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Belts Tighten Over Stomach Surgery

The popularity of stomach-shrinking surgery has hospitals adding special operating rooms, specialists booked a year in advance and doctors rushing into the field, a newspaper reports.

But it's also posing a dilemma for insurers and businesses: Is it more expensive to deal with obesity-related health problems, or pay for the increasingly popular surgery?

In the operation, known as bariatic surgery, the volume of the stomach is reduced to cut down on the patient's appetite.

According to The New York Times, bariatric procedures increased 40 percent last year, with 80,000 occurring nationwide. In 2003, the market for bariatric surgery is expected to leap by 50 percent and approach $3 billion, at $25,000 an operation.

The procedure is used only on very obese people, about 10 million Americans. But that pool of patients is growing, says the newspaper — at a rate of 10 to 12 percent a year.

The soaring number of surgeries is good news for hospitals and doctors, but a blow to insurance companies and employers who pay for their workers' coverage.

Those companies are trying to rein in the costs. New York surgeon Dr. James Rosser tells The Times that some companies "throw up roadblocks" and "keep requesting more information. Patients are left to really hound the insurance companies to get the approvals."

Medicaid's reluctance to pay has prevented some poor people from undergoing the surgery. At one California hospital, patients with Medicaid must wait 12 years for the operation, and the hospital is reimbursed for only one-third of the cost.

When the price of aftercare is added to the cost of surgery, the total bill for some patients can top $100,000.

However, businesses lose $12 billion a year because of obesity, in the form of medical bills, lost workdays, lowered efficiency and higher health insurance premiums. Obesity's health impact costs the nation as a whole $120 billion or more, according to the National Institutes of Health.

Doctors say bariatric surgery, while expensive, could reduce those costs.

"Morbid obesity is life-threatening, and surgery is the only treatment that works," University of California at Davis hospital bariatric surgeon Dr. Bruce Wolfe. "The hospitals don't have much choice but to respond."

Doctors are trying to get insurers to allow more people to get the operation by lowering the body-size threshold, potentially making 30 million patients eligible. Providers also say insurance companies need to do more to encourage patients to receive lifelong follow-up care.

Doctors use a measure called the Body Mass Index to measure body weight. A person with a BMI over 25 is overweight, and over 30 is obese.

Bariatric surgery is usually for people who are morbidly obese, meaning they have a Body Mass Index rating over 40, who cannot lose weight by other means. Less obese people might also have the surgery if they have particular health problems, like diabetes, according to the American Medical Association.

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