By RHONDA L. RUNDLE (Wall Street Journal) September 8, 2008; Page B3
The cost of the most common type of weight-loss surgery, which typically runs between $17,000 and $26,000, is offset within two to four years by medical cost savings, according to a new study.
The findings, published in the September issue of the American Journal of Managed Care, may increase pressure on health-insurance companies to cover gastric bypass surgery. Some insurance plans specifically exclude weight-loss surgery, despite medical evidence of its effectiveness as a treatment not just for obesity, but also for related conditions including diabetes, high blood pressure and sleep apnea.
"The most cost-effective treatment for obesity is bariatric surgery. If you do that, within two to four years, you will get your money back," said the study's lead author, Pierre-Yves Crémieux, a health economist and principal at Analysis Group Inc., an economic consulting firm in Boston. "We have identified the break-even point for insurers," he added.
Some policy makers and analysts are likely to question the findings because the study was paid for by Johnson & Johnson's Ethicon Endo-Surgery unit, a maker of surgical devices and instruments used in weight-loss surgery. Dr. Crémieux said he stands by the study's integrity and added that the company "has been totally hands off."
The findings will interest employers and insurance companies, but the main concern has always been the safety and effectiveness of the surgery, said Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade group in Washington. "I don't know if these results would be replicated in other populations," she added.
The journal's co-editor in chief, Michael E. Chernew, said the study addresses an "important and controversial" issue for his readers, including medical directors of insurance companies who make coverage decisions. He said the study was carefully scrutinized by independent reviewers who requested a series of manuscript revisions. "I won't deny that I would rather this be funded by some other organization, but there is no bias in the methodology," he asserted.
Each of 3,651 severely obese patients in a large claims database who underwent surgery was matched to a control subject who didn't have the surgery. The patients were matched for age, gender, geography, health status and baseline costs. The patients were predominantly female with an average age of 44 years. More than one-third of the patients had hypertension and many had high cholesterol, diabetes and other conditions.
The analysis covered six months of presurgical evaluation and care, the surgery itself and, on average, about 18 months of postsurgical care, including costs incurred from surgical complications. Some patients' postsurgical claims were tracked for up to five years. Costs included payments for prescription drugs, physician visits and hospital services. Claims were monitored for obese patients who didn't have surgery over the same period.
The study showed that insurers fully recovered the costs of laparoscopic surgery after 25 months. Laparoscopic surgery is a less-invasive version of gastric bypass with an average cost of $17,000. Between 2003 and 2005, the break-even point was reached in 49 months for traditional bariatric surgery, which carries an average cost of $26,000. The study didn't address gastric banding, a rival procedure.
Health economist Eric A. Finkelstein sounded a skeptical note. If the control group had "one really bad outcome, such as a heart transplant, that alone could be enough" to significantly change the results, he said in an interview. Several years ago, Dr. Finkelstein published a similar study using a different methodology, which suggested a 10-year return on investment on weight-loss surgery.
Dr. Finkelstein said that over time he has come to believe that the "return-on-investment" analysis of weight-loss surgery is "misguided." This economic metric isn't used to evaluate the cost-effectiveness of treatments for cancer or heart disease.
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Obesity surgery lowers insurance claims
Published: Sept. 9, 2008 at 11:23 PM
BOSTON, Sept. 9 (UPI) -- A U.S. study suggests bariatric surgery is the most cost-effective way to treat obesity.
The study, led by the consulting firm Analysis Group Inc., said insurers recover their costs for bariatric surgery in two to four years, depending on the type of surgery performed. Researches compared actual insurance claims filed by 3,651 bariatric surgery patients to actual claims filed by an equal number of morbidly obese patients who did not have surgery.
The findings of the study, funded by a company that makes surgical instruments used in bariatric surgery, are published in The American Journal of Managed Care.
The study said reductions in costs associated with obesity-related illnesses offset the $17,000 average cost of laparoscopic surgery and the $26,000 average cost of traditional, open bariatric surgery.
CHICAGO (Reuters) - Millions of poor children in the United States may be getting fat before age 10 because their mothers are stressed out and the youngsters seek escape in unhealthy comfort food, researchers said on Tuesday.
The stress is rooted in poverty and can be brought on by money woes, work loads, insufficient health insurance and other factors, said Craig Gundersen of the University of Illinois, who led the study.
"People will eat in response to feeling stress," he said in a telephone interview, and in this case children may be eating more in response to stress-related trouble at home.
