The Bariatric Examiner

May 2010: Inaugural Release

In this issue...
(click the following links to jump down the page to each section, or use the scrollbar on the right to review all news and research updates)

1. Bariatric surgery procedure updates
   • Important sign of lap band erosion
   • Lap band surgery for low-BMI patients
   • Revisional bariatric surgery: 13-Year Results
   • New Procedure: ReShape Dual Balloon device for non-surgical weight loss
2. Insurance & Financing
   • 2 major insurers now cover gastric sleeve surgery
   • Weight loss surgery covered by employer wellness program
3. Obesity-related Health Problems
   • Obesity & coronary heart disease: National Health & Nutrition Examination Survey
   • Breathing after bariatric surgery
4. General News & Research
   • Controversial weight loss surgery center for teens opens
   • Lap band surgery may be an option for obese children

Bariatric Surgery Procedure Updates

Important sign of lap band erosion

• Study Objective: To determine whether band management after surgery, band size, or filling beyond the manufacturer-determined maximal volume has an effect on the incidence of erosion at a university hospital in the United States.
• Study Conclusion: A band that needs to be overfilled might be a sign of lap band erosion, and patients should undergo endoscopy. Band revision has a greater rate of erosion than primary banding. The Vanguard band has a greater risk of erosion than the 4-cm3 bands.

Click here to review the study’s complete abstract.

Lap band surgery for low-BMI patients

• Study Objective: To determine whether patients with a BMI that does not meet the current National Institutes of Health body mass index criteria could also experience similar weight loss from bariatric surgery and the benefits associated with it.
• Study Conclusion: Moderately obese patients whose BMI is less than the current guidelines for bariatric surgery will have similar weight loss and associated benefits. Laparoscopic adjustable gastric banding is a safe and effective treatment for patients with a BMI of 30–35 kg/m2.

Click here to review the study’s complete abstract.

Revisional bariatric surgery: 13-Year Results

• Study Objective: To evaluate the safety and effectiveness of revisional bariatric surgery at a tertiary institution. Revisional bariatric operations for unsuccessful weight loss or intolerable complications following the primary intervention are increasing.
• Study Conclusion: Although revisional bariatric surgery is associated with higher risk of perioperative complications compared with the primary procedures, it appears to be safe and effective when performed in experienced weight loss surgery centers.

Click here to review the study’s complete abstract.

Also see: Gastric Bypass Revision Surgery

New Procedure: ReShape Dual Balloon Device for Non-Surgical Weight Loss

ReShape Medical™, Inc. has begun the government process of assessing the safety and effectiveness of its new dual-balloon device, which can be implemented without surgery.

According to the manufacturer, the ReShape Dual-Balloon “is designed to be placed in the stomach during a 15-minute outpatient procedure using only deep conscious sedation. The balloons remain in place for six-months and are then removed.”

The balloon is designed to expand in the stomach to help patients lose weight by making them feel full sooner.

Click here to go to ReShape Medical’s website for more information.

Insurance & Financing

2 major insurers now cover gastric sleeve surgery

Aetna Inc. and United Healthcare now cover laparoscopic gastric sleeve surgery, according to a report from the American Society of Metabolic and Bariatric Surgery (ASMBS).

When asked about the addition, John Baker, president of the ASMBS, had this to say…

"In the rapidly changing field of bariatric and metabolic surgery, it is important to provide coverage and access to a wide range of proven treatment methods. Sleeve gastrectomy has now reached that threshold where the data and our experience with the procedure supports its safe and effective use in people affected by the chronic disease of morbid obesity."

The procedure was previously considered “investigational” by both Aetna and United Healthcare. We expect other insurance companies to begin to follow suit shortly.

For more about weight loss surgery insurance, see our Bariatric Surgery Insurance ( DS, VBG, Gastric Bypass, Gastric Sleeve and Lap Band Insurance ) page.

Weight loss surgery covered by employer wellness program

Hawaii Pacific Health (HPH) has become one of the first employers to add weight loss surgery to their employee wellness program. Rather than having employees share in the cost of surgery as is the case with most insurance-covered weight loss surgery, weight loss surgery coverage through the HPH wellness program is both outside the scope of the insurance contracts and is 100% paid for.

According to Gail Lerch, Hawaii Pacific Health’s executive vice president of human resources and organization development, “it will cost us far more in medications and lost attendance for our employees, who we are helping to make changes in their life…We take the cost out of the equation…what’s more significant is, we’re reducing absenteeism and helping them get off of all the medications they’re taking for those other health problems. We know it’s not a magic bullet and it’s not for everyone, but we’re chipping away at it because the fact is, it’s easier to take a pill than exercise, and this requires a little more work.”

So far, about 25 employees have received bariatric surgery through the program.

For more information about business reasons to add bariatric surgery to a company's employee benefits package, see our Weight Loss Surgery Insurance page.

For the full story, click here.

Obesity-related Health Problems

Obesity & coronary heart disease: National Health & Nutrition Examination Survey

• Study Objective: To examine the differences in the 10-year coronary heart disease risk with increasing severity of obesity in men and women participating in the latest National Health and Nutrition Examination Survey.
• Study Conclusion: The 10-year CHD risk, calculated using the Framingham risk score, substantially increased with an increasing BMI. An important implication from our findings is the need to implement surgical and medical approaches to weight reduction to reduce the effect of morbidity and mortality from CHD on the U.S. healthcare system.

Click here to review the study’s complete abstract.

Breathing after bariatric surgery

• Study Objective: To assess whether patients undergoing bariatric surgery would have fewer respiratory symptoms after surgery as evidenced by decreases in respiratory prescription drug claims.
• Study Conclusion: Respiratory medication use decreases significantly after bariatric surgery. A secondary benefit of bariatric surgery may include a decrease in respiratory symptoms and concomitant medication use.

Click here to review the study’s complete abstract.

General News & Research

Controversial weight loss surgery center for teens opens

The first bariatric surgery center for teens in Colorado has opened its doors at the Rose Medical Center in Denver.

With around 17% of all American children suffering from obesity, teenage weight loss surgery is becoming more popular. Proponents of teen bariatric surgery site the same benefits as bariatric treatment for adults. But some fear that teen treatment may not be safe.

At the Rose Medical Center, most teenage bariatric patients receive lap band surgery. To be approved by the hospital, patients under 18 years of age must be at least 100 pounds overweight and must have been unsuccessful with previous diet and exercise programs.

Bariatric Surgery Source is currently diving into the research on weight loss surgery for teens and will release our findings shortly (sign up for The Bariatric Surgery Blog to be notified).

For the full story, click here.

Lap band surgery may be an option for obese children

Lap band surgery for children... are surgeons pushing things too far?

Dr. David Ludwig, a leading childhood obesity researcher from Children’s Hospital Boston, used to think so, but not anymore.

And it appears that federal regulators may agree: a new gastric band manufactured by Allergan is seeking approval for sale to children as young as 14.

As with the above-referenced article, the debate rages on about whether bariatric surgery for individuals under 18 is appropriate.

For the full story, click here.

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