Bariatric surgery Featured

7:00pm EDT January 31, 2007

As obesity rates continue to climb in the U.S., the impact of obese employees can be felt in the workplace. They tend to use more sick time, have less energy at work and take more medications, contributing to employers’ overall health care costs.

Bariatric surgery has been proven effective in helping obese patients lose weight; however, not every health insurance plan provides coverage for the surgery. Often the surgery isn’t covered under general surgery, but employers can purchase riders specifically for bariatric surgery, according to Cathleen J. Crouse, RN, BSN, bariatric coordinator for the Akron General Medical Center Bariatric Center. “The problem ends up being a lack of communication between the employer and the employees,” she says. “If employees don’t let their employers know what they want in their health care coverage, they might miss out on coverage for this type of surgery.”

Smart Business spoke with Crouse about bariatric surgery and how employers and the workplace benefit when obese employees lose weight.

What is bariatric surgery?

Bariatric surgery is for the morbidly obese. It is actually a group of surgeries for weight loss. The two most prevalent types of surgeries are the Roux-en-y gastric bypass, where we create a stomach pouch and bypass part of the intestine, and the lap band where we create a smaller stomach pouch using a silicone band. The results are significant, with average weight loss for bypass patients of 30 pounds in one month, 60 pounds in six months and 100 pounds in one year. Lap band patients generally see a weight loss of one pound to two pounds per week.

Who should consider bariatric surgery?

Morbidly obese is loosely defined as being at least 100 pounds overweight. The actual determination is made by looking at a patient’s body mass index, which is a calculation of a person’s height and weight. Someone with a body mass index of 40 generally qualifies for the surgery.

What health benefits do people receive from bariatric surgery?

The health benefits of bariatric surgery are pretty exciting, primarily because many patients see results right away. The biggest health benefit is a reduction, if not a resolution, in co-morbid conditions, including high blood pressure, diabetes, sleep apnea and high cholesterol. It is so exciting to see a diabetic patient go home from surgery without the need for medications, including insulin. And, it’s not uncommon to see someone’s cholesterol level drop from 300 to 160 due to bariatric surgery.

Everyone sees some sort of benefits within one month. Many bariatric patients have problems with their knees due to the excess weight they’ve been carrying. After losing as little as 20 pounds, we see significant improvements in their ability to get around and their activity level.

How can bariatric surgery improve patients' performance in the workplace?

It has been documented that bariatric patients use less sick time and take fewer medications after having the surgery. This has an obvious impact on a company’s productivity, as well as possibly allowing the company to reduce its health care costs. In addition, employees who have had bariatric surgery are generally more active and energized at work since many of them had sleep problems like sleep apnea before the surgery, meaning they were unable to get a good night’s sleep.

How can employers obtain insurance coverage for bariatric surgery for their employees?

First, employers should have an open dialogue with their employees about what type of coverage they are most interested in and to determine if there is interest for bariatric surgery coverage. If interest exists, then employers should consider this when making their health care coverage choices.

However, employers should be wary of policies that include a coverage cap. I’ve seen several policies that include a $10,000 per member, per lifetime cap, which only covers about one-half of the cost of the surgery and leaves no coverage of any complications that may arise. This becomes cost-prohibitive for the employees and serves as a disincentive for them to have the surgery.

What are the risks associated with bariatric surgery?

Morbidly obese patients are at a higher risk for complications than the general population for any surgery. The two biggest risks are blood clots and breathing problems, including pneumonia. Fortunately, these are the two problems we can do the most to prevent by providing a blood thinner before surgery and having patients wear compression stockings during surgery to help circulation. Most bariatric programs also conduct sleep assessments on patients before surgery to detect problems such as sleep apnea, which can cause complications during surgery.

CATHLEEN J. CROUSE, RN, BSN, is the bariatric coordinator for the Akron General Medical Center Bariatric Center. Reach her at ccrouse@agmc.org or (330) 344-1950. More information on bariatric surgery can be found at www.akrongeneral.org/obesity.