Weight Minimums Block Some Surgeries
Surgery is generally a last resort after traditional ways to shed the pounds — such as diet and exercise — fail. Even so, there are strict rules for who can go under the knife.
Federal guidelines say surgery candidates must be morbidly obese with a body mass index over 40, or a BMI over 35, plus a weight-related medical problem like diabetes or high blood pressure. Insurers use the cutoffs in deciding whether to pay for the procedure.
BMI is a calculation of height and weight used to estimate body fat. Overweight begins at a measurement of 25, obese at 30 and morbidly obese at 40. A 5-foot-6-inch person is considered overweight at 155 pounds, obese at 186 pounds, and morbidly obese at 248 pounds. The current BMI limits for obesity surgery were set by the National Institutes of Health in 1991. (To compute your BMI, use the National Institutes of Health’s calculator.)
Dr. Philip Schauer of the Cleveland Clinic is among those pushing the BMI envelope. For a study, he's recruiting 150 overweight and obese diabetics with BMIs between 27 and 43. Some will have surgery and their progress will be compared to those who manage their diabetes with medicine. The goal is to see which group can achieve complete remission.
Smaller studies have hinted that stomach stapling and gastric banding — in which an adjustable ring is placed over the top of the stomach to create a small pouch — may work in diabetics who aren't so fat.
"These procedures can cause long-term remission and restore someone to normal blood sugar levels without medication," Schauer said.
How does the surgery help some diabetics beat the disease? Doctors don't exactly know, but there is some evidence that it may not all be due to weight loss. Diabetes occurs when the body can't regulate blood sugar, and some researchers think that the rerouting of the digestive tract after the operation affects the gut hormones involved in blood sugar control.
Last year, 220,000 people had obesity surgery, which can cost between $14,000 and $26,000, according to the American Society for Metabolic and Bariatric Surgery.
The surgery is fairly safe. In a 2009 study, death, serious complications, or the need for a repeat procedure occurred in 1 percent who received bands, about 5 percent who had minimally invasive gastric bypass, and nearly 8 percent who had traditional bypass.
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