|First character of title||Commenter||Comment Information
No one decides to be obese. However, when an
obese makes the life-changing decision to do
something about it, the benefits need to be
there. Bariatric surgery for the treatment of
morbid obesity is expensive, but it's a lot
cheaper in the long run than all the health
problems that insurance companies pay for to
support their morbidly obese clients. The
benefits of the surgery last a lifetime. Don't
take the coverage away from those that need it.
I am horrified that Medicare is considering
covering a procedure that is an unnatural
assault on the human body.
Do not let this happen. Too many people have
already died at the hands of these procedures.
More money should be spent looking at the
problem of fat discrimination in this country.
That is the real problem.
Being fat does not increase health risk, as new
studies have shown.
But fat discrimination kills in the form of
bulimia, anorexia, and innumerable eating
Title: A reality check
I notice most of the patients here who are singing the praises of bariatric surgery are less than 2 or 3 years post surgery (or pre op). What few statistics are available on people 10 years post op and over are not near so rosy as those in the "honeymoon stage" would like us to believe. And there are about 1000 members who are on a yahoo group for "gone wrong" bariatric surgery, most of which are definitely not happy and some of which are extremely ill from the surgery. Before you spend taxpayer money to cover bariatric surgery you should do some serious research on the percentages of healthy post ops, over 10 years out from surgery and also, on how many regained the weight.
Another issue you might wish to explore is that a recent study suggested that people over 60 should not diet at all, not even with something more sensible than surgery with a slower weight loss in a safer program. It pointed out that dieting for older people might actually shorten their lives and put them at greater risk of
Finally the idea that an individual cuts their life in half by being very obese is not proven in medical literature at all. In fact, an analysis study done by those favorable to bariatric surgery estimated that having a gastric bypass might add 3 years of life. That is a morbidly obese person would, according to this estimation live 3 years longer WITH surgery than they would if they did not have surgery. So far the bariatric surgery industry has released no long term data to the public although there have been a couple of studies going on. This suggests that the long term repercussions and success rate of the surgery might not be favorable.
I am opposed to Medicare funding for bariatric
surgery. Little to no research has been done on
the long term effect of such surgery. I have lost
over 10 friends to bariatric surgery, some on the
table and others years later. In years to come it
will be viewed much as lobotamies(sp) on the brain
to cure mental illness are viewed today.
Organization: representing myself as an individual
I opposed federal funding of bariatric surgery and
ask that you no recommend such coverage. Side
effects of such surgery include a dramatically
higher death rate than other sugeries, high risk
of additional surgeries, as well as malnutrition.
This is a dangerous and risky procedure which
should not be encouraged.
Title: Food Services Supervisor
Organization: University Health Network - Toronto, ON, Canada
I don't understand why bariatric surgery should be covered under insurance when, in the majority of cases, visits to Registered Dietitians are not covered. People can also get a tax credit for using weight loss services such as Weight Watchers, but as yet there is no tax credit for visiting a Dietitian.
This seems to me a gross oversight. Registered Dietitians are the public's best source of nutrition information and personal diet counselling. Nutrition is a wildly popular topic among the public (as evidenced by the huge number of diet/nutrition books published every year, most of them by authors without proper credentials), and yet the public is left to fend for itself, so to speak, in the wilderness of hucksters, quacks, and bizarre theories all driven by profit motives.
Nutrition is a key component in preventing some of the major diseases of our age: cardiovascular disease, Type II diabetes, and some cancers. We will not be able to move into the next era of truly preventative healthcare until nutrition, and the formally recognized practitioners thereof, is given proper accomodation in regard to insurance benefits as well as public education on the difference between a Registered Dietitian and anyone hanging out their shingle as a 'nutritionist.'
If the US is really so concerned about the 'obesity epidemic,' providing coverage for visits to Registered Dietitians should be a priority. As it is, it looks as though the special interest pressure exerted by bariatric physicians might take precedence over a treatment that might actually work without being invasive and potentially life-threatening.
Surgery does nothing to address the growing problems of eating disorders and body image disturbance present in both women AND men in the US. It is viewed as many by a 'quick-fix' alternative to behavioural modification, and many people are left uninformed about the real risks and complications involved in this surgery.
