F.C.,Greeley bariatric centers receive excellent marks

It may come as a surprise to hiking, biking, skiing, snowboarding, running Coloradans that residents of their state are becoming overweight and obese at a remarkable rate.

The incidence of obesity in Colorado nearly doubled between 1990 and 2000, moving from 8.4 percent of the population (49th in the ranking) right on up to 14.4 percent and gaining. In that same 10 years, the obesity count for Larimer County went from 7.2 percent to 13.9 percent.

According to a 2004 Centers for Disease Control study, obesity costs to the state run at about $874 million.

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Obesity is expensive, it is growing at what health professionals consider epidemic rates – and it can be cured.

“Obesity is one of the leading causes of preventable death,´ said Michael Johnell, M.D., director of the bariatric surgery program at North Colorado Medical Center  in Greeley. “It is a disease that has serious comorbid conditions like heart disease and stroke.”

The American Obesity Association notes on its Web site (www.obesity.org) that obesity is associated with more than 30 medical conditions, 15 of which have what are known as “strong correlations,” including Type 2 diabetes, high blood pressure and osteoarthritis.

When, then, does overweight (considered treatable by diet and exercise) move to obese (where the odds against losing weight through diet and exercise increase dramatically) to morbidly obese (where surgery is almost the only cure)? The standard is the Body Mass Index, a weight-to-height measurement tool. Obesity starts at a BMI of 30 (e.g., six feet tall, 220 pounds).

“Generally speaking, a morbidly obese person is 100 pounds overweight,´ said Becki Mudgett, bariatric coordinator for the Northern Colorado Surgical Associates. “The largest person who has come to us weighed 800 pounds. He’s doing great.”

It is in the context of rising rates of obesity and the associated rising costs to employers and health care that two surgical centers, one in Greeley and one in Fort Collins, have been designated as centers of excellence by the American Society of Bariatric Surgery. The ASBS inspectors review the bariatric program and its ability to accommodate patients who exceed their body weight by 400 pounds or more.

“Our center of excellence is an association between Northern Colorado Surgical Associates in Fort Collins and Poudre Valley Hospital,´ said Jo zumBrunnen, director of surgical and specialty services at PVH. “Together we are the Bariatric Center of the Rockies.”

While Northern Colorado Surgery Associates practice general surgery, including bariatric procedures with three specialists, the Greeley program is a specialty practice.

“I came to Colorado in 2001, and in 2004 joined NCMC,” Johnell said. “Banner Health has made this a priority. Bariatric surgery is safe and effective and cures many diseases that lead to early death.”

So when there is a cure for morbid obesity, a disease that has measurable economic impacts, why do the numbers keep going up instead of going down? First of all, the prospective pool is growing. That is, there are social issues that are moving large numbers of the population from healthy weight to overweight where genetics and psychological factors kick in.

Virginia Englert, director of the Poudre Valley Health System’s Obesity Task Force, said that people sit a lot more than they used to, partly because the nature of work has changed. They eat differently, too.

“It’s hard to stay a healthy weight because there is food everywhere and the portions are out of control,” she said. “But it’s easier to prevent obesity with diet and exercise than it is to treat it.”

The facts of sedentary modern life apply equally to people who have never been overweight and those who, for an array of reasons, always have.

“Some of our patients have been overweight since they were teens,” Johnell said. “They lose and gain weight, but once they become morbidly obese, the body’s metabolism has changed, impairing the body’s capacity to lose weight.”

Once a person arrives at a morbidly obese weight, the barriers to a cure keep piling up. The body will not cooperate with even the most focused effort.

And then there is the expense: bariatric surgery costs somewhere between $20,000 and $30,000. Ironically, as the surgery has become demonstrably successful, the insurance guidelines have become stricter.

“The surgery is working, and so the demand has increased,´ said Lorrie Linquist director of bariatric services at NCMC. “So there are suddenly more insurance restrictions. Patients may have to document they have been under a diet program under a doctor’s care for six to 12 months.”

The AOA fact sheet notes that Medicaid does not cover obesity procedures, but does cover prescriptions for Viagra. Medicare does not cover treatments for obesity (unless it is caused by another medical condition such as hypothyroidism), but does cover services related to alcohol detoxification, drug rehabilitation and sexual impotence.

 “It may take years, but it is just a matter of time until insurance companies have to take this surgery seriously,” Johnell said. “Patients can come off their medication for high blood pressure, diabetes and high cholesterol because those conditions no longer exist.”

Taking the surgical approach to weight loss is not without its detractors – just Google in “Al Roker and weight loss” for a lively exchange. One of the criticisms is that the surgeries are no panacea for the constellation of causes that manifest themselves as obesity. That is why those associated with Northern Colorado’s centers of excellence are emphatic about what makes their programs successful.

“You can’t treat it like a surgery,” zumBrunnen said. “The center involves a whole array of services. Our patients must make a lifelong commitment to change.”

Linquist added that there are important psychological issues patients discuss before surgery.

“The treatment begins with the surgery,” she said. “Then the other members of the team step up: the nutritionist, behavior nurse, a case manager who follows the patient and the leaders of support groups.”

The hospitals, too, had to make a commitment to make them competitive in an emerging surgical specialty.

 “When we were preparing ourselves to become a center of excellence, we had to reevaluate our furniture and equipment,” zumBrunnen said. “We had to get chairs, wheelchairs, blood pressure cuffs, operating tables and gowns to fit. These things enhance the quality of the patient’s hospital stay and helps in their recovery.”

A center of excellence does not mirror what Dr. Johnell called one of the last legal forms of discrimination in this country. Even those in the medical profession have had their doubts that surgery was a suitable substitute for good old American will power.

“I know people who have been skeptical,” zumBrunnen said. “And then they go to one of the support groups and hear people say things like ‘thank you for giving me my life back’ or ‘I went to the park with my kids for the first time,’ or ‘the day of surgery is the birthday I celebrate.'”