Huntsville, AL – When a new obstacle or challenge appears across the globe, there is a general understanding that a change in policy is required to mitigate it. Covid-19 is no exception to this. Because we have no cure to this strain of disease, the public is changing policy to prevent spreading it. Hospitals in particular are having to adjust their policy in regards to who to treat, and who should get top priority during this state of emergency.
All of this is putting bariatric surgeons in a peculiar position. For starters, hospitals altogether are starting to take on elective surgeries again. But they are still trying to figure out which procedures need to be done sooner rather than later. This provides an unexpected platform for weight loss surgeons to categorize which weight loss procedures are more essential.
How is that a benefit? What consequences are coming from this type of discussion? What changes are surgeons and hospitals are going to make in the world of weight loss surgery? Let’s find out.
The Weight Loss Surgery Dilemma
One of the common complaints from weight loss surgeons who have to deal with insurance companies, is the use of BMI solely determining surgery criteria. In a publication, Francesco Rubio MD, a professor of metabolic and bariatric surgery in Kings College, London, stated the following:
“Historically, bariatric and metabolic surgery have had a low uptake due to factors such as lack of insurance coverage and stigma. Many physicians also inappropriately view it as risky, ineffective, and/or as a last resort treatment. They don’t refer for surgery even though the evidence we have that it benefits for patients is unquestionable. Because of that background, insurance companies penalize patients with obesity and type 2 diabetes in comparison to any other conditions that need elective surgery.”
Basically, general practitioners are not referring patients to weight loss surgery and insurance companies are not granting coverage on the basis of prejudice and old standards.
This has been a common frustration for a lot of weight loss surgeons and endocrinology specialists. There has even been publications pointing out just how useless the standard of BMI was back in 2012.
But since the formula has been around since the 1830s, and it is cost effective. No company or medical society would want to overhaul the system according to new data,. And that is reasonable to some extent. Hospitals and Insurance companies deal with larger numbers and have to look at the big cost effective picture. Overhauling that criteria would have taken time that they did not have.
Then Covid-19 happened.
Weight Loss Surgery, Covid-19 and the Elective Procedure Backlog
Predictably, the moment when a disease with no cure began to spread rapidly throughout the country, hospitals quickly shut down to exclusively deal with the problem. They still are dealing with the problem today, by mitigating space and man power to manage a sudden influx of people that needed treatment.
Now, things starting to slow down in parts of the country. This leads to hospitals discussing and planning for the return of patients for elective procedures. However, elective procedures, as we discussed before, means procedures that can be scheduled ahead of time, not superfluous ones. By that logic a cancerous tumor removal, depending on the stage could count as an elective procedure.
When a hospital and patients postpone surgeries for month, it creates a backlog of procedures. Meaning that if hospitals are not careful enough to anticipate it, there would be a flood of people clamoring to get a spot first. Despite of how severe or benign the condition they are suffering is. This puts doctors and surgeons in the position of examining the criteria for what elective procedures should come first. This puts weight loss surgeons and endocrinologists in a position that they haven’t had before. The chance to prioritize.
The Proposal of New Weight Loss Surgery Criteria
Weight loss surgery and obesity experts are given an opportunity to showcase what they know, with a backlog of confirmed information to change the criteria of who should get weight loss surgery treatment first. And, they are aware of it. Francisco Rubieo MD, along with multiple collegues who worked on the publication beside him, have proposed a new metric.
Instead of prioritizing weight loss surgery access from BMI (or how big a person is) instead, they can prioritize patients that are suffering from the side effects of obesity. In spite of what most people think, there is a huge difference between someone who is bigger but more healthy in comparison , and someone who is slimmer, but are suffering from diabetes, sleep apnea, and other comorbidities. There also should be high priority for those who have already had the procedure but might need repair.
This way, there is less focus on perceived aesthetic and more on combating the severity of the disease itself.
So, far, it is well received by the medical community with interested parties stating “I think it’s a very sensible piece where they’re thinking through things that haven’t really needed to be thought through all that much. That’s partly with respect to COVID-19, but even beyond that I think this will be a valuable platform going forward.”
Only time will tell how this will pan out for certain. However, this does teach us a valuable lesson. There are unintentional positive consequences, even during a disaster.
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