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SEATTLE, Wash. - (Oct. 19, 2007) -Medicaid patients who are obese and undergo Roux-en-Y gastric bypass surgery may be more likely to return to work than obese Medicaid patients who do not undergo the surgery, according to a report in the Archives of Surgery's October issue on bariatric surgery.

About 65 percent of adults in the U.S. are overweight and 5 percent are morbidly obese, having a body mass index (BMI) greater than 40, according to the article. Obesity is associated with a variety of diseases, including diabetes, hypertension, hyperlipidemia, degenerative arthritis, sleep apnea and left ventricular hypertrophy. Depression, social isolation and discrimination further compound the disability associated with morbid obesity. "As a result, morbid obesity results in dramatic increases in health care costs," said Richard Thirlby, MD, bariatric surgeon at Virginia Mason Medical Center.

Amy J. Wagner, MD, Richard Thirlby, MD, and colleagues at Virginia Mason studied 38 medically- disabled patients receiving Medicaid who between 1997 and 2002 underwent Roux-en-Y gastric bypass performed by a single surgeon and compared these patients with 16 patients receiving Medicaid who were seen by the same surgeon, but did not undergo surgery. Patients' medical data were obtained by a review of their clinical charts and long-term follow-up telephone interviews.

Patients who underwent surgery had an average age of 48 and an average BMI of 58 before surgery and were followed for an average of 44 months, while those who did not undergo surgery had an average age of 51 and an average BMI of 54 at the beginning of the study and had an average of 32 months of follow-up. Average follow-up BMIs for the operative and non-operative groups were 36.2 and 52, respectively.

The article concluded, patients who underwent Roux-en-Y gastric bypass were more likely to return to work, with 37 percent working, compared with 6 percent of the non-operative control patients. "Return to work was more likely in patients who had resolution of comorbid conditions [more than one simultaneous illness] after surgery," said Dr. Thirlby. Those who returned to work no longer required Medicaid funding.

"The practical implication of these findings is that the presence of reversible obesity-related comorbidities may be an appropriate prerequisite for approval of bariatric surgery in this population," Dr. Thirlby concluded. "Surgical treatment of morbid obesity has a profound effect on patients' quality of life as evidenced by the sustained long-term weight loss, reversal of comorbidities, improved rating of quality of life and the patients' ability to return to the workforce."

(Arch Surg. 2007;142(10):935-940.  Available at www.jamamedia.org.)

Virginia Mason Medical Center
Virginia Mason Medical Center, founded in 1920, is a non-profit comprehensive regional health care system that combines a primary and specialty care group practice of more than 400 physicians with a 336-bed acute care hospital in Seattle. In addition, Virginia Mason has a network of clinics located throughout the Puget Sound area, and manages Bailey-Boushay House, a nursing residence and adult day health program for people living with HIV and AIDS. Virginia Mason also has an internationally recognized research center, Benaroya Research Institute at Virginia Mason.

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