I plead with you not to cover this type of surgery, and instead to invest in a preventative treatment that can not only address obesity, but also eating disorders, and the growing social stigma attached to being fat. Our country is in body crisis at present, and the services of Registered Dietitians are sadly unrecognized in the very field where they could be best put to use.
Organization: University Health Network
I want to add that most people commenting here whooppose the surgery, myself included, are FATPEOPLE. Anyone who thinks that we are prejudicedagainst the surgery because we don't understandwhat it is like to exist as a fat person iskidding themselves.
This surgery may indeed be appropriate for peoplewho are in immediately life-threateningsituations, when it is used as a last resort.Unfortunately, this surgery seems to have alreadybecome far more popular than needed. Furtherfunding by CMS would only exacerbate that problem,I'm afraid, unless very strict and enforceablerestrictions are put into place. In our currentclimate of "get rid of fat at any cost," I verymuch doubt whether such restrictions would be used.
I don't doubt that many fat people have seendietitians, that this surgery is a difficultdecision to make, etc. What I doubt is the entiremodel of a healthcare system that promotes a riskyweight-loss surgery (for which the long termeffects, say 20-30 years, are unknown, and forwhich the complications can result in furtherrisky surgeries) over promoting HEALTH and bodyacceptance.
Fat people can remain fat and enjoy good health.Unfortunately, some fat people will come to thissurgery as a way to escape the social stigma,health be damned. And in our current paradigm,this will be accepted by doctors (who havethemselves evidenced "anti-fat bias" in empiricalstudies) because they believe it is impossible tobe both fat and healthy.
Weight loss does not automatically equal healthimprovement. It may be so in some cases, but theoverwhelming demand for weight loss treatments tocure social, not physical, problems will burstthat dam, no matter how many fingers you stick in it.
Title: US Citizen
Morbid and super morbid obesity are serious illnesses. They require serious attention. I have seen a lot of comments from people who have relied on hearsay. I have researched bariatric surgery for 4 years. The mortality rate is less than 2% and the success rate is between 60 and 85% depending upon which surgery you choose and your compliance. Also, bariatric surgery is the only known cure for Type II diabetes.
On the other hand, can you tell me the mortality rate of a 55 year old morbidly or super morbidly obese individual? What if that individual has Type II diabetes? And compromised kidney function because of the diabetes? How about vascular disease? How about the effort it takes to lug around a 4-500 pound body. Have you ever had to try to oxygenate a body that large? Life is not pretty when you get over 350 pounds at 5'3".
People who seek this solution do a lot of soul searching before they request being cut-up. These surgeries are not an easy way out for obese people. They require a lifetime of supplementation and compliance. These surgeries can be reversed if there are life threatening complications down the road.
I do believe in complete screening. Most docs require a psych eval. A patient's motives also need to be questioned. If a pt is looking to become a size 8, that is not a real expecation. A person needs to realize that weight loss is only 80 - 90% of excess weight. You could still be overweight, but you will at least not be morbidly obese.
Also, the public needs to understand that Medicaid approval of bariatric surgery does not mean it is only for senior citizens, that there are many people under the age of 65 who are covered by medicaid.
Title: Director of Patient Financial Services
Organization: Mesquite Community Hospital
CMS should define the list of comorbid conditions
that qualify a patient for bariatric surgery. In
addition, CMS should adopt criteria for
facilities and surgeons who deliver these
procedures (including 23 hour lap band
Title: Registered Nurse
I whole heartedly support payment of weight loss
surgery (WLS) for the morbidly obese.
Comorbidities of obesity are costly and bring
suffering and enormous expense to all involved.
WLS is the only research proven, successful
treatment for weight loss. Criteria should be
set so that patients don't undergo this serious
surgery without significant thought and with the
understanding that it is just a tool in the fight
for normal weight. As a Registered Nurse who
cares for hospitalized patients with obesity
related problems, I would welcome a possible cure
for the helpless/hopeless affect I see in many of
the obese patients with problems.
