This is in stark contrast to the broad coverage offered to adults these days. Over the last ten years, there has been a steady rise in the amount of policy coverage given to adults who undergo bariatric surgery. Most companies today offer some level of coverage for these procedures. But teens are often left out in the cold.

According the Centers for Disease Control and Prevention, the obesity rate among teenagers has tripled since 1980. Today, 17% of children and adolescents are technically obese. Blame Xbox and PlayStation. Blame the Internet. Blame the parents, for that matter. You can blame whoever or whatever you want, but it doesn’t change those startling statistics. And every year, more and more of these teens use surgery to curb their obesity.

Health Insurance Obstacles

A rising number of teens (and their parents) are turning to weight loss surgery as a solution to this problem. In 2007, I wrote about a 12-year-old girl in Texas who underwent bariatric surgery. At the time, this was shocking. Now it’s commonplace. We could debate the sense and safety of this trend all day. But that’s not the point of this story. This is a tale of health insurance coverage — or a lack thereof.

“It’s harder to get teens covered [for weight loss surgery],” said Robin Blackstone, president of the ASMBS. “Plans just say they cover people 18 and over.”

This is a common stipulation found within health insurance policies today. Adults may be covered for bariatric procedures under their existing policies. But teens are rarely covered. Of course, this could all change over the next few years. The rising obesity rate among teenagers may force insurance companies to reexamine their policies and procedures.

Surgery Risks for Teens – A Much Needed Discussion

Bariatric surgery is often promoted with an intentional underemphasis of risks. The billboard or magazine ad shows a young, shapely woman standing on a beach, her toned arms raised in triumph. “Have weight loss surgery,” these ads imply, “and you can look like this!” The complications and risks are purposefully omitted from such ads.

Teens who are considering bariatric weight-loss surgery need to understand the risks associated with such procedures. Just ask the dozens of people who have left comments on this blog post. They’ll be happy to tell you about the darker side of these procedures. But you probably won’t hear it from the surgeons who make a living from these procedures.

Earlier this month, the FDA sent warning letters to the folks at 1-800-GET-THIN (and the surgery centers associated with that company). The company’s billboards follow the typical format described earlier: The fit and attractive woman. The not-so-subtle suggestion that you will look like her, if you get a Lap Band procedure. According to the FDA, the billboards “fail to provide required risk information, including warnings, precautions, possible side effects and contraindications.” Not surprising.

Teens may have trouble finding insurance coverage for weight loss surgery. But even worse, they may have a hard time finding the truth. Parents must do as much research as possible into the potential risks and complications of bariatric surgery. The average 15 year old is not mature enough to do this kind of research on her own.

Surgeons typically offer information about the risks of these procedures. But the parents of teens who are considering bariatric surgery should go much further with their research. After all, the surgeon is a biased source. You want to get some feedback from patients who have actually had these procedures. Fortunately, the Internet makes this fairly easy .There are several online forums and communities designed for bariatric patients. This is a great way to get unbiased information about the real-world complications and risks. You can post a question on BariatricVoice.com to get started.

Do you have questions about medical insurance for teens, as it applies to weight-loss surgery? Visit BariatricVoice.com and post your question in the appropriate group. You’ll get input from people who have been down this road ahead of you.

First, some definitions for anyone who is unfamiliar with these concepts:

Obesity — A condition of excess body fat that leads to a variety of health problems. In most cases, obesity is identified by using the person’s body mass index, or BMI. The number is calculated by dividing a person’s body weight (in kilograms) by his height (in meters). There are other methods for determining obesity, such as waist circumference. But the BMI measurement is the most widely used method today. A person with a BMI of 30 kg/m² or higher is said to be obese.

Type 2 Diabetes — A medical condition frequently seen in obese people. This condition results in high levels of sugar (glucose) in the blood. Type 2 was formerly referred to as adult-onset diabetes, and you may still see it labeled this way in some medical literature. Type 2 diabetics are often overweight. The initial diagnosis usually occurs when the patient is older than 35 years. Diabetes can lead to a variety of serious health problems, such as heart disease and nerve damage.

