After his weight-loss surgery, Gary Weiss can now climb multiple flights of subway stairs without getting winded.
It was May 2010, and I was undergoing my annual physical. Topic A, as usual, was my weight, which was edging toward 300 pounds. Every year my GP would ask me that same question. Usually I'd answer "80," prompting him to respond, "How many overweight 80-year-olds do you see on the street?"
|TYPICAL ONE-TIME COSTS|
|Bariatric surgery (with insurance)||$2,000-$6,000|
|Plastic surgery (optional)||$10,000-$25,000|
|TYPICAL ANNUAL COSTS|
|Vitamins, minerals, and supplements||$150-$700|
|Follow-up with surgeon||$200-$500|
|Band adjustments (for Lap-Band)||$300|
|Yearly blood work||$50-$100|
He was right. Even 70 was pushing it. My mother died of a coronary at 52, and she was not as heavy as I had become, and I had already passed her in age. I began to feel that I was living on borrowed time. My body mass index had reached, and exceeded, 40.
I was now officially "morbidly obese."
After I climbed off the scale, my doctor suggested that I consider weight-loss surgery, and I listened. Sure, there are other ways of shedding pounds, but I had tried -- and failed at -- all of them over the years: diets, nutritionists, Overeaters Anonymous, even hypnosis. Surgery was my last hope, the medical equivalent of a Hail Mary pass.
It worked, thankfully. Three years later I'm 100 pounds lighter; I feel better than I have in decades, and I have no regrets about having the surgery. I do realize now, however, that there was another factor in the decision I didn't fully comprehend at the time: how much the whole process could cost.
In a country where one in every four people is obese (a BMI of 30 and above) and nearly 4% are morbidly so (40-plus), according to the Gallup-Healthways Well-Being Index, weight-loss surgery has quickly become part of the vernacular.
Some 160,000 people now undergo bariatric procedures each year, ranks that have famously included weatherman Al Roker, comic Rosanne Barr, and New Jersey Gov. Chris Christie. But while the relative merits of the surgery have been debated to no end, lost in much of the discussion are the financial consequences of having the procedure.
Of course, losing a lot of weight can save you a tremendous amount on health care in the long run. In the short term, however, you could be shoveling out a lot of cash. Even if your insurance covers the procedure -- not a sure bet by any means -- the surgery can run into thousands of dollars. Without insurance, you're looking at tens of thousands. In either case, your surgeon may tack on extra fees for pre- and post-operative treatment. Follow-up surgery, if necessary, could surprise you with another five-digit bill.
Then there are a host of more minor expenses your doctor is unlikely to cover as he shows you gruesome plastic models of your digestive tract. "The 'after' costs are something people don't talk about," says Carolyn McClanahan, a financial planner in Jacksonville who is also a physician.
The economics of the surgery become part of the conversation only once you've gone through it. In the support groups and online bulletin boards where my fellow "WLS" patients gather to swap advice, recipes, and exercise regimens, money is a constant theme -- both money spent and, joyously, money no longer needed for the pills, the fast food, and the plus-size pants.
The costs of obesity
There's no question that extra pounds put an extra load on your balance sheet. Obesity can have a significant impact on your health care expenses, which I know from experience. As my weight crept toward the edge of my scale, my high blood pressure was worsening, my arches were giving out, and my blood sugar levels were becoming worrisome. My situation was not even so bad, comparatively.
According to the U.S. Centers for Disease Control and Prevention, being obese elevates your risk of coronary heart disease, diabetes, stroke, and cancer. As a result of these and other ailments, the obese spend 42% more on medical care and 77% more on drugs than people of healthy girths, studies have found. They also spend 48% more time in the hospital. In sum, "for an individual who is severely obese -- a BMI of 35 or above -- additional health care costs are anywhere from $3,000 to $10,000 a year," says Dr. Vivek Prachand, director of the Center for Surgical Treatment of Obesity at the University of Chicago Medical Center.
Excess weight also weighs you down in the workplace. Obese women earn up to 6% less than thinner counterparts, while larger men take home paychecks 3% lower, according to the Obesity Action Coalition. Bigger individuals are more often passed up for promotions, coalition spokesperson James Zervios says. "And they're sometimes viewed as lazy or incompetent." Absenteeism doesn't help: A landmark study out of Brigham Young University found that obese employees are 1.7 times as likely as leaner peers to take seven or more sick days.
