Should obesity be classified as a disease?

I wonder if those rates will be better with more "medical" programs? I think those figures might include people who are going it alone. Maybe more support = more success?
I know that the stomach stapling will be covered but I'll bet that programs, esp Medicaid as it relies on more state funding and is run by states, will have some strict rules about who gets it.
As to the success of stomach reduction, I think I've read that people have to eat small portions after the surgery otherwise they could get really sick. Have you heard the same? I guess that might be some motivation to stick with it.

[Auspicious]

As to the success of stomach reduction, I think I've read that people have to eat small portions after the surgery otherwise they could get really sick. Have you heard the same? I guess that might be some motivation to stick with it.

It's my understanding that if you deviate from the prescribed diet too much, you feel debilitatingly sick for about an hour, which pretty much removes the temptation to overeat.

[houseelf]

I'm too lazy to go back through this thread to discern whether this has been discussed or not, but DH says that a significant portion of gastric bypass patients "out eat" their surgery within a few years and become obese again. Some of these patients go in for a second operation. 8O

This surgery is on the fairly risky side with a higher than average mortality rate and tons of post-op complications. This certainly is not a quick fix.

Kelly

[Auspicious]

I gotta say, I haven't really seen gastric bypass presented as a quick fix anywhere. Even the fluffier things I've seen and read about it, like celebrity interviews, talk about all (or most) of the risks and side effects discussed here and how it's still a tough row to hoe. I think "looking for a quick fix" is one of the unfair images society has about obese people.

I was kind of under the impression that because this is a surgical procedure and not a corporate endeavor that this had been spared much of the commercialization/marketing/blind promotion that plauges most of the rest of the weight-loss industry. Whatever sources are promoting it as a simple or easy or worry-free solution I've missed.

[PrincessFiona]

I don't know that I've necessarily seen it presented as a 'quick fix'... I guess I'm drawing that skewed view from a specail that I saw on tv about a woman who had the procedure done....did anyone else see this? She had a daughter and was a single mom and was profoundly overweight. Whe was taken in by a christian couple before/after the procedure. She did have great weight loss at first and even lost enough to have plastic surgery (ie the skin on her tummy removed)...then she started acting out in other ways...drinking/staying out with men, etc...because many of her underlying problems weren't addressed. At the end of the special I was struck by the fact that her daughter had become obese. Maybe that is where I am getting my negative feelings about all of this???

I know that they do the bariatric surgery here and I'd be lying if I said I hadn't thought about it myself because of my own weight struggles. The people are required to go through counseling before the procedure and are supposed to lose 10 pounds on their own first....

I guess my fear is that as this becomes a more acceptable procedure it will be viewed more and more as a quick fix solution...?

I guess my fear is that as this becomes a more acceptable procedure it will be viewed more and more as a quick fix solution...?

This is just being picky....but I would say more common rather than acceptable. I don't think it's really a looked down on procedure.

I think if Medicare and Medicaid are paying for it, it will be more common. (I'm really curious about how Medicaid programs will handle this and if and how it will be covered). So, instead of hearing about Al Roker and that singer (daughter of beach boys or mama & papas, I can't remember), we will hear about our neighbor, family member, etc having the surgery. Given the side effects and downsides, we will also hear more about those too. But I'll bet that the successes of people we see on a day to day basis will win out and demand will increase.

[SueC]

I haven't been following this topic at all, but I did want to add a little to the gastric bypass conversation. I actually do have a neighbor AND a relative (not the same person ) who has had GB surgery. Both were morbidly obese and one of them had both knees replaced about a year ago. I'm sure if her weight doesn't come off, she has many other complications to look forward to in the future as a result of her size. I would think assuming the surgery is in fact a success it might be more cost effective for the insurance company to cover it than to pay for the multitue of problems that might otherwise occur. My cousin has had GB twice. The first one didn't take (according to her, her body rejected the staples, but I suspect she might have overeaten and caused her stomach to stretch back out--I don't know for sure). Because her insurance company didn't cover another surgery (and I'm not arguing that they should have), she went to Spain and paid out of pocket for the procedure. She came back and spent months in the ICU (and almost did not survive) due to infection, which I'm sure you already know is a huge risk with this surgery. I'm sure she cost her insurance company a fortune in that instance. Luckily, she pulled through and is now down to a normal size. As she is only in her 30's, she added years to her life. I think this surgery is already becoming more common, but I would hope with the high risk of complications/mortality it will not be thought of as a quick fix. So I guess, I would be in support of GB surgery to treat people who are beyond hope when it comes to weight loss. In my cousin's case, she was told she absolutely would not live much longer if she didn't lose weight. I know she got herself there by overeating, lack of exercise, but when somebody gets to 500+ pounds, what else is there?