Bariatric Surgery — This refers to a variety of surgical procedures intended to help the patient lose weight. The bariatric “umbrella” includes stomach-banding procedures such as the LAP-BAND® System, as well as gastric bypass surgery. These procedures used to be reserved for patients who were obese. But the spectrum of eligibility has widened in recent years to include those who are merely overweight.

Does Bariatric Surgery Actually Cure Diabetes?

So what’s the connection between obesity, type 2 diabetes, and bariatric surgery for weight loss? Can these procedures actually cure diabetes, the way some people say they can? Yes and no.

Significant weight loss can certainly improve the health of an obese person with type 2 diabetes. And bariatric procedures are one way to achieve that level of weight reduction. Diet and exercise can accomplish the same thing, but without the risks of an invasive surgical procedure.

So the best option, clearly, is to reduce body weight by making dietary and lifestyle changes. But that’s not always easy for some folks. According to the National Institutes of Health, obese people “whose diabetes is not well managed with diet and medicine may consider bariatric (weight loss) surgery.”

So it’s the weight loss that reduces the effects of type 2 diabetes in patients suffering obesity. If you underwent bariatric surgery but did not lose a significant amount of weight and body fat, then you might not see any improvements at all. But if you lost a great deal of weight (and body fat in particular), the symptoms of your type 2 diabetes could very well subside.

According to numerous studies over the last few years, bariatric weight-loss surgery can reduce the severity of diabetes in obese patients. In 2010, the American Diabetes Association (ADA) began studying the potential benefits of these procedures last year.

Reviewing the Research

Erika Gebel, PhD, wrote an article on this subject for the Diabetes Forecast (the healthy living journal published by the ADA). In her March 2010 article, she explained that definitive studies on the link between bariatric surgery and type 2 diabetes could take years to complete. So we clearly don’t have all the answers yet. She goes on to point out the well-known connection between obesity and this form of diabetes. So it stands to reason that anything the reduces the patients weight will also improve the symptoms of their type 2 condition.

“Still,” she said, “the numbers are startling.” Here are the numbers Ms. Gebel was referring to:

• In 2009, a meta-analysis of 600 studies covering more than 135,000 patients found that 78% of patients with type 2 diabetes experienced total resolution of the disease after having weight-loss surgery.
• Additionally, 87% of patients studied saw improved blood-glucose levels.

So based on these studies, yes — bariatric surgery can effectively resolve type 2 diabetes in obese patients. But it all comes down to the amount of weight lost. If the procedure does not result in a significant reduction in weight, the person may not experience the same positive effects as those discussed above.

But here’s the interesting part. Certain types of surgery have been shown to resolve symptoms of type 2 diabetes even before the weight comes off. This is supposedly the case with gastric bypass surgeries. There are several theories as to why this occurs. Some researchers believe it has to do with the “rerouting” of food that results from a gastric bypass. When the path of food is altered within the stomach and intestines, the cells in the lower small intestines release more of an agent that reduces blood-glucose levels (and the effects of diabetes). Research is still ongoing in this area.

In March 2011, the International Diabetes Federation (IDF) released a position statement that promoted the use of bariatric surgery for eligible patients with type 2 diabetes. According to the press release that accompanied their statement, weight-loss surgery is a cost-effective treatment option for obese patients who are suffering from the disease. Professor George Alberti, a co-chairperson at the IDF, said bariatric surgery should be considered earlier in the treatment path, instead of being viewed as a last resort.

So is bariatric surgery the cure for type 2 diabetes in obese patients? I think it’s too soon to use the word “cure.” But it certainly shows promise in resolving the condition. We do not yet know the long-term effects, because most of the research is still young. You can rest assured this is one story we will follow closely in the coming months and years.

We will get into the details in a moment. But first, here’s a quick definition for readers who are unfamiliar with this area of medicine:

Bariatric surgery refers to a variety of surgical procedures designed to help the patient lose weight. It was traditionally reserved fro the morbidly obese. But over the last few years, the spectrum of eligibility has opened up considerably (related story). “Bariatrics” is the field of medicine that deals with obesity.

