[Suzanne 3FC]

Surgical treatment for obesity gaining in popularity
Date: 04-27-2002; Publication: The Toronto Star; Author: Theresa Agovino



Surgical treatment for obesity gaining in popularity By Theresa Agovino ASSOCIATED PRESS NEW YORK Theresa Agovino
A lifetime of attempted diets didn't stop Andy Schlesinger from ballooning to 705 pounds.

At 13, he was a chronic overeater who weighed 200 pounds. His desperate parents tried everything from padlocking the refrigerator to electric shock treatments to keep him from adding more weight. At 32, the 5- foot-eleven-11-inch exporter reached his maximum weight and was practically homebound.

"I'd take five steps and be out of breath," he recalled.

Sheer size kept him out of many places. He didn't fit in movie theatre seats or public toilets. He broke bar stools.

Two years ago, he submitted to surgery that drastically reduced his body's capacity to hold and digest food. He now weighs 203 pounds, and is making up for years of lost time, travelling and trying activities like jet-skiing.

"The surgery was a tool that gave me back my life," said Schlesinger, now 34 who lives in North Miami Beach, Fla. "I can't even begin to explain what it meant to me."

Schlesinger's operation, called bariatric surgery, limits how much the stomach can hold, often to the size of only an egg, and sometimes involves rerouting the lower intestine. It is an increasingly popular procedure, reflecting an increasingly overweight population and a growing number of doctors and hospitals moving into treatment of obesity.

This year, some 75,000 people will have the operation, up from about 45,000 in 2001 and 25,000 three or four years ago, according to Dr. Kenneth Jones, president of the American Society for Bariatric Surgery. The society's membership has doubled in the past three or four years to 500.

From 1991 to 2000, the number of obese adults in America increased 61 per cent to 38.8 million, or about 20 per cent of the adult population. The common measure of obesity is the body mass index, calculated by dividing a person's weight in kilograms by the square of his or her height in metres. Anyone with an index of 30 or above is considered obese.

To be eligible for surgery, a person must be what is called morbidly obese, or have an index of 40 or above. According to the industry publication Health Care Strategic Management, some 13 million to 16 million people in the United States are in that category.

"The market for this type of surgery is tremendous," Jones said.

There are four types of bariatic surgery. In the most common procedure, called a Roux-en-Y gastric bypass, the stomach is separated and a very small pouch is created through stapling or banding. That curtails food intake. Next, a section of the small intestine is redirected to the pouch, bypassing the first and second sections of the intestine to limit food absorption.

While operations cost from about $14,000 to $35,000 (U.S.), some hospitals say they are losing money because of insurance reimbursement and costly start-up expenses. Training nurses, psychologists and nutritionists to treat the obese takes time and money. Wheelchairs that can carry the obese can cost $40,000. Operating tables can run $90,000. Ongoing counselling is required for patients.

Most insurance companies offer some type of coverage for obesity treatment, but just how much varies widely. Some insurers have yet to acknowledge advances in bariatric surgery since the operations first were performed in the 1960s, when failure rates were high.

Today, doctors say the success rate is about 90 per cent, although about 1 per cent of patients will die. Doctors say the risk is acceptable because the morbidly obese have a very high likelihood of early death from problems such as diabetes, high blood pressure, high cholesterol and sleep apnea.


Theresa Agovino, Surgical treatment for obesity gaining in popularity. , The Toronto Star, 04-27-2002.