Demand for weight management medications is at an all-time high. Any medication that can produce clinically meaningful weight loss is great news for patients, but hospital and health system leaders worry that Wegovy and similar drugs will erode their bariatric surgery volumes and revenue. While this concern is valid, it’s a singular service line perspective. Instead, we want to challenge healthcare leaders to think like an integrated system and consider leveraging comprehensive obesity care to drive surgical services growth by: 

1. Improving surgical outcomes
2. Increasing surgical volumes
3. Reducing surgical costs

When health systems and providers integrate different obesity care pathways under one umbrella, they can drive growth for surgical services by improving outcomes, increasing volume, and decreasing costs.

Obesity is associated with poorer outcomes for five of the six top revenue driving surgical categories:

• Transplant
• Joint replacement
• Oncology procedures
• Neurological/Spinal procedures
• Gastroenterological procedures

Access to comprehensive obesity services before and after these surgeries has the potential to improve surgical outcomes. For example, The American Academy of Orthopedic Surgeons highlights that patients with lower BMIs are less likely to experience wound complications, postoperative dislocation, infection, and blood loss compared to patients with obesity. In other cases, pre- and/or post-surgery weight loss isn’t best practice. For example, pre-surgery weight loss isn’t an option for a patient who needs an emergency operation, but post-surgery weight loss might support healing. Comprehensive obesity services can help surgeons and patients navigate the right options for each individual case, and thus optimize outcomes for surgical patients across service lines. 

By improving their surgical outcomes, hospitals and health systems can increase quality score performance and brand recognition. This can lead to increased external referrals and revenue growth.

When a comprehensive suite of obesity care services is integrated under one offering, it can help grow the number of eligible patients for surgeries like joint replacements, transplants, and spinal procedures.

Comprehensive obesity care means providing patients with the full spectrum of treatment options, including:

• Lifestyle and behavioral support
• Mental health support
• Medications
• Surgical support
• Navigation to other services commonly needed by obese patients (e.g., diabetes management)

Many surgeons today are reluctant to perform certain procedures on patients with obesity due to the potential increase in risk. Clinical guidelines for transplants, joint replacements, and neurological/spinal procedures, however, do not preclude patients from surgery based on body mass index (BMI). Instead, these guidelines highlight the risks of surgeries on patients with higher BMIs and sometimes recommend weight loss prior to surgery. An integrated obesity care offering can therefore support select patients in becoming better candidates for certain surgeries.

As obesity rates continue to increase in the U.S., the proportion of surgical candidates with obesity will grow.  Surgical providers will require new training on how to perform procedures on patients of all shapes and sizes, and many will also need weight bias education. Health systems can utilize obesity care specialists to provide some of this teaching. When surgeons are more comfortable operating on patients with higher BMIs, restrictions on surgery eligibility could lift, increasing surgical volumes.

Integrating a healthcare organization's surgical program with its obesity management offerings could lead to decreased hospital costs. Surgical patients with obesity have approximately 4% higher inpatient costs than patients without obesity, translating to about $648 higher per capita inpatient surgical costs. Surgical programs that partner with comprehensive obesity care programs to support their patients in losing weight pre- or post-surgery could experience fewer post-surgery complications, shorter operating times, and reduced length of stay—all of which could lower costs.

1. Boost the referral networks between surgical teams and obesity services providers, especially for non-emergency surgeries.
2. Educate providers about obesity care. Ensure that all those involved in the delivery of integrated obesity care, including surgeons, have access to trainings and seminars on the complexities of obesity. For surgeons taking a more hands-on approach to obesity management, provide anti- weight bias training and discuss the limits of BMI as a measure for health.  
3. Break down silos. Most health systems have multiple obesity care service offerings (e.g., nutritionists, diabetes programs, bariatric surgery) that may be operating in silos. Bring together existing obesity care offerings under one umbrella to ensure that all treatment options are easily accessible to patients.  
4. Engage providers across the care continuum to generate support. The more touch points a patient has, the more successful that person will be in their weight management journey. PCPs, endocrinologists, pharmacists, and surgeons can support patients and increase the long-term success of the program. Generate buy-in from multiple clinician groups to create revenue potential for different service lines.

Emily Schmidt contributed to this research.