Desperate dieters gain pounds for weight-loss surgery

Interesting Article from the Wall Street Journal Desperate dieters gain pounds for weight-loss surgery By Tara Parker-Pope WALL STREET JOURNAL Some frustrated dieters are doing what once would have been unthinkable -- eating more to gain pounds to qualify for weight-loss surgery. While celebrities like singer Carnie Wilson and weatherman Al Roker are boasting of dramatic results from their own weight-loss surgeries, a darker side to the sometimes risky procedure is beginning to emerge. Desperate patients who are turned down for the surgery because they don't weigh enough are returning to doctors' offices weeks or months later after intentionally gaining 10, 15 or even 25 pounds to qualify. The phenomenon isn't widespread. But it is one reason that the American Society for Bariatric Surgery last month decided to hold a major conference next spring to re-evaluate the guidelines for who qualifies for the surgical procedure, which essentially shrinks the stomach, prompting drastic weight loss. "This is not at all isolated -- it's happening," says Walter J. Pories, past president of the ASBS. "We should not be forcing patients to overeat" in order to get surgery. To qualify for surgery, a patient must be at least 100 pounds overweight or have a body mass index of at least 40, putting them in the high-risk category of the morbidly obese. The index, known as BMI, is a formula based on a person's weight and height. At that point, doctors consider the risk of being overweight to be bigger than the risk of the surgery. In some cases, patients with a BMI above 35 are considered for the surgery if they have other life-threatening health problems such as heart disease that could be helped by weight loss. If a patient doesn't meet the guidelines, insurers won't pay for surgery and most doctors won't operate even if the patient offers to pay for it themselves. The guidelines, the result of a 1991 National Institutes of Health consensus conference, are strict because the surgery isn't without risk. About 1 percent of patients will die from complications. And because the most common form of the surgery limits the body's ability to absorb food, patients can suffer malnutrition, requiring a lifetime of nutritional supplements and follow-up care. In addition, patients must adjust to never again eating more than a minuscule portion at a sitting, or they'll vomit. Nevertheless, many patients who fall short of the numbers still desperately want the surgery after a lifetime of failed dieting efforts. Pories, a professor of surgery at Brody School of Medicine at East Carolina University in Greenville, N.C., says some of his own patients have gained weight to meet the guidelines. "Imagine if you were 87 pounds over your ideal body weight, and you have diabetes and your joints hurt because you've got arthritis, and you're short of breath," says Pories. "And then I tell you, 'If you weighed 13 more pounds then we could operate. ... Obviously, you would go home and eat." That was the decision 47-year-old Paulette Zanotti faced when doctors at the University of Pittsburgh told her she didn't qualify for the surgery despite weighing "well over" 200 pounds. She says her BMI was about 39 and she was about 90 pounds overweight despite years of dieting. "When I heard 'You're not heavy enough,' I actually got into the car and tried to figure out how much weight I had to gain to get my BMI up," she says. "I can remember driving through the McDonald's at the same time and actually saying, 'OK, give me a Big Mac and a Diet Coke.'" A year later, Zanotti says she had gained about 10 pounds and her BMI had inched up to 40. Her surgeon and insurance company finally agreed to a $26,000 gastric bypass, which reroutes the intestines and shrinks the stomach. In the 15 months following the surgery, Zanotti has lost 100 pounds, but it hasn't been easy. "It's an absolute lifestyle change, and that's the concern about people who gain weight to qualify for surgery," says Zanotti, who knows two women who have gained as much as 25 pounds to qualify. "If you're going out and eating whatever you want to gain weight, how are you going to reprogram yourself not to do that once you have the surgery? The real danger is they might not be able to repair the psychological damage you've done." And while gaining 10 or 20 pounds may not sound like much for a person who is already 75 or more pounds overweight, doctors say it can drastically increase a patient's risk for various health problems, including heart attack. One study found that every two pounds a person gains as an adult increases risk for hypertension by 5 percent. One irony is that while most insurance companies will pay for gastric bypass surgery, they won't pay for medically supervised weight-loss programs, which can cost thousands of dollars, says Madelyn H. Fernstrom, director of the University of Pittsburgh's weight-management center. "A patient says, 'I can't afford medication. I can't afford to self-pay for this team approach, so I'll just eat my way up because the surgery is paid for,' " says Fernstrom. Still, at best nonsurgical approaches can offer only modest average weight loss. Surgeons say the guidelines for bariatric surgery need to be re-evaluated because severely overweight patients inevitably will develop serious problems, even if they aren't yet 100 pounds overweight. "We're asking, should we lower the BMI so these people who have risk from their disease of obesity can be better served with surgery," says current ASBS President Alan C. Wittgrove, the San Diego surgeon who performed Carnie Wilson's surgery. "The problem with this group is there's really nothing available for them right now."

From reading this article maybe insurance companies will consider covering weight loss medications to prevent people in that "grey area" from resorting to gaining weight. I was surprised that insurance would not cover weight loss medications (even after my doctor and the pharmacutical company wrote letters) but they will cover weight loss surgery. I'm afraid that insurance companies will take a harder stance on approving surgeries if this trend continues and the people who truly need the surgery to survive will lose this vital option.