As the prevalence of overweight and obesity in the United States has increased dramatically in recent years, there has been a similar increase in the number of patients seeking and receiving treatment including various types of surgery to reduce the size of the stomach.  Between 1998 and 2002, the number grew five-fold and it is estimated that in 2004, some 145,000 of these surgeries will be performed.

While these procedures, collectively known as bariatric surgery, have been increasing in number, there is little information available about their safety and efficacy.  The Obesity Surgery Project, funded by a Department of Health grant, created a partnership between health plans and ten of the leading bariatric surgeons in New York state for the purpose of developing and disseminating a best practices set of consensus guidelines for the evaluation of patients suitable for surgery, pre- and post-operative care of bariatric patients, and information about the training qualifications and experience of surgeons performing the surgery.  To compliment the consensus guidelines, a separate Obesity Surgery Primer, “Food For Thought,” was also developed.  The primer, providing an overview of the growing problem of obesity and other related health issues as well as plain language explanations about various surgical procedures, potential risks and other helpful information, is intended to assist health care professionals and individuals considering surgery.  The guidelines and primer were published in the spring of 2004.  

Participating Health Plans also contributed claims information on members who had undergone bariatric surgery for analysis.  Phase I participating plans include:  

• Affinity Health Plan
• AmeriChoice
• Capital District Physicians Health Plan
• Fidelis Health Care New York
• Health Net
• HIP Health Plan of New York
• Hudson Health Plan
• Independent Health
• MVP Health Care
• Oxford Health Plan

The health plans data were analyzed and a report developed by Dr. John Cawley, Associate Professor at Cornell University.  The report was accepted for publication in Obesity Surgery, the Official Journal of the International Federation for the Surgery of Obesity.

The New York State Department of Health has provided funding for a second phase of the Obesity Surgery Project to bring together additional process stakeholders to review the guideline developed during the first phase of the project with an eye toward endorsing a final consensus bariatric surgery guideline.  The final guideline will be use to educate insurers, physicians, patients and employers about the risks and benefits of surgery for morbidly obese individuals.  Since gastric bypass operations are elective, not emergency surgery, and with morbidly obese patients at greater risk for complications, the need for the adoption of a comprehensive set of patient selection, surgeon qualifications and facility standards to protect patient safety is imperative. 

Consensus Guidelines for Obesity Surgery
Obesity Surgery Primer: “Food For Thought"
Obesity Surgery report