Treating Obesity

Abstract

According to the 2003-2004 National Health and Nutritional Examination Survey, the prevalence of obesity among U.S. adults was 32%, with almost 5% of adults falling into the morbidly obese category.1 The highest increase in rates of obesity is among adolescents and young adults, suggesting that the obesity epidemic will continue to grow.1'2 Concurrent with the increase in obesity trends, obesity-related diseases have also increased. In fact, obesity and obesity-related diseases have almost surpassed tobacco as the most significant cause of preventable death.3 As could be anticipated, healthcare expenditures attributable to obesity are increasing.4 Estimated healthcare expenditures attributable to obesity accounted for 9.1% of the total U.S. healthcare expenditures for fiscal year 1998.4 The burden of the obesity epidemic on healthcare resource utilization has been demonstrated for every aspect of the healthcare delivery system. Increases in physician office visits, hospital admissions, hospital length of stay, general surgical procedures, nursing home admissions, and prescription drug usage have been described for obese patients.58 However, none of the aforementioned increases in healthcare utilization come close to the explosion observed in the use of bariatric procedures during the past decade. Both the adaptation of advanced laparoscopic techniques for the treatment of morbid obesity and the lack of effective alternative therapies both have contributed to the increase in bariatric procedures. Numerous large surgical series report successful weight loss and the resolution of comorbidities after bariatric procedures.9 These successes have led surgeons to pursue training in laparoscopic techniques and patients to pursue surgical treatment of obesity. In this issue of Medical Care, Encinosa et al10 attempt to quantify the intermediateterm costs and complications for a population-based cohort of patients undergoing bariatric procedures. The researchers found that complications requiring readmission, emergency room, or outpatient hospital visits occurred in nearly 40% of patients during the 6 months after their bariatric procedure rates much greater than the traditionally reported ones of 10-20%. Slightly more than half of the complications occurred during the initial hospitalization but, surprisingly, the researchers found that nearly 11% of patients who did not have a complication in the initial 30 days developed 1 between 30 and 180 days. By including emergency and outpatient visits, these authors more provide a comprehensive snapshot of the utilization of the healthcare system after bariatric surgery. Overall, 7% of patients required readmission to the hospital after their bariatric procedure during the 180-day follow-up period. As would be expected, patients with complications requiring readmission had a greater than 2-fold increase in healthcare expenditures than those not requiring readmission. These authors, as well as others, begin to explore the complications and costs associated with bariatric surgery that occur after the initial hospitalization for the procedure. By comprehensively examining utilization of all aspects of the health care system, not just hospital readmissions, Encinosa et al10 were able to provide a more complete picture of the intermediate-term resources used by patients undergoing bariatric procedures. Unfortunately, what they did not address was the costs and resource utiliza-