Demand for stomach-shrinking operation booms

THE BALTIMORE SUN

Doctors and hospitals across the country are scrambling to satisfy the booming demand for surgery that shrinks the stomachs of severely obese people.

Dozens of hospitals are adding operating suites for the procedure, called bariatric surgery, which attracted wide notice after public figures such as Al Roker of NBC's Today program, Sharon Osbourne of MTV's family reality show and Rep. Jerrold Nadler, a Manhattan Democrat, had the operation. Some bariatric surgeons are fully scheduled 12 months in advance, and hundreds of doctors have jumped into the field recently and started to advertise their availability.

Bariatric procedures - meant for obese people at extremely high risk for severe health problems, as defined by a National Institutes of Health consensus - increased more than 40 percent last year, to 80,000. This year, the number is expected to climb to 120,000, according to Frost & Sullivan, a consulting firm. Spending on bariatrics is approaching $3 billion a year, at an average cost of $25,000 for each procedure.

With the number of people eligible for the procedures growing by an estimated 10 percent to 12 percent a year, bariatric surgery is profitable for many hospitals - and more so for surgeons. But the costs are a major concern for insurance companies and employer health plans. Surgeons say some insurers routinely delay approvals.

"The companies throw up roadblocks," said Dr. James Rosser, a surgeon at Beth Israel Medical Center in Manhattan. "They keep requesting more information. Patients are left to really hound the insurance companies to get the approvals."

Doctors and patients are putting pressure on insurers to lower the body-size threshold on paying for people who have advanced problems with diabetes and other weight-related diseases. That could triple the number of people potentially eligible for surgery to more than 30 million, a panel of medical advisers to Blue Cross and Blue Shield was told recently.

Most bariatric procedures produce weight loss by restricting the intake of food. Part of the stomach is partitioned off, and the intestines are rerouted. Afterward, many patients lose their outsize appetites.

The procedure is approved for patients at the upper end of the body mass index, a measure of weight in relation to height. Under National Institute of Health guidelines, widely followed by health plans, candidates must first try diet and exercise regimens.

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