You’ve probably seen the statistics. In Louisiana, more than 35 percent of adults report being obese, one of the highest rates nationwide. Obesity can lead to diabetes, heart disease, liver disease, gallstones, high blood pressure and cancer. The annual health cost for Louisiana’s obese population has ballooned to a staggering $3 billion. Medical claims, sick days, short-term disability and workers compensation expenses for a worker with obesity costs employers around $8,100 a year, more than twice that of a normal-weight worker.
The percentage of people who have obesity grows each year, so much so that businesses practically need witchcraft to reduce those health costs.
But this kind of sorcery is in short supply … with one possible exception: weight-loss surgery.
A large percentage of type 2 diabetes patients who undergo bariatric surgery experience a change so profound that some scientists, not to mention a recent article in the Journal of the American Medical Association, refer to it as “magic.”
Within days of surgery, most patients’ diabetes symptoms go into remission. Many no longer need diabetes medications. Overeating is less of a struggle. Months after the pain of gastrointestinal surgery has faded, some patients who might have consumed 3,000 calories or more each day are content with less than 2,000.
“Bariatric surgery has the ability to reverse type 2 diabetes in over 75 percent of cases.” — John Kirwan
Dr. Hans-Rudolf Berthoud, a professor at LSU’s Pennington Biomedical Research Center, says the “miracle” behind early diabetes remission is easily explained: severe starvation and the accompanying weight loss. Bariatric-surgery patients’ diets are often severely restricted before surgery. Afterward, they typically receive 500 calories or less per day for 10 to 20 days, and if given to patients with obesity but without surgery, this low calorie diet leads to the same rapid improvements in blood-sugar control , Berthoud says.
Based on studies in rodents recently published in the International Journal of Obesity and Obesity, Berthoud and his collaborators concluded that bariatric surgery may reprogram the body mass set point, the narrow range where a person’s weight normally stays.
After surgery, patients often don’t want to eat as much as they did before. Although many continue to battle cravings and the desire to eat, winning the fight becomes easier. “The reasons for this are not clear, but many researchers think that some surgery-induced changes in the gut send signals to the brain making the patients happier with less food,” Berthoud says.
Meanwhile, surgery-specific effects that don’t depend on weight loss are also contributing to diabetes remission, Berthoud says. Both of these effects warrant further investigation, as their understanding could eventually lead to knifeless treatments.
All of those changes add to the patients’ quality of life and can add up to profound savings for employers.
The annual health care costs for severely obese people plunged by 57 percent after surgery, according to a study called “Heads Up” conducted by LSU’s Pennington Biomedical Research Center for the state’s Office of Group Benefits (OGB).
Big weight loss and even bigger health savings?
On average, the annual health costs for a severely obese person – someone overweight by at least 100 pounds – dropped an average of $7,822 when compared to a severely obese person who did not undergo surgery.
“Projections for savings in health cost indicate that the state could recoup the expense of all 490 surgeries in six to seven years and begin to realize more than $2 million in savings each subsequent year,” says Heads Up study Principal Investigator Dr. Phil Brantley.
A planned five year follow-up of each surgery patient will confirm these predicted benefits. Pennington Biomedical is collaborating with OGB and Blue Cross and Blue Shield of Louisiana on the study. The Heads Up Obesity study enrolled 1,412 participants, starting in 2012. Of those, 490 underwent surgery.
“Not only are we discovering that bariatric surgery has the ability to reverse type 2 diabetes in over 75 percent of the cases, we are also seeing that it can reduce hypertension and the overall medication burden on diabetic patients,” says John Kirwan, Pennington Biomedical’s executive director.
Some 922 participants underwent nonsurgical intensive medical intervention, which involved up to four months on a low-calorie diet and nine months of behavioral lifestyle change group counseling sessions. The nonsurgical interventions netted average savings of $4,674 per person, or 35 percent when compared to obese members who weren’t treated.
The participating workers showed significant improvements in weight, blood sugars, cholesterol, and blood pressure. The workers also reported significant improvements in their quality of life, from self-esteem and physical functioning to quality of sleep and sexual functioning.
Ricky Brock, director of Pennington Biomedical’s Comprehensive Obesity Management Program, rejects the word “magic” in referencing weight-loss surgery, or scientific research for that matter. “No magic. But it is currently the most effective treatment we have,” Brock says.
The annual health costs for a severely obese person fell 57 percent after weight-loss surgery. – LSU Pennington Biomedical Research Center
Brock cannot claim other businesses could expect similar results, although its possible firms would see some savings in a comparable population.
Berthoud also sounds a cautionary note. There are major limitations to the study, including the post-surgical observation period, he says.
Most patients underwent surgery around at around 40 years of age and are expected to live another 40 years. The projected savings are only correct if there are no surgery-related complications later.
Still, employers may well find the potential cost savings enchanting.