Obesity surge creates more business for hospitals

Daily Record, The (Baltimore), Feb 10, 2004 by Robyn Lamb

The paint is still wet.

The extra-sturdy seats have yet to be installed, and yet Union Memorial Hospital's bariatric center already is averaging five calls a day from people eager to get the stomach reduction surgery that promises a 77 percent loss of excess weight after just one year.

With obesity on the rise, Baltimore-based Union Memorial hopes to capitalize on the decades-old surgery.

It expects to conduct between 200 and 300 surgeries per year - the industry standard - within the next two to four years.

But Union Memorial's service is more than a surgery.

The Comprehensive Weight Management and Bariatric Center is a soup- to-nuts approach to weight loss and management, said Peter Liao, director of bariatric medicine.

In some ways this is completely new, it is an umbrella group, said Liao. The goal is to have [patients] seen and screened by a psychologist, a nutritionist and a doctor, all of whom are on staff, before they are offered the surgery.

Union's one-stop approach to bariatric surgery has two components - one medical, the other surgical.

Patients - even the 85 percent or so that come in wanting the $5,000 surgery - undergo a six-month supervised weight-loss program that includes physical evaluation, nutritional counseling, exercise instruction and psychological counseling.

The process is supposed to identify and resolve any physical or emotional problems, such as an eating disorder, that could hinder weight loss.

If that does not work, men at least 100 pounds overweight and women with at least 80 pounds of excess weight are considered for surgical treatment. Those with less to lose must have a medical complication to be eligible.

Liao, the center's lead surgeon, performs a gastric bypass procedure known as Roux-en-Y.

One of the most common bypass surgeries, the procedure shrinks the stomach capacity by creating a smaller stomach pouch - one that will hold one ounce of fluid, or the equivalent of a medicine cup. In the meantime, a tiny stomach outlet is constructed, slowing the speed at which food leaves the stomach so that a person feels fuller for a longer period of time.

In the past, individual surgeons at Union Memorial and other hospitals in Baltimore have performed bariatric surgery, but never in the multi-disciplinary environment the new center provides, Liao said.

This is all supported by the hospital and there are no big egos involved, said Liao, adding that it cost at least $200,000 to buy the sturdier operating tables, beds, wheel chairs and other devices needed to equip the center.

It is an investment many hospitals are increasingly making, said Jack Kavanaugh, director of emerging trends and technologies for Michigan-based Trinity Health. Of the health system's 45 hospitals, eight have comprehensive bariatric programs and others are under consideration.

It trends with obesity, said Kavanaugh.

As the weight of the population grows, so has the demand for weight reduction surgery.

The number of obese people has increased 74 percent since 1991 to 44 million people, according to a 2003 study by the Centers for Disease Control.

Meanwhile the number of bariatric surgeries doctors performed has jumped from 16,000 procedures in 1992 to 47,000 in 2001, an increase of 194 percent.

And the growth is only accelerating - just over 64,000 surgeries are projected for 2002.

Whether the procedure is covered by medical insurance depends on the individual's insurance provider.