Bariatric surgery is also referred to as weight-loss surgery. The most popular treatments in this field are (A) the adjustable gastric band, (2) the gastric bypass, and (3) the gastric sleeve. All of these procedures aim to reduce the patient’s stomach and eating capacity, which leads to weight loss.

All of these weight-loss surgery options are available in Oregon. From what we have gathered, the state will cover all forms of bariatric surgery (if the patient meets other program requirements). Income is one of the primary considerations. As of now, only low-income patients will receive coverage under the Oregon Health Plan.

Dr. Lisa Dodson of the Oregon Health Services Commission says the state could actually save money in the long run. By offering coverage for certain types of weight loss surgery, the state could end up paying less in total health expenses related to obese patients. The theory is by doing the surgery on the front end, you save money in the long run.

“It’s not just about cost,” Dr. Dodson told KATU News. “We consider cost-effectiveness.”

Officials with the Oregon Health Services Commission have created a list of medical conditions they are willing to cover. Bariatric / weight-loss surgery is on the list, but priority is given to patients who have diabetes. Obese people without diabetes have a lesser chance of receiving coverage.

The state of Oregon paid for 88 bariatric surgery procedures during the period of 2008 – 2010. Health officials have not said whether they expect to cover more or fewer surgeries in 2011.

Bariatric procedures cost anywhere from $15,000 – $29,000, depending on the type of surgery, location and other variables.

Weight loss surgery is one of the fastest-growing fields of medicine. The growth rate is staggering. Between 1998 and 2004, we saw an 804-percent increase in the total number of bariatric surgeries in the U.S. No, that’s not a typo. It was an 804-percent increase. In 1998, there were approximately 13,000 procedures. In 2004 … more than 120,000. These statistics come from the Agency for Healthcare Research and Quality, a government organization.

Oregon residents who wish to undergo bariatric surgery basically have three financing options:

1. Pay for the weight loss procedure out of pocket.
2. Have insurance cover all or part of the surgery.
3. Seek coverage from the state of Oregon.

The first option is financially unrealistic for many patients. The section option is feasible, if the patient’s insurance company is willing to cover the procedure. Many insurance companies won’t cover bariatric surgeries, while others have strict requirements for body mass index or BMI. The third option (state coverage) will only be available to a select few individuals — particularly those with diabetes.

Bariatric surgeons are always clamoring for wider FDA approval, so they can perform weight-loss surgery on patients with lower and lower body mass index (BMI).

The question of the hour: Is weight-loss surgery safe for patients who are considered mildly obese? A new study suggests that it might be.

For the record, we are neither opponents nor supporters of bariatric weight-loss surgery. We maintain a neutral stance on the subject, for the sake of reporting. We also recommend that people pursue natural weight-loss techniques (such as healthy diet and exercise) before resorting to surgery. But, on to the recent study…

A doctor-led study shows that adjustable gastric banding is safe for patients who are mildly obese. Gastric banding is a process that reduces the usable portion of the patient’s stomach, often through the use of a specially designed silicone band. The study was led by Esteban Varela, MD, who currently performs bariatric surgery at Washington University’s School of Medicine.

For this study, Dr. Varela examined the post-surgery results of 30 patients who underwent adjustable gastric banding procedures. Of the 30, 20 were considered obese by current medical standards while the other 10 were only mildly obese. The research team closely monitored the patients for a 30-day period after their gastric banding procedures.

All of the patients were said to have fared well after their surgeries. There were no deaths reported, and only minor complications occurred. Most of the complications were found in the patients were severely obese, as opposed to those who were mildly obese.

A Valid Study on Bariatric Surgery?

This can hardly be considered a definitive study of weight-loss surgery. In our view, the study group was too small, and the observation period was not long enough to measure long-term complications. We would also like to have seen some involvement or oversight from disinterested parties — i.e., people who do not work in the bariatric surgery field.

It almost seems like the study was carefully crafted to deliver the desired results, which further supports the availability of weight-loss surgery to a wider audience. But that’s a matter of opinion.

You can decide for yourself. The entire study was published online in the journal Obesity Surgery. Just be aware that the editors of this journal are also bariatric surgeons.