The findings show there is a need for a firm social safety net for poor families with protections such as food stamps; better financial education to help people better manage money; and adequate health insurance coverage, he said.
Gundersen and colleagues at Iowa State University and Michigan State University looked at data on 841 children in families living below the poverty line who were part of a government nutrition survey conducted from 1999 to 2002.
"We found that the cumulative stress experienced by the child's mother is an important determinant of child overweight," the research team reported in a study published in the September issue of Pediatrics.
Children in stressed homes where there was plentiful food were more likely to be overweight or obese than those living in stressed situations where food was scarce, they added, because while both were reacting to stress, the former group had food available in which to find refuge.
"Children in food-secure households may have a greater ability to consume more 'comfort foods,' which are often unhealthy, in response to the (stress) they experience," they wrote.
Because most American children do not live in settings where food is scarce, the findings on maternal stress "may be an important factor for children in the United States who are overweight or obese," they concluded.
"Our findings are particularly relevant for children between the ages of 3 and 10," the researchers wrote, because older children can find release outside the home through friends or work.
An estimated 17 percent of U.S. children between the ages of 2 and 19 are obese and another 16 percent are overweight.
"A number of mothers in this study suffer from at least one symptom of depression and anxiety. By providing these women with relevant medical care and counseling, these symptoms may be alleviated with the further indirect benefit of reducing childhood overweight," the researchers wrote.
(Editing by Maggie Fox)
Last update: Thursday, 04 September 2008
Truvia - the New Stevia Sweetener
Taste-Testing Truvia, the Newest Zero-Calorie Sweetener
Tips and tricks from our resident dietitian, Julie Upton, RD
It’s not often that the Food and Drug Administration gives the OK to a new sugar substitute; over the past several decades, only five have been granted the “generally recognized as safe” status, including aspartame (Equal, NutraSweet), sucralose (Splenda), and saccharin (Sweet’N Low).
A new proposal, however, has been submitted for the first all-natural sugar replacement to be approved as a food additive in the United States. Coca-Cola and Cargill have teamed up to create Truvia (pronounced tru-VEE-a), a zero-calorie sweetener made from leaves of the stevia plant. If the FDA clears it, as expected, you’ll begin to see new products containing the Truvia logo—and flavor—beginning this fall. Thanks to a regulatory loophole (keep reading), you can even order it now online at Truvia.com.
Truvia (also known as rebiana) is made by taking the best leaves of the stevia plant, drying and soaking them, and then isolating the active compound. The stevia plant, which grows naturally in South America, has been used as a sugar substitute since the early 1900s and has recently been sold commercially in several countries. Since stevia products have not been approved as food additives in the United States, they have not been incorporated into any processed foods and can only be sold as dietary supplements, which aren’t regulated by the FDA. In grocery stores they’re often found in the vitamin aisle.
For me, this is big news: I have a well-known love affair with Splenda and I have tried just about every sugar substitute on the market. My previous experience with stevia-based sweeteners was, um, less than sweet. I found that they had an off flavor and didn’t dissolve in my tea the way sugar does. They certainly didn’t have the clean, enjoyable taste of sugar or Splenda. So I was eager to try out Truvia to see if it really is new and improved.
After I stirred one packet of Truvia tabletop sweetener into my tea (as I would Splenda), I was pleasantly surprised at how clean and sweet my drink tasted. It wasn’t the Splenda flavor I’m used to, but it also didn’t have much of a distinguishable aftertaste—a problem I’ve had with pretty much every other sweetener I’ve tried. I’m betting the slight aftertaste I did detect is due to erythritol, a naturally occurring sugar alcohol.
Here’s what other two other Health.com staffers had to say about the Truvia samples we recently tried:
It has a texture similar to sugar, and has a similar sweetness. It’s not harshly or chemically sweet, though it has a bit of bitterness and a fairly strong vanilla-like aftertaste, and you’re left with a vague, lingering sensation of having tasted something sweet that wasn’t quite sugar. —Scott Mowbray, editorial director
It was less sweet than Splenda, but still had a not-real-sugar taste. It practically dissolved in my mouth—very light. —Mara Betsch, editorial assistant
Not so sweet news The bitter news about sugar substitutes is that they aren’t a guarantee for weight loss. Some people who use them may unconsciously eat and drink more just because they are sweetened with sugar subs, and sugar subs don’t help break a sweet tooth. Also, preliminary animal studies suggest that when the taste of sweetener isn’t supplying the body with calories, sweeteners may trip up our body’s internal mechanisms to control hunger and satiety.
