Bariatric surgery options are expanding in Rhode Island, but practitioners say that many more people could benefit from the weight-reduction procedures than actually seek them out.
While as many as 25% of Rhode Islanders are considered obese, a tiny portion of that population turns to a surgical option for weight reduction.
Stigma associated with the surgery could be a factor, as well as the cost. More education is needed to explain the long-term benefits of surgery and why it may be an appropriate option for people with severe obesity, according to bariatric specialists.
“It’s getting better with time, but there is still a big stigma with bariatric surgery. A lot of times it’s viewed as the easy way out when that’s not true at all,” said Dr. Lindsay Tse, a bariatric surgeon with the Center for Surgical Weight Loss at Care New England.
The Care New England Health System program expanded in September into a new location at South County Commons in South Kingstown.
The move is aimed at expanding its geographic reach and to attract more people in southern Rhode Island who are now going to Connecticut for the procedure, Tse said.
The Center for Surgical Weight Loss is among three centers in Rhode Island that are accredited through the American Society for Metabolic and Bariatric Surgery. The other two are at Roger Williams Medical Center and the Center for Bariatric Surgery at Lifespan Corp.’s The Miriam Hospital, both located in Providence.
Prior to the expansion into South County, the Center for Surgical Weight Loss performed about 300 bariatric surgeries a year at Kent County Memorial Hospital in Warwick.
Bariatric surgery involves a reduction of the size of the stomach, and sometimes the lower intestine, to reduce the absorption of calories. There are several types of surgeries available in Rhode Island. The most common is the gastric sleeve, which involves the removal of a portion of the stomach and stapling to create a smaller stomach section.
It is a major abdominal surgery that requires general anesthesia and one or two days in a hospital. But it can lead to reductions in chronic conditions that undermine health, according to specialists.
These can include liver disease, cancer, high blood pressure and diabetes, said Dr. Dieter Pohl, director of the bariatric surgery center at Roger Williams Medical Center.
“Obesity is a big problem in the United States,” Pohl said. “The accepted criteria is a person with a body mass index of 35, and diabetes, or something like that, is eligible for surgery and would actually benefit from surgery. Their life expectancy is higher with surgery than if they don’t have surgery.”
The procedure costs about $15,000 to $25,000, depending on the type of surgery and where it’s performed, according to the National Institute of Diabetes and Digestive and Kidney Diseases. It is covered by most insurance plans, depending on the body mass index of the patient, their age and weight-related conditions.
Roger Williams Medical Center has performed weight-reduction surgeries through an accredited center since 2005. It was the first in Rhode Island to use laparoscopic surgery – featuring small incisions and the aid of a camera. Because laparoscopy is less invasive, it ushered in more acceptance of bariatric surgery, according to Pohl.
The center performs about 500 surgeries a year, he said, and is the largest in Rhode Island. The medical center charges about $13,500 for patients, not including insurance coverage, he said.
The surgery is profitable for the medical center, but more importantly, it saves and extends lives, he said.
“If you look at what people go to the doctor for, other than routine [physicals], it’s because they have high blood pressure,” Pohl said. “They have high cholesterol. They have diabetes. Their joints hurt. They have heart disease. If you go down to the root cause of all these problems, it’s obesity.”
People who have to lose a substantial amount of weight can try to do so through diet and exercise. But the likelihood they will lose it and keep the weight off is uncertain, he said. “The weight-loss surgery breaks through that. It helps people keep 70 to 80% of that lost weight off for decades,” Pohl said.
All of the Rhode Island centers have similar qualifying criteria for bariatric surgery.
People without serious medical conditions must have a body mass index of 40 or more. People with conditions such as diabetes or hypertension must have a BMI of 35 or more.
Nationally, fewer than 1% of the people who are eligible for bariatric surgery are seeing surgeons, according to both Pohl and Tse.
Over time, more primary care physicians have started referring patients to bariatric surgery, Tse said. She sees a mix of patients, including those with BMIs in the morbidly obese category. “But I do see a fair amount of patients who have a BMI under 40,” she said. “These are patients who have insulin requirements, uncontrolled hypertension, and they’re inquiring about bariatric surgery.”
Pohl said about one-third of his center’s patients are referred – but he added that it remains a difficult conversation consultation. “No one wants to be told they’re overweight,” he said.
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
