Weight-Loss Surgery Can Prevent Cancer, Now Let's Pay for It

The evidence of weight-loss improving overall well-being and predisposition to chronic as well as acute conditions is mounting. We now need coverage policies that can help patients take advantage of weight loss procedures.

Endometrial cancer affects nearly 55,000 women annually in the United States and one of the risk factors for the disease is obesity. Now, a study conducted at the University of Virginia Cancer Center has found that bariatric surgery, resulting in a drastic reduction in weight among obese women, eliminated precancerous uterine growths in those who previously had them.

“If you look at cancers in women, about a fifth of all cancer deaths would be prevented if we had women at normal body weight in the US,” said Susan C. Modesitt, MD, of the University of Virginia Cancer Center, and the first authors on the study. “When you’re looking at obesity-related cancers, the biggest one is endometrial cancer, but also colon cancer, breast cancer, renal cancer and gall bladder cancer. We think about 40 [percent] to 50 percent of all endometrial cancer, which is in the lining of the uterus, is caused by obesity.”

Of the 71 women enrolled in the study, the mean body mass index (BMI) was 50.9 (BMI of 30 is considered obese), 68 underwent bariatric surgery, 2 declined the procedure, and 1 died of a heart condition prior to surgery. The average weight loss following surgery over a 1-to-3-year follow up period was 100 pounds. About 10% of participants had precancerous uterine changes, which seemed to have resolved following their procedure. These outcomes were over and above the improved quality of life, improved glucose homeostasis, and better insulin responsiveness observed among participants.

The evidence of weight-loss improving overall well-being and predisposition to chronic as well as acute conditions is mounting. We now need coverage policies that can help patients take advantage of weight loss procedures—pharmacotherapies or bariatric surgery, or gastric bypass—and avoid costs associated with treating subsequent health conditions resulting from being overweight. The economics are quite transparent; 5% weight loss has been shown to deliver substantial financial benefits with a potential saving of over $2000 annually in medical costs. While obesity drugs like phentermine/topiramate and lorcaserin are being covered by Express Scripts and Aetna, CVS has added liraglutide to its 2016 formulary.

However, coverage policies for bariatric surgery may vary by plan type and there could be guidelines that dictate qualification for the procedure.