Being heavy comes with other costs that add up as well. There's the fact that "plus size" or "big and tall" clothing is more expensive. The heaviest of us need to buy two seats instead of one when flying or going to a concert. Those who drive may even find, depressingly, that their weight results in decreased fuel efficiency -- every 100 pounds could lessen your miles per gallon by up to 2%, the U.S. Energy Department reports.
The biggest cost of all is the one that obesity extracts from your life. For Mike Hajj, a 43-year-old automotive electrical instructor in Waterford, Mich., whose weight peaked at 460 pounds, surgery was literally a life-or-death decision. He suffered from both diabetes and high blood pressure. And in the months before his 2006 gastric bypass, he recalls, his doctor told him that without dramatic weight loss, "you're doomed to be making your funeral arrangements in the next two years." By now, Hajj says, "I'd have been dead already."
According to the U.S. Surgeon General's Office, those with a BMI above 30 have a 50% to 100% increased risk of premature death compared with individuals of a healthy weight. A separate study by the Organization for Economic Cooperation and Development found that moderate obesity cuts life expectancy by an average of three years, while morbid obesity brings you eight to 10 years closer to dying.
So while an average man my age at the time of surgery would live until 82, I'd have been more likely to die at 72 -- and accrue additional medical costs of $50,000 to $150,000 along the way.
The skinny on surgery
Since the closest that I had ever come to an operating room was watching Scrubs reruns, the idea of having my intestines rearranged was daunting to say the least. My wife, who joined me in doing research on the options, was concerned about the risks of such major surgery.
My GP referred me to Dr. Scott Belsley, a bariatric surgeon who is director of robotic surgery at St. Luke's-Roosevelt Hospital Center in Manhattan. He patiently fielded our questions and explained the options: There's the Lap-Band, which is installed like an old-fashioned garter around the stomach. That procedure requires the shortest hospital stay but necessitates frequent follow-ups for the doctor to adjust the tension on the band. (The physician inserts liquid into a "port" that causes the band to expand.) Then there's gastric bypass, the most common form of weight-loss surgery today. That involves your small intestines being surgically connected to a portion of your stomach, creating a small pouch that's a kind of new stomach. Gastric-bypass patients tend to lose more pounds (76% of excess weight, vs. 48% for the Lap-Band, according to one widely cited study), but it's a more intense surgery, even though it's also laparoscopic. Still, Dr. Belsley described the gastric bypass as the "gold standard," and I could see why. I opted for that.
In the past few years another bariatric procedure, called the gastric sleeve, has gained popularity. In that surgery 75% of the stomach is removed, creating a long thin tube. Dr. Jaime Ponce, a Georgia bariatric surgeon who is immediate past president of the American Society for Metabolic & Bariatric Surgery, says that it is safer than the bypass with comparable results, while requiring less maintenance than the Lap-Band.
The health improvements following any of these surgeries can be phenomenal. Diabetics have been known to walk out of the hospital, before any weight loss, "with their diabetes under complete control," notes Ponce. (The surgery can kick-start communication between the intestine and pancreas, allowing insulin produced to work more effectively.)
High blood pressure, sleep apnea, and gastric reflux generally begin to improve once the pounds start coming off -- and often disappear over time, he adds. On average, health care costs for patients suffering from morbid obesity were reduced by 29% within five years of bariatric surgery as a result of the reduction or elimination of obesity-related conditions, according to a study in Obesity Surgery.
I was eager to see whether I too would be a success story. But before we could go ahead with my surgery, Belsley required I undergo a psychological evaluation and attend support-group meetings to ensure that I was mentally ready. I was also put on a liquid diet for five days beforehand and given a detailed guide to the vitamins, minerals, and supplements I would need postsurgery as a result of changes in nutrient absorption.
Finally, on Nov. 3, 2010, the 40-odd-ounce cavern that once was my stomach was replaced with a two-ounce pouch that made hunger a thing of the past. Within a year I went from just shy of 300 pounds to 167. As usually happens, I've gained some of it back. Today I weigh in at about 193, a number I hadn't seen on the scale since the Clinton administration. My shirt size has gone from XXL to M; my waist from 50 to 38. My cholesterol, triglyceride, and blood sugar levels are all suitable for framing.
I'm not exactly thin since my rebound, but that's not the purpose of the surgery. It's designed to make you not obese.
Beating a bulky hospital bill (cont.)
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