I'm very interested in hearing your responses to
this NY Times article, published September 30, 2004 and copied below. Discussing Medicare's potential coverage of weight loss surgery, this article by author Gina Kolata contains a grim view of the long-term efficacy of weight loss and it's accompanying health benefits.
The sections in bold are my own (fairly liberally applied) emphasis.
So what are your thoughts? I'll tell you mine. This reminds me of that other piece of horse**** Meg so kindly shared here not long ago. It's potentially destructive in its role as a weight loss deterrant, and I wonder where they get their data?? That said, regain statistics are staggering......so what's the verdict? You guys are living it, so you're the experts.
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Weight Loss Surgery May Soon Be Paid by Medicare
By GINA KOLATA
Published: September 30, 2004
Carmen J. Pirollo expected his latest attempt to lose weight would take a while. At 5 feet 11 inches, he wanted to weigh 180 pounds, down from 260. A veteran dieter - "I've lost and gained a whole person in my lifetime" - he knew it would not be easy.
But while Mr. Pirollo, a 55-year-old sixth-grade teacher in Haddon Heights, N.J., says he is healthy, he worries that his excess weight might take a toll on his health. And, of course, he wants to look good.
"I'm an American," he says. "We live in a society where people have to be beautiful."
Who should pay for people like Mr. Pirollo to try to lose weight? For decades the answer has almost always been the patients themselves.
That soon may change.
At a meeting in November, Medicare's advisers will assess the safety, efficacy and cost of one increasingly popular method of weight loss - surgery - as a first step in a new policy that could lead to the use of federal money to cover a range of other obesity treatments.
Yet, at a time when coverage by Medicare and other insurers may increase, the evidence suggests that few obese people can lose significant amounts of weight in the long term. And some obesity researchers are also questioning the fundamental idea that losing weight improves health. Are weight loss programs, they ask, unnecessary medicine?
"No one wants to hear this," Dr. Jules Hirsch, an obesity researcher at Rockefeller University, said, "but I would ask where the data are."
None of the experts, however, are suggesting that people should abandon healthy eating habits and exercise, which have clear benefits.
At the moment, Medicare will pay for surgery for obesity when patients suffer other problems associated the condition, like diabetes. Now, Medicare says it may decide to cover treatment for those who are simply obese, meaning their body mass index, a measure of body fat, is at least 30.
The agency said that it would need to determine if obesity treatments help people lose weight and improve their health, adding that as yet it has no estimate on costs.
The insurance debate, for now, is aimed at the obese, not those who want to lose a few pounds here and there. But that still includes 61 million Americans, nearly a third of the adult population, and 9 million of Medicare age, 65 and older.
They include, for example, a woman 5 feet 5 inches tall and weighing more than 180 pounds, or a man 6 feet tall and weighing more than 221 pounds.
The immediate question is whether to cover so-called bariatric surgery, which costs $30,000 to $40,000 if there are no complications, and greatly reduces how much food can be consumed and the calories that can be absorbed. But commercial diet programs as well as many obesity doctors, including members of the American Obesity Association, whose sponsors include makers of weight loss drugs as well as companies like Weight Watchers and Jenny Craig, say they want coverage for other programs, too.
The obesity association said that it planned to use Medicare as a wedge to open the door for broader coverage for the obese and then, possibly, for overweight Americans.
Obesity, said Morgan Downey, the association's executive director, is a disease, and should be treated. Insurers pay for treating other chronic diseases, he added, although "there are very, very few cures out there."
Doctors, of course, have been telling patients for years that weight loss will greatly improve their health. But, in fact, there is only one long-term study following obese people who deliberately lost weight - in this case, with weight loss surgery - and comparing their health with those of similar people who did not lose weight. The results were a surprise.
The study of 692 patients by Dr. C. David Sjostrom of Goteborg University in Sweden, found, as expected, that the surgical patients lost weight - 68 pounds in the first year and 44 pounds after eight years.
Otherwise, the results were mixed. The rate of diabetes among the surgical patients remained steady, at 10 percent, but tripled to 24 percent in the patients who did not have surgery and did not lose weight.
Blood pressure, however, was a different story. It fell in the first year after surgery but then crept up again. Eight years later, the blood pressures of the surgical patients were the same as those who did not have surgery.
For the minority of obese people who are surgical candidates, the operation can turn their lives around. But they risk serious consequences, like bowel obstructions and malnutrition leading to anemia and bone loss, as well as a 1 percent to 2 percent risk of death. What is not known is whether the surgery's health benefits outweigh its risks over the long term.
Dr. Russell Harris, an internist at the University of North Carolina who evaluated weight loss studies for the U.S. Preventive Services Task Force, an independent panel of experts that advises the Agency for Healthcare Research and Quality, said that when it came to surgery, the group decided, "we just don't know" what to recommend.
Other studies have focused on populations, trying to determine whether overweight or obese people who voluntarily lost weight were healthier. Some studies found that they were; some found no difference; and some found that they actually died at a greater rate.