Cover IT!!! It is unbelievable how many people
here posting against have thier FACTS completely
and utterly wrong. WLS does not have a HUGE
mortality rate, WLS does not have a HUGE failure
rate - it has a large SUCCESS rate - if people
follow the rules. This is not an EASY way out -
this surgery changes your life FOREVER to help you
get HEALTHY because nothing absolutely NOTHING
else worked. And it is REVERASABLE. The people
posting against this I can only assume have never
faced being obese, never had to deal with what its
like to be trapped under all the weight. I suggest
to them they go sensitivity training, and put on
the "fat person" suit so they can see how day to
day living and facing People hurts, because being
obese has never been "accepted" and people hurt us
Title: Executive Director
Organization: NAASO, The Obesity Society
NAASO, The Obesity SocietyComments on Coverage Review of Bariatric Surgery
Re: NCA Tracking Sheet for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R)
Thank you for the opportunity to make comments regarding the NCD request for bariatric surgery for the treatment of obesity. We are writing on behalf of NAASO, The Obesity Society. We are the leading scientific organization in the field of obesity. Founded in 1982, our mission is: “To promote research, education and advocacy to better understand, prevent and treat obesity and improve the lives of those affected.”
NAASO membership is comprised of the 2,000 leading scientists and clinicians in the field. Our journal, Obesity Research is the leading journal in obesity and our Annual Meeting is the world’s largest scientific meeting dedicated to obesity.
Over the past ten years a consensus has emerged that surgery can produce substantial weight loss and may markedly improve a number of health outcomes. This consensus is supported by the findings of the National Heart, Lung and Blood Institute (NHLBI) in 1998, the AHRQ 2003 Technology Assessment, and the CMS MCAC panel in November of 2004, among others. NAASO supports these conclusions, and believes that surgery does have its place in the obesity treatment continuum.
In response to your questions posted in the NCA Tracking Sheet for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R)
Is the evidence adequate for evaluating health outcomes of the bariatric surgery procedures listed in the request?
We do agree that the evidence is adequate to support the safety and effectiveness of the surgical options included in the requested NCD.
Should CMS define the list of co-morbid conditions that qualify a patient for bariatric surgery?
We agree that it is appropriate to include as examples the list of currently known co-morbid conditions of obesity. However, obesity is a complex disease and through research, we are continuing to expand our knowledge of its effects. As we learn of new co-morbid conditions, obese patients with these conditions should not be denied access to care because the condition is not included on the list.
Should CMS adopt criteria for facilities or surgeons who deliver these procedures?
Data support the fact that patients are more likely to have successful surgical outcomes if the surgery is performed in a facility that is adequately equipped and staffed and by a surgeon who is properly trained and has performed a number of surgeries. [Flum D 2004. Impact of gastric bypass on operation survival: A population based analysis.] We support the inclusion of criteria for facilities and surgeons, and suggest that these criteria be based on those currently being used by the surgical societies.
Is there a need for routine data collection on the delivery or outcomes of bariatric surgery?
We believe there is a need for routine data collection, particularly in certain populations such as the elderly. There is a lack of data for elderly obese patients. However, we do not wish to see unnecessarily burdensome procedures implemented that may increase the complexity of the process and may reduce the number of participating providers. We recommend that the data collection process be developed in collaboration with affected physician societies.
Finally, we were also pleased to see included in the request the coverage for long-term post-operative care. NAASO believes that without proper pre and post-operative care patients may develop serious complications or may not maintain their weight loss. We strongly encourage inclusion of coverage for perioperative care to help ensure the best outcomes possible.
Thank you for your consideration.
Sincerely,Louis J. Aronne, M.D. FACP, PresidentThomas A. Wadden, Ph.D, President-elect Eric Ravussin, PhD, Vice-PresidentGary Foster, PhD, Secretary/Treasurer
Title: Director of Clinical Affairs
Bariatric surgery has a 1:200 risk of mortality. New data reveals that approximately 80% of patients regain their weight within 5 years post bariatric surgery. The silicone lap band procedure results in such significant post-op complications that 80% of the patients requires lap band removal. Other complications include malabsorption disorders, acid reflux, osteoporosis, and body disfigurement that requires extensive cosmetic procedures. There is still much yet to learn about the long-term effects of bariatric surgery. Given these facts why should government funds be used for a surgical procedure that has significant post-op complications, high mortality rates and is proven to be an ineffective long-term treatment for obesity. Obesity is more than
a disorder of over-eating and sedintary lifestyle. Obesity is caused by an unhealthy obsession with eating. Unless the underlying psyche is addressed and a permanent life-style change occurrs, no intervention will be successful.
