by Shelley Bond
Editors’ Note: Last month, an article in JAMA Surgery reported that bariatric surgery was not associated with health care cost savings as previously believed by many insurance companies and health care analysts. The authors examined the health records of 29,820 BlueCross BlueShield plan members who had bariatric surgery with a 1:1 matched comparison group of persons not undergoing surgery. The study used health records dated January 1, 2002, through December 31, 2008. Overall, the authors concluded that “Bariatric surgery does not reduce overall health care costs in the long term.” The study focused exclusively on financial costs, though the authors do suggest that “future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.” We agree that the focus should be on health and well-being, and asked ASDAH Board member Shelley Bond, who has been outspoken about her opinion of bariatric surgery, if she would be willing to share her thoughts on the “costs” of weight loss surgery.
At the time I chose weight loss surgery (WLS), I was new to the HAES® concepts. I didn’t understand how they could—and eventually would – be an extremely positive part of my life and would lead to the self-acceptance that I’d never had. I was feeling desperate about being fat and was just coming off of a summer where I had been in many new situations and where I keenly felt my weight was a very negative factor. I felt desperate and hopeless. Let me be very clear: WLS is not a choice I would make today. It never made me thin and has left me with physical vulnerabilities and requirements that negatively remind me of that choice every day.
The following is not a study of any kind—just an observation from planet Shelley.
I had a Roux-en-Y technique weight loss surgery about 10 years ago. Of the eight or so people I personally know who have had WLS, I am the only one who has not had to have hospitalization or surgery to correct a subsequent problem related to the operation. Those are costs I’ve not had to pay, but many or even most people do incur them.
At the time, I had no trouble receiving the blessings of the insurance company for me to go ahead with the surgery. Since I doubt that the insurance company was concerning itself with my (perceived) happiness, I’m guessing I received their go-ahead based on the belief that I would be a less costly customer for them in the future if I was thinner, no matter their bariatric surgery costs. I’m bewildered by this, as WLS has been around now for many years. Haven’t the insurance companies been keeping tabs on what sort of costs their insureds have accumulated post-surgery either relating directly to the WLS or to the post- WLS body?
What sort of costs am I talking about just for me, who hasn’t had to have any subsequent surgeries or hospitalizations? Prior to surgery—and since my mid-20s—I’ve been treated for hypertension. Post-surgery, my blood pressure never really went down, and over the years my BP meds have changed and increased, all of which involved many doctor visits and medications.
I didn’t have diabetes at the time of surgery, but I developed it about a year ago, which surprised me: I didn’t know it was possible to get diabetes sometime after having WLS. This disease involves specialist visits every quarter, along with many fine drugs and monitors and testing strips. And diabetes comes with its own set of possible side effects which can be costly and life-changing, resulting in surgeries, hospitalizations and expensive medical equipment. Diabetes appears to be a pricey disease for the insured and the insurer.
At the time of my surgery, I was just entering the stage in life where people may develop joint inflammation/soreness due to arthritis. A post-WLS body cannot take anti-inflammatory meds. So for pain (in my case due mostly to a back injury from an accident in the 1980s, as well as occasional joint pain) I take prescription medications prescribed by a physiatrist.
And then there are the vitamins… It is recommended that you take a multivitamin, plus extra supplements of calcium, iron, vitamin B12, vitamin D, and vitamin K. Because the area of the intestine that absorbs the best has been bypassed, I need to take at least twice the recommended dosage of these vitamins and minerals or I will become malnourished. These supplements are very expensive. The supplements are so important that I have blood tests several times a year to make sure I am taking enough. Despite the supplements, I’ve had a difficult time maintaining acceptable levels of both vitamin D and iron.
Here are a few more costs that I don’t know quite how to compute into dollars. Again as a result of my inability to fully absorb food now, I must eat at least 70 grams of protein per day. That can be expensive. Since the surgery, I have a hair-trigger digestive system. My slight lactose intolerance pre-surgery has become a raging lactose intolerance. (Do you know that most drugs contain lactose? Every time I get a new prescription I need to be sure it either doesn’t have lactose or has amounts so small that it won’t upset my digestive system. This lactose sensitivity makes me miserable, and that’s a high price to pay!) I can’t eat most legumes. When I am not careful enough about my food intake, I pay for it in a most inconvenient way and too often end up canceling plans and staying at home as a result.
A few parting thoughts… I lost 100 pounds as a result of the surgery. I’ve regained about half of that. I’m very sorry that I had gastric bypass surgery and whenever possible I recommend not to do it when I’m asked my advice on the subject. The cost is very, very high.