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Weighing the Options
Aired August 29, 2003 - 20:25 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SOLEDAD O'BRIEN, CNN ANCHOR: Want to lose some weight? You could go on a diet. You could get some exercise. Or you could to do what more and more people are doing, have surgery.
It's estimated that 120,000 Americans this year will have gastric bypass, or bariatric, surgery in order to lose weight.
Here to discuss this growing trend is Professor Glen McGee. He's the associate director for education at the University of Pennsylvania Center for Bioethics. And he joins us from Philadelphia. And from Cleveland, Professor Paul Ernsberger. He teaches about nutrition at the Case Western Reserve Medical School.
Gentlemen, good evening. Thanks for joining me.
O'BRIEN: Professor McGee, let's begin with you.
The procedures, the number done, the percent, has climbed 40 percent in a year alone, up to 80,000. And many, as we just mentioned, are expecting that that number is actually going to go to 120,000 next year. Does that huge increase over such a short time, does that trouble you?
GLEN MCGEE, UNIV. OF PENNSYLVANIA CENTER FOR BIOETHICS: It troubles me.
And it's a part of a big increase broadly in what you might think of as fee-for-service procedures. Most of these so-called bariatric surgeries, where the stomach is either stapled or shrunk surgically by removing part of the stomach, are performed by surgeons who, like most cosmetic surgeons in America, haven't been specially certified to do this kind of operation. There are enormous side effects that can happen.
Proponents of the surgery say it can reduce Type 2 diabetes, which costs Americans up to $100 million a year. It can help people who are really, really -- the so-called morbidly obese patient lose weight. But what is really happening today is that more and more Americans who are just a little bit overweight are considering this procedure instead of diet or exercise.
O'BRIEN: Professor Ernsberger, then, it sounds as if, if doctors are going ahead with patients who may not be morbidly obese, this is a cash cow, is it fair to say, for doctors? PAUL ERNSBERGER, CASE WESTERN RESERVE MEDICAL SCHOOL: Yes, it can be very profitable for physicians and also for the hospitals, because there's not only the procedure, but people often have complications and need to go back for additional procedures. There can be extended hospital stays.
And there's very extensive follow-up treatment, which may be done by the surgeon or by a gastroenterologist for the rest of the patient's life. And there's very severe complications. So the net cost to the health care system is going to be tremendous.
O'BRIEN: At the same time, Professor McGee, doctors would say, you want to talk costs? OK, let's talk some numbers. Look at the savings. Obesity-related conditions, like diabetes and heart disease, breast and colon cancer, those add up to $100 billion. And then, if you look at the numbers we have up here, these are the costs of other cosmetic surgeries, $8,000 for a face-lift, $6,000 if you want to get your breasts done, $6,500 for a tummy tuck.
O'BRIEN: They'd say, overall, actually, what they're doing is providing a service that, in the long run, will actually save a lot of money.
ERNSBERGER: That's wrong. That's already been disproven.
MCGEE: Yes, I think that's right. And, moreover, you better have your platinum card, because insurers are not going to be willing to pay for this.
Insurance companies have kind of wiggled about this. Some have said, yes, we'll pay. We'll go ahead and cover this for the morbidly obese patient. And that's -- one in 2,000 patients would qualify under the typical guideline. There, yes, you probably will see, assuming even some side effects, a real reduction in risk over the long term...
ERNSBERGER: No, you don't.
MCGEE: ... for some kinds -- well, if you will excuse me, actually. For Type 2 diabetes, I think I'll give them that it's clear that the data that's been published, in "The New England Journal of Medicine," for example, does show this is effective.
But the reason I think that this procedure is such a dangerous, in fact almost sham, surgery, is that, frankly, it isn't going to do that for most people. And obesity, as I think most of us recognize, is usually a symptom of a broader problem. So, if what you've really got is an emotional trauma that you're recovering from, from childhood or something that happened recently that's very stressful in your life, if you're eating, as it were, to make yourself feel better -- there's a whole literature on how food has become so related in American life to our emotions -- cutting your stomach in half isn't going to solve that problem.
And, moreover, it's likely not going to help with the weight.
O'BRIEN: Professor Ernsberger, proponents would say it is the only effective way to keep the weight off, to take the weight off. And then you look at the host of celebrities who very successfully had the surgery who look fantastic. Is what they're saying relatively fair, that it works? It seems like you're saying it's not shown to be effective.
ERNSBERGER: Well, that's one thing I'm saying. What you see is people in the honeymoon period. So weight loss will peak at about one and a half to two years. And then people regain the weight. I've talked to many people five, 10 years after having gastric bypass, they've regained the weight, but now they're having severe side effects. The side effects are permanent, the weight loss is not.
But I want to say something about the effectiveness. Does this save money? There's already been one clinical trial done in Sweden where they had a control group that got diet and exercise. They had another group that got surgery. The surgical group lost more weight. But they had to pay just as much for medications, and hospitalization was much more expensive. There's not only the hospitalization for the surgery, but also for the complications. The obese people who dieted did not -- they had very few days in the hospital. So this does not save money. Swedish studies proved that.
O'BRIEN: And that's going to be our final word on that. Professor Paul Ernsberger, and also professor Glen McGee, thanks for joining us this evening. Appreciate it.
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