[DCJenn]

Medicaid already will pay for it if there is a physician's prescription- like if you will die without it. but, this is the same medicaid that won't pay for general dental care but WILL pay for emergency dental surgery. Which is what youwill need without general dental care.

When I am in charge of HHS, life will be better for all.

I promise.

Jenn

[PrincessFiona]

When I am in charge of HHS, life will be better for all.

I promise.

Jenn

Go Jenn!!! We're right behind you!!!

Sue, it sounds like your cousin's insurance paid for it? I was wondering if any private insurance was currently paying for it. Makes sense that some would for the reasons you gave -- much higher costs to be paid. I think that more private insurance -- but not all -- will pay for it given the Medicare decision.

Jenn, you just let me know when they put you in charge of CMS. I'll give you my list. Thanks for M'caid info, I was wondering what they were doing about it. Is that the case for most states?

[SueC]

Yeah, they paid for it the first time, and I believe they paid for her ICU stay after the second one. I'm sure she maxed out her out of pocket expense since she was there for a couple of months.

[Sheherezade]

When I wrote of the surgery being presented as a quick fix, I was incorrect. I guess what makes me uncomfortable is the operation's new popularity . I have seen it on the cover of People, Newsweek, Reader's Digest and now National Geographic. Al Roker and Carnie Wilson talk about it in multiple reports. Still, from those that I've read, the weight still took a year to come off. It isn't liposuction !! The woman who plays a nurse on ER lost a ton of weight using a medically monitered diet and exercise program out of UCLA (I think). I read one article on that. It seems that the surgical option is just more "sexy" (as my old lab advisor used to say about some hot new idea).

I know we aren't allowed to do this---but mad scientist that I am--I wonder what would happen if you took one group of people the gastric bypass surgery and gave the other no surgery but the same food/exercise/lifestyle post op for a year. Both groups would lose the weight, right? It just seems extreme to do the surgery when it is the behavioral changes post op that actually result in weight loss.

From the Nat Geographic article: 15% of surgeries fail because patients snack continuously throughout day and keep total daily intake high; 1/100 surgeries result in death.

As long as we are revealing our bias When I was in Boston, the stomach stapling program was shut down for a time because of high death rate ( I think two good candidates died) and misrepresentation of the surgery to the patients. At least that was The Globe's spin......

Angie

[PrincessFiona]

It seems that the surgical option is just more "sexy" (as my old lab advisor used to say about some hot new idea).

I'm not ready to define obesity as a disease or embrace stomach stapling...I think though that if people could stick to that low calorie diet they wouldn't end up going for the stomach stapling? My mom lost 80 pounds on the optifast program several years ago...she ended up gaining it back...plus about 50 more pounds Shes' doing Jenny Craig now and it seems to be working for her....what really helps her is the weekly meetings with the nutritionist/counselor through the program and the weigh-ins. Dieting just isn't one-size fits all....it would be great to think we could find an easy fix....

Just to be clear - I'm not advocating that coverage result in a GB surgery free-for-all. It should be a last-ditch effort. It does seem like there should be more to in terms of behavior change it than the threat of horribly painful stomach cramping if you eat too much.

[Sheherezade]

Wow. You guys post fast. There are 4 new posts on this since I started typing!

I can't wait till Jenn is running HHS either--prevention seems the way to go.

And Sue- what a story. If you are 500 lbs. plus and have severe health issues I can see it. I do wonder where the line for these decisions will fall though. Al Roker was fat, but he seemed to get around ok. He could still hit the gym and money for healthy food wasn't really an issue. The woman they profile in the Nat Geog article is 5'5" and 300 lbs, but her health complaints are varicose veins, depression and high blood pressure. Bad, but not extremely abnormal in our society. I guess what I'm wondering is how fat do you have to be and how unhealthy to make the risks worth it? And is that the medical community's call, or is that an individual decision (if you meet height/weight criteria)? Some people are healthier than others with the same BMI. Is it general ill-health (obesity-related) or just obesity we use to make these decisions?

Angie