Of an estimated 30 million Americans with morbid obesity, one percent or less undergo bariatric (weight-loss) surgery that could benefit them.

“There are so many patients with morbid obesity, which is a serious condition. Yet there's a huge disconnect between the number of patients who could benefit from weight-loss surgery and the number of patients who are actually receiving treatment. This surgery would significantly improve their life and reduce their comorbidities,” says T. Karl Byrne, M.D., a professor of surgery at MUSC Health.

According to Dr. Byrne, several factors, including health insurance coverage and misinformation, contribute to the low percentage of people undergoing bariatric surgery. He wants primary care physicians and patients to know that there are safe and effective bariatric surgery options.

Insurance: One Barrier to Bariatric Surgery

According to Dr. Byrne, a dearth of health insurance plans covering bariatric surgery is one key reason so few people with morbid obesity actually seek out weight-loss surgery.

Whether a health insurance plan covers weight-loss surgery (and for whom) varies with a company, policy, even state. “For example, in about half of the states in the nation, the state health plans will cover weight-loss surgery,” explains Dr. Byrne. “In the state of South Carolina, our state healthcare plan does not. Medicare and Medicaid, however, do cover weight loss surgery.”

Patients who need to self-fund bariatric surgery are significantly less likely to continue with the process. Because of that reality, Dr. Byrne says insurance status is one of the first topics broached with patients inquiring about bariatric surgery.  “If a patient’s health insurance doesn’t cover weight loss surgery, we then discuss with them a range of options for self-pay,” he says.

Lack of Information About Weight Loss Surgery Safety Advances

Another obstacle to bariatric surgery: patient education. While Dr. Byrne says family practitioners are becoming more open to discussing weight-loss surgery for applicable patients, misinformation among patients still abounds.

“There is a significant amount of myth among patients as to the safety of surgery for obesity,” he explains. “In the last several years, the mortality rates for patients undergoing surgery for obesity have dropped dramatically. Secondly, most of the cases that are performed today are being done laparoscopically, so wound complications are practically nonexistent anymore.”

When comparing data across the nation, the 30-day mortality rate after a bariatric procedure is currently zero. In fact, Dr. Byrne says weight-loss surgery today is safer than many other types of surgical procedures, such as joint replacement.

“Unfortunately, that information hasn't percolated down to our patient population yet,” he says.

MUSC Bariatric Surgery Program: A Snapshot

Strict guidelines and protocols for care as well as comprehensive bariatric surgery teams comprised of various subspecialists have helped to make these surgeries safer and more beneficial for patients. MUSC’s bariatric surgery program, an accredited center from the American College of Surgeons, offers a range of weight-loss surgery options for patients as young as 15 and as old as 75, using minimally invasive approaches.

In general, candidates for weight loss surgery include patients with a body mass index (BMI) of 40 or a BMI of 35 with a weight-related medical problem, such as diabetes. Not all patients would benefit from the same type of bariatric surgery, which is why MUSC offers options, such as:

  • Gastric bypass, previously the gold standard for bariatric surgery, a procedure that’s still common today
  • Sleeve gastrectomy, the most common weight loss surgery performed today
  • Duodenal switch, a more complicated procedure that’s shown to be beneficial for super-obese patients, or patients with a BMI of 50 or more

“The gold standard operation for weight loss has always been the gastric bypass, which is done laparoscopically now,” says Dr. Byrne. “However, that has been superseded in terms of numbers by the sleeve gastrectomy, which is now the most common weight-loss procedure performed throughout the United States.”

In sleeve gastrectomy, a surgeon removes the vast majority of the stomach, leaving a long, thin, cylindrical or sleeve-like stomach in its place. Compared to gastric bypass, Dr. Byrne says gastrectomy is more straightforward and easier to perform.

A standard laparoscopic sleeve gastrectomy procedure at MUSC today can be completed in as little as 45 minutes. Most patients stay in the hospital overnight and go home the next day. “The vast majority of patients will have that kind of experience,” says Dr. Byrne. “Likewise with gastric bypass surgery, the hospital stay has been reduced significantly. It's now a one- or two-day stay as well.”

Weight Loss Surgery’s Mounting Benefits

Increased safety, shorter hospital stays and more procedure options: Bariatric surgery has changed for the better in recent years. Still, a large percentage of patients have yet to realize it.

“That’s unfortunate,” says Dr. Byrne, “because many patients who have a bariatric procedure lose a significant amount of weight, reduce the number of medications they take and completely reverse comorbidities such as diabetes and hypertension.”

For more information, contact Dr. Byrne at byrnetk@musc.edu.