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Article:Medicare: Not enough data on obesity surgery


leatha_g
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Agencies considering changing policy on payments

Friday, November 5, 2004 Posted: 10:59 AM EST (1559 GMT)

BALTIMORE, Maryland (Reuters) -- Obesity surgery has helped many patients lose weight and improve their health, a panel of experts told U.S. regulators Thursday, but they added there was not enough data on how well it has worked for elderly patients covered by Medicare.

The Centers for Medicare and Medicaid Services (CMS) is considering whether the government's health insurance plan for the elderly and disabled should change its payment policy for the surgery, which shrinks the stomach by removing part of it or implanting a removable band.

"I didn't see any data whatsoever that these very same results could be applied" to Medicare patients, said Barbara McNeil, panel vice chairwoman and head of health-care policy at Harvard Medical School.

Regulations limit CMS coverage to defined diseases, but earlier this year the agency deleted language that said obesity was not a disease. The panelists' advice is not binding but will help CMS officials decide if changes are needed.

The agency already covers weight loss surgery to alleviate serious obesity-related conditions like diabetes, but coverage varies among regions. Most Medicare patients who get coverage for the surgery are younger, disabled patients, according to the American Obesity Association.

Private health insurers, which often eye Medicare coverage decisions when formulating their own, have been growing more skeptical of such surgeries, some experts have said.

The panelists examined data on several types of surgeries, including gastric bypass, which removes part of the stomach and connects the remaining portion to the small intestine to bypass much of the digestive system.

Another procedure, called gastric banding, uses a type a adjustable fluid-filled band to squeeze off a part of the stomach.

A number of companies make devices or parts used in the surgery, including Inamed Corp., International Ltd. and Synovis Life Technologies Inc.. Johnson & Johnson also makes stomach bands used in Europe.

Doctors and advocates called on the panel to recommend that CMS cover all obesity surgeries, including the adjustable band, as well as psychiatric and nutrition counseling.

Picking a specific treatment "is a decision best left to the patient and to the surgeon," said Dr. Henry Buchwald, a non-voting panelist and surgery professor at the University of Minnesota in Minneapolis.

Some surgeons complained that Medicare denied coverage for some severe bypass cases and called on officials to establish a clearer policy.

Weight problems are a growing health issue in the United States, where nearly two-thirds of adults are overweight or obese, according to the National Institutes of Health.

Obesity is defined as having a body mass index (BMI) - a weight-for-height ratio - of more than 30. For an average woman, that usually means being 30 pounds overweight and, for an average man, 35 to 40 pounds.

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    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
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    • Doughgurl

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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