Related: Patients complain of gastric banding problems

Dr. K. Robert Williams and Dr. Stephen Boyce, surgeons with the New Life Center for Bariatric Surgery in Knoxville, TN, earned recognition for supporting the organization’s mission an improving patient care.

Surgeons at the New Life Center for Bariatric Surgery have succeeded with vitamin supplementation for patients who have undergone weight-loss surgery. Dr. Boyce, in particular, has been helping patients achieve their weight-loss goals through the use of medically supervised diets and bariatric surgery. He has been working in this capacity for more than 20 years. Boyce claims that he offers vitamins and supplements that meet or exceed standards set forth by the ASMBS.

About the Bariatric Surgeons

Dr. K. Robert Williams graduated from the University of Virginia School of Medicine, and did his surgical residency at the Union Memorial Hospital. He has been doing laparoscopic bariatric surgery since 2003. Along with Dr. Boyce (see below), he also established the development of the New Life Center for Bariatric Surgery in Knoxville, Tennessee. after he joined him at the Parkwest Hospital in 2006.

Dr. Stephen Boyce attended the University of Texas Southwestern Medical School, and did his residency at the Parkland Memorial Hospital. He later earned a masters certification in bariatric surgery.

To learn more about these Knoxville bariatric surgeons, you can visit their website at www.parkwestcwlc.com. The surgery center is located at 200 Ft. Sanders West Blvd., MOB 1, Suite 200 in Knoxville.

Current FDA guidelines only allow the procedure for patients with a BMI of 40 or higher — unless they have health problems related to obesity, in which case they may have a BMI of 35 or higher. If the FDA accepts the recommendations of the advisory group, the number of Lap Band surgeries in the U.S. could increase significantly.

Many would-be patients fall into the 35 – 40 BMI range. Under current FDA guidelines, this would exclude them from having Lap Band surgery, unless their health is seriously being affected by their weight. If the guidelines are relaxed, however, these people would be “eligible” for the procedure.

The LAP-BAND System® is the most popular gastric-banding procedure in the United States. It works by placing an adjustable band around the upper portion of the patient’s stomach. This reduces the amount of food intake, which can lead to weight loss. The device was originally approved by the FDA in 2001. Currently, the Realize Band is the only other banding system approved for use within the U.S.

The researchers studied the post-surgery results of 13 patients who underwent bariatric surgery at the Mayo Clinic facility over a 15-year period. This group was compared to six heart-failure patients who did not undergo any type of surgery.

If those numbers seem small to you, that’s because they are. Looking at 13 patients over a 15-year period can hardly be considered statistically valid — or scientifically useful. Mayo Clinic’s Francisco Lopez-Jiminez, MD, said the following in a press release: “these results should be considered preliminary and suggestive of some benefit, but additional research is needed to confirm these results.”

If further studies are conducted in this area, it may be very meaningful for obese people who also suffer from heart failure. It has the potential to reduce the symptoms of HF, while reducing the patient’s weight at the same time. The combined health benefits of such a surgery could be significant, though certainly not without risk.

Bariatric weight-loss surgery is one of the most heavily researched fields of medicine right now. So there will likely be more research of this nature in the future. We will keep you posted as to any new developments that arise.

Insurance companies (always trying to minimize their coverage costs) argue that weight-loss surgery is an elective procedure that should not be covered by a policy. Doctors and patients, on the other hand, argue that the procedures are necessary for good health, and deserving of insurance coverage.

Over the years, more and more insurance companies have started covering weight-loss surgery procedures. You can now add MGM Resorts International to that ever-growing list.

Employees of MGM Resorts International who have the company’s preferred provider organization (PPO) coverage are now covered for bariatric weight-loss surgeries through the Gastric Band Institute of Las Vegas.

This new development results from a partnership between MGM Resorts and the Gastric Band Institute, which offers gastric banding and bypass procedures.

Dr. Jim Atkinson, owner of the Gastric Band Institute, explained how bariatric surgery can actually benefit employers in the long run: “Studies have shown that people with obesity tend to miss more work days than healthy individuals.”

Employees of MGM Resorts who have other types of plans won’t be covered under the new arrangement.

