Weight Loss Surgery Can Reverse Both Obesity and Type 2 Diabetes
Obesity is a major contributing factor to type 2 diabetes, a condition affecting about 24 million people in the United States. Lifestyle changes and weight loss have been shown to lower blood sugar levels, leading to improved health. Weight loss surgery for those who are significantly obese has also been shown to reverse diabetes. In a recent study from Johns Hopkins, nearly 75% of patients eliminated their diabetes medications within six months of bariatric surgery.
Study evaluated 2,235 diabetic patients who had weight loss surgery
Lead researcher Martin Makary, associate professor of surgery at the Johns Hopkins University School of Medicine, and colleagues evaluated 2,235 adult diabetic patients who had bariatric surgery between January 1, 2002 and December 31, 2005. The patients were covered by Blue Cross and Blue Shield insurance and about 86% were on at least one diabetes medication prior to surgery. About 23% were on insulin.
Many patients were able to stop taking medications almost immediately after surgery, even before they had lost weight. Previous research has shown that hormones altered by surgery are able to better control blood glucose levels than weight-loss alone. Almost 85% of patients remained off diabetes medications two years later. Many were also able to stop other medications as well, such as those for high blood pressure.
Most insurance carriers have a medical policy for bariatric surgery outlining the pre-surgical requirements, such as BMI, access to nutritional and psychological support, and a “waiting” period where patients must participate in a structured weight loss program in preparation for surgery. However, bariatric surgery coverage is often provided as a “rider”, meaning that employers who choose to cover the weight loss intervention must pay more for each employee. Many opt out due to financial concerns. Even with coverage, only about 15 to 20% of patients who are eligible for surgery are given a referral by primary care doctors.
However, the study from Johns Hopkins underlines the healthcare cost savings that weight loss surgery can provide. The average cost of treating each patient before surgery was $6,376 up to two years before surgery and $10,592 in the year leading up to surgery. In the year following bariatric surgery, the average cost per patient was $6,992, but fell to $4,197 in the second year and to $1,878 three years after surgery.
Some insurance plans are realizing the potential of this study. South Carolina State Employees, for example, have previously not been covered for bariatric surgery under the State Health Plan, which is managed by Blue Cross Blue Shield of South Carolina. Beginning in 2011, the Employee Insurance Program will offer 100 patients coverage for weight loss surgery in a pilot program to address the high rate of obesity in the state. Sixty-five percent of South Carolina residents are overweight or obese.
Arch Surg. 2010;145:726-731.