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September 30, 2020

Bariatric surgery is booming, as obese patients worry about their Covid-19 risks

Daily Briefing

    Bariatric surgery, a significantly underutilized treatment for weight management, is beginning to see an uptick in use—a trend spurred by a somewhat unlikely cause: the novel coronavirus epidemic.

    The 3 most important considerations for patients deciding on bariatric surgery


    According to the New York Times' "Well," bariatric surgery is an increasingly safe, effective, and simple procedure available to patients with a BMI of at least 40 who cannot lose weight via diet and exercise alone, as well as patients with BMIs between 30 to 35 who have obesity-related health issues.

    Bariatric surgeries—including gastric bypasses, laparoscopic bands, and gastric sleeves—work by reducing the physical size of the stomach and curbing appetite by altering the hormonal signals between a patient's stomach and brain. Bariatric surgery, according to "Well," has become increasingly safe over the years, with the rates of complications and deaths related to such procedures plunging from a peak of 11.7% and 1%, respectively, in 1998 to 1.4% and 0.04% in 2016.

    However, despite the safety and efficacy of the procedure, experts say it's significantly underutilized. "Only one-half of 1 percent of people eligible for bariatric surgery currently undergo it," Anne Ehlers, a bariatric surgeon at the University of Michigan, said.

    According to a JAMA article, this under-use of bariatric surgery likely stems both from "the reluctance of the medical community and patients to accept surgery as a safe, effective, and durable treatment of obesity," and because patients worry that they "may be judged by others for taking the easy way out and not having the willpower to diet and exercise."

    The link between weight and severe cases of Covid-19

    According to the Wall Street Journal, several studies have found a link between obesity and its related health issues—such as diabetes and hypertension—and increased rates of serious Covid-19 infection. In fact, CDC this month confirmed that new research demonstrates that Covid-19 patients who are obese have a greater risk of severe outcomes.

    Researchers think this increased risk for obese patients may stem in part because of how the coronavirus enters the body via an enzyme called the ACE2 receptor. This enzyme is located in cells that line the lungs and fat tissue, which means that patients with excess weight may be more likely to experience a high viral load. In addition, obesity is linked to hyperinflammation and shortness of breath, two conditions that make it more difficult for someone to combat viral infection.

    As John Morton, head of the bariatric practice at Yale Medical Center, said, "The virus frankly has an easier job" replicating itself among patients who are obese, because "[i]t has more targets."

    But ongoing research indicates that losing weight—and losing weight via bariatric surgery in particular—may help lower this risk, the Journal reports. According to a clinical study from the Cleveland Clinic that's currently under peer review, patients with obesity who've had bariatric surgery were 25% less likely to require hospitalization after contracting Covid-19 when compared with obese patients who have not had the surgery. In addition, among those patients in the study who were hospitalized, none of those who've had bariatric surgery were admitted to the ICU or died from the pathogen—compared with 13% and 2.5%, respectively, of hospitalized patients who have not had the surgery.

    An increasingly popular procedure

    In light of this increased risk, some patients who are struggling with their weight are undergoing bariatric surgery as a proactive measure against severe infection—a trend that seems to have made bariatric surgery more popular than ever, the Journal reports.

    In fact, while most scheduled procedures are now experiencing a rebound after several months' pause amid the epidemic, bariatric surgery is not only rebounding more quickly than other services, but it's surpassing even its 2019 levels. Specifically, according to research from health care data company Perception Health, claims for bariatric surgery fell to nearly zero in April, but then rebounded by June to a higher level than that same month in 2019.

    Separately, Optum, which owns medical facilities and surgical centers across the country, reported a 26% annual increase in patients joining bariatric-surgery programs this summer. (The Daily Briefing is published by Advisory Board, a division of Optum.) Similarly, Cigna said that while prior authorizations for bariatric surgeries declined 38.8% annually between March and May of this year, they increased 9.3% annually in June, July, and August.

    The leaders of various surgical practices at major hospitals have reported similar anecdotal evidence, according to the Journal. For instance, Morton said that after Yale reopened its five hospitals for scheduled surgeries in June, bariatric surgery volume increased 20% when compared to 2019 levels—and inquiries about the procedure are also on the rise. "The only two surgeries that have been Covid-proof have been cancer and bariatric," he said.

    Similarly, Ali Aminian, director of the Cleveland Clinic's Bariatric and Metabolic Institute, said intake for severely obese patients seeking bariatric surgery increased 40% annually over the summer. "We've had patients who wanted to come and take care of their obesity, to be healthier, and when we ask them, why did you come now? It's because they've heard this message that it's a risk factor for Covid infection," Aminian said.

    And speaking as a bariatric surgery patient, Eliza Henderson said the coronavirus spurred her to "take the plunge" and schedule herself for the procedure later this month. "I don't want my being obese to stack the odds against me with something like coronavirus," Henderson explained. "More than anything, I want to have a better chance to survive" (Whelan, Wall Street Journal, 9/28; Brody, "Well," New York Times, 9/28).

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