COSTS IN THE BILLIONS

Nearly 73 million Americans are considered obese, defined as having a ratio of weight to height, or Body Mass Index (BMI), of more than 30. For example, a 5’9” adult weighing more than 203 pounds is consider obese. About 12 million people are classified as morbidly obese, defined as having a BMI over 40.

The condition is the second leading cause of preventable death in the country behind smoking, as it can cause type 2 diabetes, heart disease, stroke, osteoarthritis, gall bladder and liver disease and many types of cancer. It leads to nearly $150 billion in annual U.S. healthcare costs.

A survey by Hewett Associates found that 45 percent of U.S. employers cite obesity as one of the most significant health concerns for their businesses, but many of their insurance plans - 44 percent of those with 5,000 or more employees - do not cover bariatric surgery.

Bariatric surgery coverage is often viewed as a separate benefit, said Gus Georgiadis, president of Triad USA, an employee benefits services and consulting firm. Larger employers tended to have better coverage.

Employers who do cover surgery often define patients as eligible at a higher BMI and require them to first try other methods for an extended period of time - even if they already have already made such attempts - and undergo a psychological evaluation. Most plans have high co-payments of around $5,000 to $7,500, making it too expensive for many.

“If you’re making $25,000 a year and you have a $5,000 co-pay, that’s 20 percent of your salary,” said Joseph Nadglowski, President and CEO of the Obesity Action Coalition, a patient advocacy group. “High co-payments and the hoops and hurdles insurance companies put in front of surgery is limiting.”

But Nadglowski still wants to see patients first try diet and exercise programs, followed by medications and then surgery as a last resort.

“There’s a gap between Weight Watchers and surgery,” Nadglowski said.

His organization is pushing for more access to all kinds of treatment, including nutrition counseling.

Georgiadis argues that certain treatments are more or less appropriate for a patient, given their condition.

“Diet and exercise at a BMI of 35 or greater will fail more often than it will succeed,” he said.

Studies show that bariatric surgery is almost 10 times more effective for losing weight and keeping it off than other approaches. Some research has shown that gastric bypass is superior to banding, with bypass patients losing more weight and keeping it off better than patients who got the band.

Patients who choose gastric bands may do so because the surgery is less invasive and the device can be removed. But they require more maintenance and follow-up doctor visits for adjustments.

The band sometimes slips from where it was placed and in rare cases can erode into the stomach, complications that require removal.

The number of all types of bariatric surgeries was down about 8 percent in 2010, a year that saw a decline across the board in medical procedures as many Americans lost health insurance when they lost their jobs. High co-payments are also to blame.

Although just a small part of Allergan’s revenue, LapBand sales fell 14 percent from a year ago to $156 million in the first 9 months of 2011, even after the Food and Drug Administration lowered the weight requirement to get the device.