The only way to keep your health is to eat what you do not want, drink what you do not like, and do what you've rather not
Mark Twain

I have written extensively about obesity and its impact on health, insurance costs, and the paucity of good non-surgical therapies (July 21, July 22, August 30, Sept. 26, Oct 17). The bottom line is that an obesity rate approach 40% is going to overwhelm the American health care system. The insurmountable expenses associated with the secondary diabetes alone makes any attempt to control costs impossible. Non-surgical therapies, such as those specified by Obamacare, have been proven costly and ineffective. Neverheless, I asked whether surgery, although effective, could have been justified in such a large population.

A new study in the New England Journal of Medicine has given us some vitally important data. The authors calculated the impact of obesity on lifespan. The results are pretty grim. In summary, the more overweight you are, the higher your mortality. Extremely overweight people increased their mortality 250%. Although even moderately overweight people had substantial increases in risk of death from all causes, with a 31% increase in mortality for every 5 point increase in Body Mass Index (BMI).

What they did not say, and perhaps the most important conclusion of this study, is that one can use these data to compare the relative risk / reward of staying obese with weight loss surgery, the only proven effective therapy. I think the calculus is pretty compelling. The surgery costs between $ 10-20,000 dollars, and has a risk of death of 1 in 1000. For the most at risk group, the expected increase in lifespan could have been anticipated to be at least four years. In addition, the surgery is frequently curative for diabetes, and decreases the incidence of heart disease, cancer and osteoporosis for all groups. The money saved treating these secondary problems alone may justify the surgery in huge numbers of people.

This study has changed my mind about whether wide scale weight loss surgery (bariatric), as a primary treatment could be justified. When confronted with to the wrinkling mortality associated with obesity and the failure of diets and other therapies, surgery appears to be the only alternative. Lap band procedures (narrowing the stomach to 1 inch) are efficient, life prolonging, and will save enormous amounts of money, even if done on 100 million Americans. Insurance companies, medicare, federal government need to realize that funding these procedures, and making the wid available available, may be the only realistic way to confront our health care crisis. Maybe I should go back and become a surgeon.

http://www.nejm.org/doi/full/10.1056/NEJMoa1000367