Bottom line If you have an insatiable sweet tooth, better to satisfy it with fresh and dried fruit before using intense sugar substitutes—natural or unnatural ones. If you drink soda, switching to calorie-free is a great option, and if you normally add one to two teaspoons of sugar to your coffee or tea, a switch to a sugar sub is ideal. If you want a different sugar substitute, go ahead and give Truvia a try.
By ASHLEY M. HEHERAP Business Writer2:22 AM PDT, June 29, 2007 CHICAGO — A burgeoning industry of wellness advisers, counselors and consultants is booming as corporate America tries to increase productivity and control insurance costs by helping its employees get healthy and shed pounds. The change is fueled by well-meaning, cost-conscious executives who are looking for ways to trim bottom lines along with waist lines. "The truth is CEOs are the ones that have to address it," said Mike Huckabee, the Republican presidential candidate and former governor of Arkansas who created a wellness program for state employees after losing more 100 pounds.
And they are. About 53 percent of large employers offered health risk assessments for their staff last year -- up from 35 percent in 2004, according to a survey by Mercer Human Resource Consulting. The prevalence of corporate-sponsored disease management, nurse advice lines and other health-related programs is also climbing as companies find they can no longer trim extra savings out of health insurance policies. "Employers have spent a lot of time tweaking those, and they haven't spent a lot of time getting a consumer engaged," said Tami Collin, a Mercer consultant who focuses on health and productivity management. "You'll see plan designs that are really starting to get engaged and motivated."
The change is driven by cost. A study published in April by a group of Duke University researchers showed obese employees had higher rates of workers' compensation claims, more lost work days and costlier medical bills than their trim co-workers. Frustrated by health insurance costs that were growing more than 10 percent a year, Ohio State University launched a massive wellness program last year with the hope of cutting medical expenses. Organizers hope the initiative, which offers gift certificates and other prizes, will help the school save $30 million over the next five years, program spokeswoman Kim Schuette said. While wellness programs once offered counseling or education to only the sickest workers, they're now preaching prevention and more cohesive services that address a range of issues. "Educating me is one thing. Giving me something that will help me move forward is another," said Kenneth Mitchell, vice president for health and productivity at Chattanooga, Tenn.-based Unum Group, the nation's largest disability insurer. "There's a trend to become more actively engaged and more focused in helping people."
That's fueling the rapid growth of the niche industry of wellness advisers who provide everything from corporate gyms to medical risk screenings at work and healthy grocery lists that can be downloaded on an iPod. At a workplace weight management conference in Chicago on Thursday, nearly 100 people -- including Huckabee -- debated the most effective ways to promote healthy living for employees, while helping them maintain their new lifestyle. "What we don't have in the weight control business now is a program of maintenance," said Rebecca Reeves, an obesity researcher and associated professor at Baylor College of Medicine in Texas. "There's recidivism, and it does return." As the field grows, businesses looking for help can find a dizzying array of methods to help employees, and very little research to back up which provide the best method.
CALL ME: Developed years ago, the tried-and-true method of telephone counseling and educational brochures continues to be an effective way to help workers manage health care. Got a question about your blood pressure? Dial a nurse. Trying to keep your diabetes in check? Counselors will call you. These companies can get permission to mine insurance claims data and do everything from remind you to take your medicine to offer over-the-phone counseling.
FEEL THE BURN: On-site gyms and fitness centers can be more than an 80s-era stationary bike stashed in a corner. Wellness companies today will design, build and manage a corporate gym. Personal trainers take note of medical histories while classes help the out-of-shape get active. Plus, the gyms can be a recruitment tool for wooing potential employees. "Just having a facility shows the employees that the company cares about their well-being," said Brenda Loube, president of Montgomery Village, Md.-based Corporate Fitness Works Inc., which operates such facilities for dozens of companies across the country.
SAY 'AHHHH': Health risk assessments do just that: study employees' medical status to find out if they're at risk for chronic conditions. Corporations usually provide prizes and sometimes even cash to employees who undergo diagnostics and commit to getting healthy. The screenings can include cholesterol checks, blood pressure screenings and weigh-ins. More detailed versions can include bone density checks and skin cancer screenings. "Everyone now agrees that today's lower- and moderate-risk person is going to be tomorrow's higher-risk person," said Andrea Lazar, president and chief executive of Phoenix-based Kronos Optimal Health Co. "So much of health care costs are determined by the lifestyle choices we make."