Organization: Personal. Like, a taxpayer?
Let's see. At least 50% of the people who
have "weight loss" (and regain) surgery are still
fat two years after the surgery. The death rates
are between 2 and 20 percent, depending upon
procedure and whether or not the deaths caused
directly by the surgery have been masqueraded
as "obesity" related. Aaaaannnnddd, fat peopls
who exercise are as health as, or healthier, than
people of any size who don't. And, even if the
surgery doesn't kill them, the weight yoyoing
(just like in all those other schemes that fail
98% of the time) creates or exacerabates hearth
disease and diabetes. So, why do you want to
cover these procedures again?
Oh, right. So a bunch of immoral quacks can screw
over even more people for even more money.
You've GOT to be kidding.
Lifestyle interventions should be the source of
treatment: EXERCISE! Pay for programs that add
physical atcivity back into people's lives.
Title: Housewife and Mother
All of you who oppose this surgery, have ANY of you actually seen a fat 90 year old? No, you haven't, because obesity kills more people than the surgery does. If you add up what the government would pay for treatment of obesity related ailments, such as diabetes, high blood pressure, etc, including equipment such as wheelchairs, it would add up to LESS than what it would cost for the government to cover the surgery for that person. Personally, I'd rather have the surgery, lose the diabetes, high blood pressure, be able to walk again. Think before you speak.
You try exercising when your legs won't support you. You try dieting when your metabolism is so slow that your body laughs at the word "diet".
For the love of God. If you are going to comment on this site, KNOW THE FACTS BEFOREHAND.
If you are able to post a comment that means you have access to the internet. RESEARCH PEOPLE. Visit the message boards on the net. You will find all the evidence you need to see that the benifits of surgery outweight the risks. This is a lifesaving procedure. It benifits all obese patients with or without co-morbidities. Obesity kills. There is risks with any type of surgery.
There are quite a few different kinds of surgery being performed. Each has benifits and drawbacks. Each person is different and has different issues to consider. The patient and the surgeon has to decide which is best for the patient.
Please continue to cover bariatric surgery, all of them. This surgery is not forced on anyone. We have a choice.
If it deemed medically necessary we have the right to have all of the procedure covered just like any other lifesaving procedure.
The documentation on the safety, effectiveness, advantages and disadvantages is available, JUST ACCESS IT AND READ IT. The proof is there for anyone to see.
When you have the facts in front of you, then you can make an intelligent decision on whether or not it should be covered.
Is there evidence that this procedure increases
life expectancy, or even (with all the side
effects and associated deaths) improves their
long term health? No. I wouldn't be surprised
if weight loss surgery increases long term costs
rather than decreases them, and reduces people's
long term quality - and quantity - of life rather
than increasing it. First, do no harm...
The Institute of Physical Medicine and Rehabilitation (IPMR) has a successful and well established weight management program in collaboration with the University of Illinois College of Medicine at Peoria. The majority of our patients are over the age of 50, with an age range up to 82. Our program is only available to individuals who have a lifetime history of weight loss and gain, who have co-morbidities such as diabetes, hypertension, etc., which cannot be effectively managed without weight loss, who must delay orthopedic surgery until a significant weight loss occurs, or who have had prior bariatric surgery but can no longer sustain weight loss.IPMR is a non-profit organization and since there is no third party reimbursement for these services, we have priced the programs significantly below cost, to ensure access to medically underserved individuals.
With appropriate physician services, physical activity recommendations, evidence-based nutritional recommendations and psychotherapy as needed, we have found bariatric surgery is rarely necessary. The complication rates, the lack of appropriate and long term psychological support in the majority of surgical programs, and the absence of long term studies of medical efficacy raise significant questions about bariatric surgery programs.
We are now treating individuals who had bariatric surgery years ago who have regained the weight (and acquired new co-morbidities along with the old ones). Because of the permanent changes from the surgery (e.g. reduced calcium absorption) dietary and exercise choices are far more restricted. We understand bariatric surgery is warranted in specific and well-defined cases. But it is neither a quick fix nor is it a substitute for a medically sound, evidenced-based weight management program.
