PREVENTIVE MEDICINE: Step-by-Step Health Plan Beats Other Options

By Katz, Dr David | New Haven Register (New Haven, CT), July 23, 2012 | Go to article overview

PREVENTIVE MEDICINE: Step-by-Step Health Plan Beats Other Options


Katz, Dr David, New Haven Register (New Haven, CT)


One of the arguments for bariatric surgery in principle is that by addressing the problem of often severe obesity effectively, the procedure should alter the entire trajectory of health in a way that saves money. Obesity and its complications are costly; fixing the one and forestalling the others should attenuate those costs.

But such pecuniary hopes attached to weight loss surgery were themselves somewhat attenuated last week with the publication of a new study in the Archives of Surgery. The study, limited to older, male patients in the Veterans Affairs hospital system, showed that costs rise acutely with the surgery itself, as one would expect, but then fail to fall for the three years following -- for reasons as yet unclear.

Before following where this leads, I hasten to add that saving money is not the primary reason for bariatric surgery, any more than for coronary bypass. In general, intervening to address severe threats to health carries a cost, often a high cost, and one our society has proven repeatedly it is willing to pay. Bariatric surgery can reverse disease, avert death, and extend life. That it is the best thing going for the treatment of severe obesity is well established by the available evidence currently in hand. I believe strongly it should be available to all who need it.

Our societal problem is letting too many need it in the first place.

While we keep spending vast fortunes on a status quo which, if we are quite blunt about it, covers the expenses of the highly imperfect efforts of all the king's horses and all the king's men, we could spend vastly smaller sums to blaze new trails entirely.

Consider a study in which ordinary people who are lean and healthy in the midst of an obesigenic environment are enrolled. The group should be diverse, and we would want people who CAN gain weight, but don't.

The group assembled, we should use readily available research methods to make a systematic audit of their skill sets, and the resources/tools they use as a matter of routine to stay healthy and lean. Then, the inventory of skills and tools could be assembled, and matched against the daily challenges they are used to overcoming. …

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