The reason for the dearth of information on the long-term effects of weight loss, researchers say, is that very few people keep weight off. The National Institute of Diabetes and Digestive and Kidney Disease is now, for the first time, trying to get some concrete answers with an 11-year study of 5,000 overweight and obese diabetes patients.
In justifying the new study, its designers state the quandary: "Given the paucity of data on the impact of weight loss on morbidity and mortality, an increasing number of critics in both the lay press and professional literature have questioned whether obesity should be treated at all."
Another question raised by obesity researchers is whether a fat person who loses weight is as healthy as a naturally thin person of the same weight.
It is true that thinner people tend to be healthier, but studies have found that, biochemically, the formerly fat are like people who are starving: obsessed with food, needing fewer calories to maintain their body weight. Many - again the issue is with the obese, not those who want to lose a few pounds - have slow heart rates after they lose weight and always feel cold; women may stop menstruating, even if they are still relatively fat. Is that better or worse than remaining fat? No one knows for sure.
Another unknown should weight loss turn out to improve health: How much weight must be lost? Most obese people dream of being thin, but researchers say a more realistic goal is losing just 5 percent to 10 percent of their weight.
That is the best that can be achieved in clinical trials lasting a year or two, they say, and over the short term, is associated with lower blood sugar and blood pressure.
As for other health benefits, Dr. Hirsch said, "the data get fuzzier and fuzzier."
While scientists ask questions, a robust weight loss industry takes in tens of billions of dollars each year and reaches into all aspects of society. It includes diet foods and beverages, weight loss centers, diet books and prescription medicines, diet supplements, visits to doctors, lab tests, and surgery. The Federal Trade Commission estimates that annual revenue from sales of diet foods and beverages alone reaches $40 billion.
Weight loss surgery alone has begun to hurt insurers. In Pennsylvania, the number of operations went from 674 in 1999 to 6,791 in 2003, and total charges went from $24 million to $242 million. Private insurance paid for 85 percent of the operations. In Florida, Blue Cross Blue Shield announced that it would not pay for the operation after this year, saying its costs nearly doubled in two years, to $17 million a year.
The problem with weight loss, researchers say, is that the advice so often given, eat less and exercise more, has not been much help.
Research studies at academic medical centers, providing intensive diet, exercise and behavioral therapy, result in losses of 8 to 12 percent of body weight in six months. But most people gain the weight back in a few years.
As for commercial weight loss programs, in a two-year study sponsored by Weight Watchers involving 358 people averaging 205 pounds, those assigned to the program lost 6.4 pounds. Participants who were randomly assigned to try to lose weight on their own lost nothing. Neither group showed a change in blood pressure or levels of cholesterol, blood glucose or insulin.
While Weight Watchers did not have much of an effect, "it's as good as most academic centers do," said the study's lead author, Dr. F. Xavier Pi-Sunyer, chief of endocrinology at St. Luke's-Roosevelt Hospital Center in New York.
It is almost impossible to tell the blunt truth about the success rates of treatments, some researchers said. "It is like resisting Mom, apple pie, and the flag," said Dr. Bruce Schneider, associate vice president for clinical research at the Association of American Medical Colleges.
Many said they know the data but encourage patients to continue trying to lose some weight, or at least stop gaining, especially those whose blood sugar level is elevated or who have joint problems that are worsened by weighing so much. Clearly, doctors have not yet given up on the idea that weight loss may improve health. Yet, they said, when they urge patients to lower their expectations about how much weight they can lose, some react with shock.
Dr. Judith Korner, an endocrinologist at Columbia University, tells obese patients that a 5 percent to 10 percent weight loss would be terrific. "Some of them look at me as though I'm crazy," she said.
Those few who succeed at weight loss may end up on what amounts to a permanent diet. People in a national registry of successful dieters - they maintained a weight loss of at least 30 pounds for at least a year - report consuming just 1,400 calories a day and walking, or doing equivalent exercise, for an hour a day.
Still, people who lost weight said they felt better, they looked better, and they found just moving around and going about their daily lives much easier.
That leaves a question, Dr. Hirsch said. "If it's all that good, why don't people maintain their weight loss?"
Mr. Pirollo, who lost 30 pounds since March, said he was confident he would reach his goal and that this time his weight loss would last. He would like insurers to pay but his latest treatment as a participant in a two-year clinical trial costs him nothing. Already, Mr. Pirollo reports, his doctor halved his dose of blood pressure medication.
But insurers have to make some tough decisions, said Dr. Madelyn H. Fernstrom, director of the weight management center at the University of Pittsburgh Medical Center.
"Let's say your weight went down 20 percent, but your blood pressure did not change,'' she said. "Your self-esteem may be better. But the payer might say, we're glad you're happy, but the bottom line is, Are you saving the company money?"
NY Times Article 9/30/2004
) Why? He said that it’s not that our bodies are different NOW that we’ve lost weight; it’s the way we were born. It’s that old cave man survival thing — how we’re the people who are exquisitely evolutionarily adapted to live on very few calories. He cited those same NWCR statistics that are in the article about the 1400 or 1500 calories and hour of exercise per day and says it’s because we’re the survivors. In other words, it’s in our genes -- it is was it is (too bad it sucks 
).
