Obesity Surgery Grows and Grows to Billion-Dollar Industry

ROCKVILLE, Md., Jan. 12 -- Obesity surgery is a billion-dollar growth market for patients from ages 18 to 54.

Bariatric surgery procedures for patients from the ages of 55 to 64 in the United States increased by 2,000% over a seven-year period, from 772 in 1998 to 15,086 in 2004, according to a report released by the federal Agency for Healthcare Research and Quality (AHRQ) here.

A smaller but increase in bariatric surgery also occurred among 18- to 54-year-olds over the same period, growing from 12,481 operations in 1998 to 103,097 in 2004, for a net 726% gain. This age group represented the largest segment of the obesity surgery market.

Over the same period, deaths associated with the surgery declined by 78%, from 0.9% in 1998, to 0.2% in 2004, and hospital stays declined by nearly two day in each age group.

The year 2004 also saw the first reports of bariatric surgery on adolescents, with 349 procedures for patients ages 12 to 17.

"This report shows that more Americans are turning to obesity surgery and that an increasing number of younger people are undergoing these procedures," said AHRQ director Carolyn M. Clancy, M.D. "As the rate of obesity continues to climb, the health care system needs to be prepared for continued escalation in the rate of this surgery and its potential complications."

The report's authors, Yafu Zhao, M.S. and William Encinosa, Ph.D., both of AHRQ, also found that:

• Women accounted for 82% of all bariatric operations in 2004, with 99,310 procedures to 20,977 in men. The female-to-male ratio remained largely unchanged from 1998.
• The in-hospital death rate in 2004 was 2.8 times higher for men than for women, at 0.42% vs. 0.15%. Still, men have made considerable progress since 1998, when the male in-hospital death rate was 2.76% vs. 0.46% for women, a six-fold difference.
• Adjusted for inflation and exclusive of physicians' fees, hospital charges for bariatric surgery patients averaged ,970 in 1998, and ,395 in 2004.
• While the average per-patient price for the surgery declined by 5.2% (in 2004 dollars) over the study period, overall hospital charges increased by a factor of eight, from million in 1998 to .3 billion in 2004.
• In both 1998 and 2004, privately insured patients accounted for about three-fourths of all weight-reduction surgeries (76% in 1998, and 78.4% in 2004).
• In 2004, Medicare footed the bill for 7.4% of procedures, an 8.2-fold increase over 1998. Medicaid picked up the tab for 5.4% (up sevenfold from 1998), and uninsured patients accounted for 5.3% of surgeries (9.1-fold increase). The remaining 3.4% of procedures were funded through charity and other government sources.

"A recent meta-analysis found that 62% to 70% of excess weight was lost following gastric bypass surgery," the authors wrote. "Following successful weight loss, diabetes was completely resolved in 76.8% of patients. Bariatric surgery is recommended for patients with a body mass index (BMI) > 40, or a BMI > 35 with serious medical conditions (such as severe sleep apnea, obesity-related cardiomyopathy, or diabetes mellitus)."

The report, titled "Bariatric Surgery Utilization and Outcomes in 1998 and 2004," is available online for viewing or downloading at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.pdf.