedures in Massachusetts is growing by 28 percent annually, he said.

Demand grows for the fast easy way out. People don’t realize the lifestyle changes they will endure once they have had these procedures…eating food will become an ordeal. Frequent uncontrollable bowel movements and vomiting will become the norm. Issues with malnutrition will occur as vitamins cannot be absorbed by the body; people often end up on liquid diets. Nevermind the fact that some foods can never be eaten again. The risks from the surgical procedure itself are high- infections are almost guaranteed with these surgeries. Patients often get C Diff which just adds to the misery of stomach and bowel problems.

Is it worth it? I don’t think so. A year of lifestyle habit education, diet and exercise might seem like a lot to ask of a person, in today’s world of “I want it and want it NOW!!” thinking. The insurance companies are doing people a favor by denying this “benefit” for a year or longer. Quick fixes paid for by insurance policies is not the answer. People need to do things the right way first, the medically sound and proven way. It means hard work and willpower and determination. But it works 97% of the time and has little side effects. I think the idea of willpower and exercise turn people off. No one wants to work hard for anything anymore.