I couldn’t believe my ears!! I was speaking with a fellow general surgeon, and I had just quoted him a huge meta-analysis of over 22,000 patients that demonstrated the amazing successes with weight loss surgery. His response was, “Well, I was watching on The Biggest Loser the other day…” Was this educated man really equating a TV Show to a mammoth scientific meta-analysis? I had to pause for a second to collect my thoughts. The difference in the level of rigor between the peer-reviewed publication and The Biggest Loser is the difference between the Pope speaking ex cathedra and the local busybody passing gossip over the backyard fence. Sigh… Some people well never acknowledge the superiority of weight loss surgery.
This interaction was replayed in my mind when I read this article in the LATimes the other day. I thought the article was fascinating. Fascinating in a I-can’t-believe-what-I’m-reading kind of way. Dr. Robert Huizenga is the medical director for NBC’s The Biggest Loser. For those who are unaware, The Biggest Loser is a reality show that recruits obese individuals for a vigorous exercise regiment and strict diet. Of course, an ultimate winner of the competition is crowned The Biggest Loser. The diet is a low calorie, and the work-out regiment consists of 4 hours of exercise every day. So far so good, but then Dr. Huizenga states that the changes he saw have “never been documented in the history of severe weight loss.” Really? It sounds like another day in the office to me. He further draws the comparison between weight loss surgery and the TV show.
Weight loss surgery has been and always will be a last resort for a person in their weight los journey. Before I will perform a weight loss procedure on anyone, they must have demonstrated that they have attempted diet, exercise and behavior modification without success. I have sent people out of my office when they tell me they have never tried weight loss through the traditional methods. I have monthly seminars for people interested in weight loss surgery. One thing I always say, “If you can lose your weight through diet, exercise and behavior modification, that’s what you need to do!” That does not mean that the weight loss crown is in danger of being passed from surgical intervention to NBC.
On the show, Dr. Huizenga documents the average contestant is a BMI of 40 with the majority having diabetes and high blood pressure. This is a lighter patient that most bariatric surgeons work with. A typical patient for a surgeon would be this article from the Annals of Surgery where the 379 patients had an average BMI of 46. This range is much more typical from the bariatric surgeon. A BMI of 40 or less is in the featherweight category for me.
Dr. Huizenga further describes the diet as being low-calorie, and I have no issue with the diet. But the exercise regiment is impressive. Four hours of training every day. This includes one hour of resistance training, one hour of intense aerobic activity and two hours of moderate activity. I thought to myself, “Who has time for this much exercise?” The answer is obvious- a game show contestant. There are few people in real life that are capable of this kind of time commitment. In fact, Jillian Michaels (one of the original The Biggest Loser personalities) herself states that this much exercise is “not possible” and “not safe” in real life. I was watching a similar show the other day where the contestant had to quit their fulltime job because of time constraints. Fortunately, they had a supportive spouse who got a second job, so they could continue 4-6 hours of daily exercise. This is just impossible for all but a few people.
I didn’t disagree with everything that Dr. Huizenga said in the article. I agree that “what doctors call ‘aggressive medical therapy’ is laughable.” I also agree that large weight loss results can be had safely. And I also believe that people should go to great lengths to show themselves that diet and exercise isn’t working before attempting surgery. Unfortunately, I can’t agree or disagree with his statements that his results are as good as weight loss surgery since the results are not yet published at the time I am writing this.
But the thing that got my blood pressure up was the following:
“In an interview, Huizenga said the “Biggest Loser” approach, which shocks a patient’s body to build muscle and bone while losing fat, may be intensive and costly. But he asserted it would probably be cheaper to treat obesity with such an intensive, short-term program than to treat a bariatric patient at a cost of $30,000 per surgery and the additional expense of treating complications.
“If someone like me could get half the amount that a bariatric surgeon gets to treat a single patient, you could see some amazing things,” Huizenga said.”
This ridiculous comment reminded me of Presidents Obama’s assertion about a surgeon being compensated “$30,000, 40, $50,000” for a foot amputation. People, please, if you don’t know something, don’t act like you do. A surgeon who trained me used to say, “No information is better than bad information.” No information will result in you tracking down what is correct. Bad information will result in action based on an erroneous thought.
Here is the truth about the surgeon’s reimbursement for bariatric surgery. That $30,000 figure is to cover the surgeon, the hospital, the hospital stay, the nurses, the anesthesiologist, the pathologist, the OR time, and any ancillary services required as well. In my region, surgeons don’t get reimbursed even 10% of that figure under the best of circumstances. In all cases, this price includes the follow-up for 3 months after the procedure in which we do not get compensated anything extra.
So, Dr. Huizenga is willing to personally supervise patients for a 24-week program of intensive dieting and grueling exercise for $1000 of total payment? I think most insurance companies would be on board. In fact, many patients would probably fork over one thousand dollars for 6 months of that kind of personal attention. Obviously, the doctor is gaming for the $15,000 payout, because expecting him to do that for $1,000 is as unrealistic as getting most people to exercise for 4 hours a day!