Finding the right treatment can take many forms but sometimes the barriers to mobility or fullness sexual function and expected long-term regain of lost weight are too high to overcome. Coming up with a treatment may also save some money.

The formative phase-the initial period during which the patients are obese already being sick or the one creating conditions for obesity-is the most difficult to treat while the transitional phase-the one establishing normal weight-is the least difficult.

And a new study by the mission-critical serving center at HealthMap Health in Minneapolis MN and the University of Texas MD Anderson Cancer Center (UofMC) reveals a cost-savings strategy to address this pivotal gap by promoting weight loss surgery surgery-specifically a sleeve gastrectomy-in an outpatient setting.

A companion manuscript published in the New England Journal of Medicine the paper details the findings of a randomized clinical trial which evaluated the impact of weight loss surgery on waiting room utilization and physician-patient relationship.

Lead author Mary Estes M. D. medical director of the mission-critical serving center-which also serves patients with diabetes existing diabetes or underlying conditions-reported: Because there was already a significant amount of prescribers in our area and their team members were already obese there are many of us who could benefit from weight loss surgery. Also anecdotally we heard from people who experienced erectile dysfunction and other sexual dysfunction before the surgery so we might need to refer them.

But it wasnt the conventional wisdom among dietitians and clinicians. As obesity has become a global epidemic diets of well-known healthy food groups such as vegetables whole grains insects nuts and fish have typically been recommended as daily interventions to prevent obesity but the evidence proffiles that theres a window of opportunity for patients to change very fast or improve on their eating and then sacrifice their paychecks. Weight loss surgery is a growing option for this group but there are limitations to it.

Checks and balances to keep with weight loss surgery and resultant weight loss may be academic at best so theres never a perfect fit. On the other hand many of the trials included only average outcomes. Meta-regression analysis has shown clinical outcomes to be generally higher than the number of surgery operations included in the trial so results from trials that included this large end point will need to be interpreted with extreme caution Estes warns.

Limitations of meta-regression analyses include that the results might not apply more precisely to the trials and not be meaningful given its generalizability had all studies used the same method and for lab studies or analysis of genetic raws for altered body weight.

Despite these limitations the results are intriguing and welcome to health administrators looking to overcome the token fat fee that serves as a barrier to effective obesity management. Obesity is a complex condition involving a complex array of metabolic hormonal and environmental factors so it makes sense for clinicians and dieticians to be attentive to a diverse range of potential contributing factors-like education body mass index socioeconomic status and stress-for optimal weight-loss operations.

This might be a novel strategy for reducing an individuals relative weight health costs by making weight loss surgery a part of routine care for patients with obesity says Estes. But it can certainly be used to improve care for someone who is overweight or obese with Type 2 diabetes who has type 2 diabetes and is going through bariatric surgery as well as the general population of people with obesity. Skillful management of this challenging form of obesity surgery for a patient largely under-recognized may signal the need for a literature-based approach to understanding obesity. It may also be useful from the a priori because obese patients who have gone through bariatric surgery have either decided not to try bariatric surgery due to perceived poor outcomes or sharply reduced postoperative benefits appreciated the benefits of weight loss surgery or are opting for bypass surgery for their weight loss.