Should benefit plans cover weight-loss surgery?

If you are an obese “yo yo” dieter with other related illnesses, University of Alberta Professor of Medicine and obesity expert Dr. Arya Sharma says gastric surgery is your best option for long-term weight loss. He also thinks if public coverage is not available, employer-sponsored benefit plans should cover the cost.

The two main forms of obesity surgery are a gastric bypass or gastric banding. Sharma says either one of these forms of surgery is a far better approach than diet and exercise for individuals with a Body Mass Index  of over 35 who have other serious health problems like asthma, diabetes, high blood pressure, sleep apnea etc..

“If I took 100 people off the street, and put half of them on a diet with exercise and put a gastric band on the other half, three years later you’ll find most of the diet and exercise people have put their weight back on,” he says. “Probably 70 to 80 per cent of the band people will be doing okay, assuming both groups get appropriate follow up treatment.”

The gastric bypass is paid for by the public system in all provinces, but public coverage for gastric banding varies by province. For example, it is available in Alberta, but not in British Columbia or Ontario. 

Although Alberta residents have public coverage for both procedures, there is a 2 1/2 year waiting list for either surgery at Sharma’s clinic. Because there is no public coverage, Ontario and B.C. residents can get gastric banding with little delay at private clinics, but it can cost up to $16,000 including aftercare. Some employers already cover the weight loss medication Xenical which costs $1,800 per year.

In a recent presentation to an International Foundation of Employee Benefit Plans conference in Las Vegas, Sharma cited research showing that obese employees take 13 times as many days off work and incur short and long term disability claims that are on average over $7,000 more than for healthy-weight employees.

He emphatically rejects the idea that gastric banding is a cosmetic procedure or that adding coverage will add significant cost to employer-sponsored benefit plans.

“It is our experience that that even when free surgery is available to our patients, only 2 or 3 per cent opt for a procedure. If an employer has 100 employees who qualify for bariatric surgery, two or three people may want it and not necessarily all in the same year.”

Sharma also argues that the cost to employers of adding coverage for the few employees who do undergo gastric banding will be more than offset by savings in drug plans, absenteeism and disabilities.