Sunday, March 31, 2013

Bariatric Surgery May Not Be Cost Effective

Many people believe that bariatric surgery is the most effective weight loss method. And because the FDA has lowered the BMI levels for the surgery, more obese people satisfy the guidelines. Up until the FDA's action, an individual's BMI had to be at least 35 before bariatric surgery was indicated. Now, the lower limit is 30, provided the obese person has specific health-related comorbidities such as hypertension and diabetes.

Further, some studies show that bariatric surgery may resolve type 2 diabetes, and other ailments associated with obesity. And for some time, it was felt that the resolution could lead to a reduction in health care costs. However, this possible reduction in health care costs is becoming more doubtful.

Still, Cleveland Clinic recently started covering bariatric surgery for employees who have type 2 diabetes and a BMI of at least 30. The clinic believes that the surgery is a cost effective approach to treating obese persons with type 2 diabetes. Indeed, one of the clinic’s doctors said that "very few medical interventions have been proven to save money …but [bariatric surgery for type 2 diabetes] is an intervention that pays for itself.’

Nevertheless, some researchers suggest that bariatric surgery does not necessarily reduce  long term health care costs, because "hospital stays for complications from the procedure exceed savings from obesity-related illnesses..."

Using insurance claims for 29,820 bariatric surgical patients, the investigators compared the costs of the surgery for up to six years after the surgery with the costs experienced by a group with obesity-related conditions who didn't have the surgery. The investigators 'found no reduction in expenses to help recoup the $28,000 average cost of the initial surgery... The patients traded off the type of care they needed, with costs remaining stable at roughly $9,000 a year.'

Since bariatric surgery may not reduce health care costs, more emphasis should be placed on behavior modification using  good patient counseling, and extensive collaboration between bariatric surgeons and non surgical obesity experts. These efforts can allow the overweight or obese patient to lose weight and maintain the weight loss  in the most appropriate,  safe, and cost  effective manner.

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Sunday, March 17, 2013

Metformin As an Obesity Drug

The three obesity drugs, Qsymia, made by Vivus, Belviq, made by Arena Pharmaceuticals, and Contrave, made by Orexigen Therapeutics, are receiving the most attention these days. Qysmia and Belviq have already gained FDA approval, and Contrave is expected to gain approval in the future. However, there is a well known type 2 diabetes drug that has shown potential as a weight loss drug. That drug is Metformin. 

The Canadians approved Metformin in 1972, and the U.S. approved the drug in 1994 for the treatment of type 2 diabetes. Type 2 diabetes raises one's risks of cardiovascular problems. Therefore, improving glycemic control and reducing cardiovascular risk factors are important in treating type 2 diabetes. And Metformin has been shown to be effective in improving glycemic control, insulin resistance, lipid profiles,  and other conditions and measurements associated with type 2 diabetes and heart disease.

But Metformin may have other beneficial effects. One study indicates that "There is increasing evidence from in vivo and in vitro studies supporting its anti-proliferative role in cancer and possibly a neuroprotective effect."  And another study concludes that "Metformin causes weight loss in both diabetic and non-diabetic individuals." And that "Metformin treatment is also associated with lower circulating levels of the orexigenic hormone ghrelin."

Often, one problem with drugs is a lack of knowledge concerning their effectiveness and safety in the treatment of children. Well, at least one study has demonstrated that Metformin can be used relatively safely for the treatment of obesity in adolescents.

The researchers concluded that "in the short term, administration of Metformin in addition to lifestyle modification is relatively effective for reducing BMI and hyperinsulinemia among obese adolescents without related morbidity, and [the drug] displays an acceptable safety pattern."

Another potential problem with many drugs, especially obesity prescription drugs like Qsymia and Belviq, is the cost of the drugs. Cost becomes more of a problem when insurers are reluctant to cover part of the price of the drug. However, Metformin is relatively inexpensive. Indeed, many retailers offer a 30-day supply of the drug for  4 dollars. So, some day, Metformin might be considered an optimum option for the treatment of obesity. Only time will tell.

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