CMS is well able to distinguish which procedures are efficacious when treating arthritis and which are quackery. If the race to cover bariatric surgery is driven by an inability to judge the merits of "diet plans," there is no reason why CMS, with appropriate diligence, should not be able to distinguish fad and fiction from evidence.
Organizations other than the surgeons and manufacturers currently cashing in on this new phenom need to be brought into the dialogue before any coverage decisions are made. The unintended policy consequences and long term chronic damage from creating an incentive for this surgery need to be weighed carefully.
As an American who is deeply concerned about the
welfare of my fellow Americans, I would like to
say that I am strongly opposed to the Government
coverage of gastric bypass surgery.
This is a dangerous procedure with horrific side
effects. It artifically induces something that
cannot be maintained long term by the majority
of surgery recipients. The net effect of the
surgery is often to leave one in worse shape
than prior to surgery. Perhaps there should be
a greater emphasis on proper nutrition and
physical activity, rather than a presupposition
that anyone who is heavy is a good candidate for
this surgery, regardless of their health.
Should CMS define the list of comorbid conditions
that qualify a patient for bariatric surgery?
Yes, there should be a clearer comorbidity list
than what is provided.
Should CMS adopt criteria for facilities or
surgeons who deliver these procedures? Yes - this
is becoming a cash cow for many hospitals, they
are trying to enter into the field without the
Is there a need for routine data collection on
the delivery or outcomes of bariatric surgery?
Yes - this might help limit the number of
Organization: Obesityhelp.com We are the true voice
I think that if you have never been overweight you should have no say...period! Its an individual decision and if you don't live with morbid obesity than you have no idea what it's like. I hear everyone addressing the bad and not the good. Look how many people have their lives back!
I definitly think that bariatric surgery along with other treatments for morbid obesity should be a covered benefit. Morbid Obesity is a disease and anyone with a disease deserves treatment. If people don't believe it's a disease they should try living just a very short while with all the complications Morbid Obesity adds to your life, and then go back to being or maybe for the first time in their lives being a weight that is not disabling or health destroying. Yes there should be some criteria for who is eligble for these surgeries. The covered surgeries should be only those with the highest success rates. We often hear about the negative failures of weight loss surgery. The people who died, or the ones who gained their weight back. What we don't hear all the time is why people died, or if they had the problem before surgery that led to their death. I know that is often the case and some have actulally had longer, more productive lives because of surgery. We don't hear that the people who regained weight often do so because of a surgical malfunction. The staples come out, the stoma stretches, things like that. Stop and consider too their are possible risks and complications with all surgeries. All surgeries are more highly complicated on a Morbidly Obese person. Does that make the Morbidly Obese person less worthy of treatment? I don't think so. Being Morbidly Obese is being short of breath, it's having chronic joint pain, urinary incontinence, heart blockages, diabetis, high blood pressure, depression, back aches, having to pay for two air line tickets when you travel, not being able to fit on amusement park rides, not being able to play with your children or properly clean your house because it hurts to much to move that much, not being able to properly clean yourself when you've gone to the bathroom because you can't reach,it's more difficult to control body odors, difficulty concieving, being rejected by the general public, passed over for jobs, socially ignored, being made fun of right in front of your face as if you don't count, perceived as less intelligent, and a host of other things that go along with it. Weight Loss Surgery changes all of that. I also think the reconstruction of skin and muscle should be covered procedures after weight loss surgery when they are medically necissary and interfering with a persons quality of life. If you are against this being covered because people don't have to pay for Medicare then you should be against Medicare not the procedures. Many people on Medicare are not there because they want to be and many have worked a lot of years paying into the system. Don't be so judgmental. Spend a few minutes walking in the shoes of the person on the other side.
I do not believe that Medicaid should cover WLS.
More research that documents the long-term
effects of the surgery should be done before
taxpayer money is used.
Please allow your consumers an opportunity to
have Bariatric Surgery. Medicare will save so
much money in the long run, because the
consumers will be able to get off of many
medications, have healthier lives and have great
gratitude to you for giving them a second chance
on life. Please consider this form of treatment
for the Morbid Obese. Any questions, please
feel free to call me. I will be glad to answer
any questions you may have concerning this
need. Thank you for reading this brief