DIGITAL DISHES: Wellness companies offer mountains of information on their Web sites, from quizzes and tips to online coaching and counseling. Some even go as far as to offer customized exercise plans and recipes, along with grocery lists that can be downloaded on an iPod for easy reference.
"Some people will read the program, and change their lifestyle, some will come back on a daily basis," said Ted Dacko, chief executive of Ann Arbor, Mich.-based HealthMedia Inc., which provides services such as online counseling for more than 30 million people. "We're trying to fundamentally deal with the issues that'll change your behavior."
Obesity Surgery: Breaking the 'Quick Fix' Stereotype
Actress-Turned-Author Stacey Halprin Describes the Challenge of Losing 362 Pounds Through Surgery
By DAN CHILDS ABC News Medical Unit
May 25, 2007—
At her sweet 16 party, Stacey Halprin weighed 250 pounds.
In the years that followed, she more than doubled her weight before she decided five years ago to opt for gastric bypass surgery.
"What I inherited was depression," she notes, "and it manifested itself in food."
A lot of food. Halprin says she could never get full, and recalls eating entire pizzas, half-gallon containers of ice cream and whole pies.
As an actress, Halprin concealed her depression from the public eye, using her stature and charisma to land roles in an off-Broadway production and the movie "The Dress Code," which had her acting alongside Shirley MacLaine.
But even on the set, her weight took its toll.
"I could barely get through the filming," she says.
Coincidentally enough, it was a world-changing event that spurred Halprin to make dramatic changes in her life. On Sept. 11, 2001, when she was at her peak weight of 550 pounds, Halprin received a call from her friend.
Minutes later, she watched the Twin Towers collapse from the window of her Manhattan apartment.
"I vowed to myself that if the world made it through this," she says, "I would lose the weight."
No Quick Fix?
Halprin's situation made her an ideal candidate for gastric bypass surgery. After all, she says, she'd tried every diet solution available to her at least once.
Still, she was reluctant.
"I did not believe in gastric bypass," she says. "To this day, I don't believe in it unless it is medically necessary. It is a really terrible thing to go through."
Yet, as the morbidly obese population in the United States continues to grow, so too does the popularity of a wide range of procedures designed to limit the amount of calories the body absorbs from food.
"This has gathered a lot of publicity, because obesity is now so prevalent," says Dr. Dominick Artuso, a bariatric surgeon based in Dobbs Ferry, N.Y. "What we are seeing now is that more people are becoming candidates for this procedure."
The popularity of the surgery has even reached the point, Artuso says, where the public is beginning to view it as an easy way out of obesity -- a misconception that Halprin says could not be further from the truth.
"There are a lot of things that happen to overweight people when they lose a lot of weight," she says, noting that the sudden limitation in nutrition from the procedure caused her to experience hair loss, fatigue and other side effects before her condition stabilized.
And these aren't the only risks. While the death rate for the lap banding is about one in 3,000 -- hardly higher than the risk one takes from undergoing anesthesia -- that of gastric bypass surgery like the one Halprin opted for is about one in 200.
But for many, the health risks of not having such an operation clearly outweigh the perils of the operating table.
"I don't think it's an easy or a cowardly way out," Artuso says. "I think it's a courageous choice."
Even after surgery, patients face tremendous challenges in the recovery from surgery. But even as she suffered, Halprin's weight did come off. Following her gastric bypass operation, she lost 200 pounds after one year, 100 more pounds at the end of the next year and 40 pounds in the third year.
Turning the Corner
Now at 188 pounds, Halprin says her difficult decision to go through gastric bypass surgery changed her life.
"I am OK with who I am right now," she says. "Coming from where I was at 500 pounds, 188 is a perfect place for me. I am not embarrassed by it. I feel sexy."
More important is the fact that she has now maintained the results of her surgery for five years -- a point commonly considered a benchmark of success among medical professionals in the field.
Her success story has led to an appearance on the "Oprah" show, where she became the beneficiary of free plastic surgery to remove 20 pounds of redundant skin left over from her dramatic weight loss.
She has also written a book, titled "Winning After Losing," about her experiences. It in, she outlines the struggles and strategies of keeping the pounds from coming back.
And she says that every facet of her life -- even her romantic life -- has been touched by her weight loss.
"I went through dating late in life," she says. "My whole life has changed. People ask me, 'What are you going to do now?' My reply is, 'What am I not going to do?'"
But she says that her continuing struggle against her weight will likely have no finish line.
"The pain in your life does not disappear with the pounds," she says. "People are in for a huge awakening when they realize that.
"Eventually, you have to face the demons of the things you have to change about yourself."
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