The widespread demand for bariatric surgeries has caused health insurers to reevaluate the risks and benefits for their members, and many HMOs are ending coverage or limiting qualifying patients. This cutback comes at a time when the US government has declared obesity a public health crisis, and the number of bariatric procedures performed each year has jumped from approximately 16,000 in the early 1990s to 103,000 last year, according to Robert Steinbrook, MD, a deputy editor of the New England Journal of Medicine.
The $30,000 procedure is considered a lucrative surgery for physicians, and there is increased concern about the number of unqualified doctors performing the surgery. The surgery is recommended for the "morbidly obese," meaning men who are 100 lb overweight and women who are 80 lb overweight?or 4.7% of the US population. Blue Cross and Blue Shield of Florida will end coverage next year. That HMO's Vice President Barry Schwartz, MD, has said that risk, not cost, was the main factor in dropping coverage. He contends that obesity is a condition, not a disease, and can be modified with diet and exercise. Morgan Downey of the American Obesity Association, however, disagrees, calling diet and exercise a "simplistic" remedy. Downey has stated, "The irony is that they're still paying for all the conditions that obesity causes," such as diabetes, hypertension, arthritis, and heart disease.