According to the presentation, female patients who undergo gastric bypass surgery for weight loss may have a higher risk of bearing children with neural tube defects.

Diana Farmer, MD, University of California San Francisco (UCSF), recounted a story about a young woman who had gastric bypass surgery to lose weight, and later became pregnant. Medical testing later revealed that her fetus had spina bifida. So the woman visited the Fetal Treatment Center at UCSF Benioff Children’s Hospital to learn about the possibility of fetal surgery.

During the case workup, six additional cases were discovered where women who had undergone gastric bypass surgery for weight loss subsequently gave birth to babies with neural tube defects. Medical professionals believe that nutritional deficiencies (i.e., malabsorption) caused the defects. Malabsorption is a known symptom of gastric bypass surgery.

According to Dr. Farmer, a lead researcher in the case: “We believe that nonreversible gastric bypass surgery should be avoided in adolescent women given the increased risk of foetal neural tube defects.”

Learn more about gastric bypass.

Two Leading Companies Commit $1 Million in Funding to Better Understand Effects of Bariatric Surgery in Patients With Type 2 Diabetes

ALEXANDRIA, VA–(Marketwire – November 4, 2010) -  Two of the world’s leading medical device companies in the fields of endoscopic and bariatric surgery are joining together to support a major, novel research effort through the American Diabetes Association.

The American Diabetes Association Research Award Program in Bariatric Surgery in Diabetes, sponsored by Ethicon Endo-Surgery and Covidien, will provide $1 million in funding to support up to three, three-year research grants through the American Diabetes Association. The research grants support the investigation of the specific mechanistic effects of bariatric surgery on diabetes. They also support translational research to improve the clinical understanding of various bariatric procedures as potential treatment options for people with obesity and type 2 diabetes.

“This represents an unprecedented collaboration between two companies that have come together to advance the scientific and clinical understanding of bariatric surgery,” said Richard M. Bergenstal, MD, President, Medicine & Science, American Diabetes Association. “We welcome this approach and the partnership as there are many unanswered questions surrounding the effects of bariatric surgery on obese patients with type 2 diabetes.”

“We certainly anticipate that these projects will shed greater light on the underlying mechanism by which substantial weight loss and bariatric procedures have been shown to improve the health of obese people with type 2 diabetes,” said Dr. Richard Toselli, Chief Medical Officer, Surgical Devices, Covidien. “This research has the potential to provide better insights into the benefits we’ve seen following surgery but which have not been well understood.”

“Diabetes is one of the leading causes of death in the U.S.,” said Kenneth Sumner, Vice President, Worldwide Scientific Affairs, Ethicon Endo-Surgery. “It has only recently come to light that the physiological response to bariatric surgery may offer some new hope for the millions of people worldwide who suffer from it. Our company is pleased to be part of this important collaboration to examine the cause and effect linkage between bariatric surgery and diabetes recovery.”

The American Diabetes Association’s request for applications (RFA) is available at http://professional.diabetes.org. Research awards will be announced and recipients notified in July 2011.

About Ethicon Endo-Surgery

Ethicon Endo-Surgery develops and markets advanced medical devices for minimally invasive and open surgical procedures, focusing on procedure-enabling devices for the interventional diagnosis and treatment of conditions in general and bariatric surgery, as well as gastrointestinal health, gynecology and surgical oncology. More information can be found at the new company website www.ethiconendosurgery.com.

About Covidien

Covidien is a leading global healthcare products company that creates innovative medical solutions for better patient outcomes and delivers value through clinical leadership and excellence. Covidien manufactures, distributes and services a diverse range of industry-leading product lines in three segments: Medical Devices, Pharmaceuticals and Medical Supplies. With 2009 revenue of $10.3 billion, Covidien has 42,000 employees worldwide in more than 60 countries, and its products are sold in over 140 countries. Please visit www.covidien.com to learn more about our business.

About American Diabetes Association

The American Diabetes Association is leading the fight to stop diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.

Contacts:
American Diabetes Association
Christine Feheley
703-253-4374

Covidien
David Young
203-654-6261

Ethicon Endo-Surgery
Bridgett Golden
513-337-7387