Weighing options: The business of helping obese patients

Bariatric surgery: With increasing obesity rates pushing demand for their services, bariatric surgeons find themselves busy.

Carnie Wilson had fleeting fame as a pop singer with her group Wilson Phillips. Instead, it seems her most lasting influence will be in the field of bariatric surgery.

What once was a procedure considered by few suddenly became mainstream when the daughter of Beach Boys founder Brian Wilson had her 1999 laparoscopic Roux-en-Y gastric bypass operation performed live over the Internet. This year, nearly 60,000 people w ill undergo weight loss surgery in the United States, 50% more than in 2000, according to the American Society of Bariatric Surgery.

As a result, the number of general surgeons receiving additional training to become bariatric surgeons is rising as well. Membership in the American Society for Bariatric Surgery has grown by about 30% over the last two years. About 572 doctors are mem bers. In June 2001, the society received membership in the AMA's House of Delegates.

But Carnie Wilson can't take credit for all of this, even if some surgeons say her surgery was a turning point. What's also piquing doctors' interest is that, increasingly, insurers are paying for the procedure as they try to deal with the costs of an ever-growing, literally, populace.

As of 2000, about 20% of the U.S. was obese, defined as having a body mass index of 30 or higher, according to the Centers for Disease Control and Prevention. That number was at 12% in 1991. Twenty-two states, mostly in the Midwest and South, had obesi ty rates higher than 20%; zero were at that level in 1995. Forty-three states reported obesity rates of 15% or less in 1991; in 2000, only Colorado made that claim.

The "insurance companies have all of a sudden realized that if they paid for this, they'd save money," said Paul Selinkoff, MD, a bariatric surgeon in San Antonio.

In 1981, while a surgeon in the U.S. Air Force, Dr. Selinkoff performed his first bariatric surgery, having to learn after his boss told him that one had been requested.

"For years and years I was the only bariatric surgeon between Amarillo and the Mexican border. There were none in Austin. None in Corpus Christi. None in Waco. None in Laredo. I was it."

Now, the practice of bariatric surgery is so competitive, and the demand from patients so strong, that many surgeons are putting up Web sites, running television commercials and using other means to establish themselves early as a prime physician in a fast-growing field.

Meeting patients

About 60 people are sitting in a conference room at Good Samaritan Hospital in Downers Grove, Ill., outside Chicago, on a warm April evening, listening to a presentation from bariatric surgeon H. Richard Wienke, MD.

If the pattern from past seminars holds, at least 80% of those in attendance will at least come by the office for a consultation, usually paid for by an insurer. The center performs 40 to 50 surgeries a month.

Dr. Wienke and his three fellow surgeons at the Weight Intervention and Surgical Healthcare (WISH) Center, along with psychologists, nutritionists and nurses, host nine free seminars a month, with about 50 to 60 people per seminar. Many of the patients have done extensive research on the risks and rewards of bariatric surgeries, so they already know about how they'll have to prepare weeks in advance by beginning diet and exercise, about the side effects such as nausea, intolerance for certain foods, fe wer bowel functions and some hair loss.

Registered nurse Janet Beaudry was there -- as a potential patient. She and her 17-year-old daughter, Amanda, had heard of the session through a WISH Center television commercial.

Janet Beaudry wants to lose at least 100 pounds. "My main reason is I have diabetes and I use insulin," she said.

Amanda, who weighs 400 pounds, wants to drop 250 pounds. Her weight has contributed to depression. About seven months earlier, Amanda tried to commit suicide. That's when her family sought information about the surgery on the Internet.

"We were prepared to go to California," Janet said. Instead, they had to drive only 30 miles from their Joliet, Ill., home.

Not everyone who walks into a session is eligible for surgery, though.

Patients qualify generally under their insurance plan if they have had a body mass index of more than 40 for more than a year and have failed at other ways of taking off pounds.

Another group that qualifies, she said, has BMIs between 35 and 40 along with other health problems including diabetes.

More people are requesting the procedures, said Janet Maurer, MD, corporate medical director for CIGNA HealthCare.

"The CIGNA policy is based on a case-by-case basis. We look at each case individually," Dr. Maurer said.

About 20% to 25% of the patients at the practice of Eugene, Ore., surgeon Kenneth Welker, MD, pay out of pocket. About 30% of insured people don't have the coverage in their policies, he said.

"Over the last five years, many of the insurers have come around," said Dr. Welker, chair of the American Society of Bariatric Surgery's group insurance committee.

The cost to the average patient can be anywhere from $5,000 on up, and in most cases the surgeon gets less than one-third of that. Surgeons continue to monitor their patients' diet and exercise habits, as well as their health, for years afterward; ofte n that cost comes straight out of the patient's pocket, depending on what the insurer will cover. The reimbursement for the surgery has decreased over the years.

Hospitals and physicians often will cut deals for patients who pay in cash.

Whatever the payment is, it's not slowing down the number of patients asking for surgery. Dr. Selinkoff said his appointment schedule is backed up for 21/2 years.

By Cheryl Jackson