WASHINGTON -- In the span of 15 years, the number of bariatric surgeries performed in the United States has grown more than 16-fold to roughly 220,000 per year, gaining cachet as a near-panacea for obesity.
Despite the daunting price tag, mounting research has boosted hopes that the stomach-stapling operations could reduce the nation's health care bill by weaning patients off the costly drugs and frequent doctor visits that come with chronic obesity-related diseases like diabetes and arthritis.
But a new study has found that the surgery does not reduce patients' medical costs over the six years after they are wheeled out of the operating room.
The study, published Wednesday in the journal JAMA Surgery, tracked the expenses of nearly 30,000 Americans who got one of two forms of bariatric surgery, and compared their long-term health costs with those of similar patients who were obese but did not go under the knife to lose weight. Even when the initial $20,000 to $25,000 cost of the procedure was taken out of the equation, the ongoing expenses for the patients who had surgery were roughly the same as for those who did not.
In an editorial accompanying the study, Dr. Edward H. Livingston wrote that "bariatric surgery does not provide an overall societal benefit." Though acknowledging that such surgery has "dramatic short-term results," he added that its longer-term effects -- including on longevity -- have been disappointing.
"In this era of tight finances and inevitable rationing of health care resources, bariatric surgery should be viewed as an expensive resource" that should only be offered to patients "if there is an overwhelming probability of long-term success," he wrote.
Obesity, which affects 1 in 3 American adults, is proving a tough and expensive challenge for the nation's health care system. The annual cost of treating obesity-related diseases -- including stroke, heart disease and certain cancers -- is now $190 billion. With no decline in U.S. obesity rates, that surcharge is projected to reach $550 billion by 2030.
The finding that bariatric surgery does not save money is sure to be disappointing to public health officials seeking to "bend the cost curve" downward. Despite high upfront costs that range from $10,000 to $43,000, broadening access to bariatric procedures might help drive down health care costs in the longer run, the thinking went.
"We were so hopeful," said Dr. David Goodman of Dartmouth College medical school, who was not involved with the new study.
Bariatric procedures foster rapid weight loss by surgically reshaping the intestinal tract. To varying degrees, they aim to reduce the stomach's capacity, decrease the calories and nutrients absorbed from food, and change the chemical signals of fullness that are passed between the brain, the gut and the endocrine system.