With weight-loss surgery, type of insurance counts
People with private health insurance lose more weight after having weight-loss surgery than those covered by the Medicare health insurance program for the elderly and disabled, U.S. researchers said Monday.
Medicare patients tend to weigh more before having gastric bypass surgery, they said, and are more likely to be depressed, have high blood pressure, heart disease, diabetes, cholesterol and sleep apnea.
For them to succeed, they may need extra exercise and nutrition support, they said.
"Gastric bypass surgery is very successful so we should work to ensure that everyone has the same chance at success," said Dr. John Morton of Stanford University School of Medicine in California, who presented his findings at the Digestive Disease Week meeting in Chicago.
Gastric bypass surgery is becoming an increasingly popular treatment for obesity. It works by altering the digestive tract to reduce the volume of food that can be eaten and digested.
Large insurance companies and Medicare, the federal health plan for 44 million elderly and disabled Americans, help pay for the surgery -- which costs from $15,000 to $35,000 -- in severely obese people.
For the study, Morton and colleagues collected data on 750 gastric bypass patients with private insurance, Medicare or Medicaid, a state-federal insurance program for the poor.
A year after surgery, all patients had significant weight loss, but the private insurance patients lost more, Morton said in a telephone briefing.
"The Medicare group lost 57 percent of its excess weight, but in comparison with the private insurance group, this was much less, with the private insurance group losing about 82 percent of their extra weight," he said.
The Medicare group had slightly higher complication rates, but there were no deaths from any of the operations.
Morton said patients in the Medicare group had the biggest reductions in levels of low-density lipoprotein, or LDL, the so-called bad cholesterol that causes heart disease.
They also had bigger improvements in fasting insulin, a measure of diabetes severity.
Morton said patients in the Medicare group started out much heavier than other patients, with average body mass index scores of nearly 50, putting them in the so-called super-obese category.
Body mass index, or BMI, is a formula that takes into account a person's height and weight. A BMI of 30 is considered obese. People with a BMI of 40 to 49 are considered morbidly obese, while those with a BMI of 50 or higher are considered super obese.
Morton said the study shows that some Medicare patients are starting with more profound disadvantages, and may need more support.
He said morbid obesity is the leading public health crisis in the United States, and bariatric surgery is the only effective treatment for many patients.
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