Ted Threadgill wavered for years over whether to get bariatric surgery, the treatment option considered the most effective way for obese people to lose excess weight and, most important, keep it off.
On one hand, the 54-year-old former college baseball player knew the dangers of tipping the scales at 350 pounds, the problems it caused just playing sports. On the other, it seemed a “pretty big procedure — removing a piece of your stomach, for Pete’s sake.”
Then Threadgill contracted COVID-19, which poses a higher risk of severity in people with obesity.
Threadgill survived, but it was a frightening few weeks: double pneumonia, a temperature of 104, breathing difficulties that made it challenging to just get in bed, sleep from which he’d wake soaking wet. Finally recovered, the decision to get bariatric surgery was a no-brainer, he said.
“COVID was the last straw, the ultimate sign I’m not bulletproof,” said Threadgill, CEO of a chemical distribution company in The Woodlands. “I figured bariatric surgery would permanently shed weight I had determined I wasn’t capable of keeping off on my own.”
Bariatric surgery, considered underused by doctors, is gaining popularity because of COVID-19, both among obese people who have already battled the disease and those who haven’t but want to improve their odds. In Houston and around the country, specialists in the field have reported an increase in procedures and consultations about whether interested parties would make good candidates.
The research already indicates the procedure’s COVID-19 benefits. A Cleveland Clinic study this month showed that obese patients who’d previously had bariatric surgery were 25 percent less likely to be hospitalized and need intensive care than obese patients who hadn’t had the surgery.
Hard data about the recent increase in the procedure’s use is hard to come by, particularly among researchers, partly because bariatric surgery was one of the elective procedures stopped during the early months of the pandemic. When elective surgeries resumed, insurance company requirements that patients must first undergo weight-loss regimens typically meant it could take months before a procedure can be performed. Many such patients are still in the pipeline.
Still, insurance company data show the trend. UnitedHealth’s Optum health care program saw a 25 percent increase in the enrollment of bariatric-surgery programs during the summer, and Cigna authorizations of procedures rose 10 percent from June to August 2020 compared with 2019, after dropping nearly 40 percent during the spring. The increases came despite COVID-19 fears that scared many patients away from visiting hospitals, a phenomenon that led to an increase in deaths from heart attacks and strokes.
“I’ve definitely seen a COVID-related increase,” said Dr. Felix Spiegel, a Memorial Hermann bariatric surgeon. “In May and June, I’d say I had between 10 and 20 patients come in for consultations because of their apprehension of the disease, patients who specifically mentioned COVID.”
The latest theory is that COVID-19 is particularly hard on obese people because fat is rife with ACE2 receptors, proteins the coronavirus uses to enter cells and replicate. In other words, the more fat a person has, the more COVID-friendly receptors he or she will have — and the greater the odds of a high viral load.
On another level, COVID-19 more severely affects the obese because of downstream consequences of too much weight. It decreases lung capacity, COVID-19’s favorite battleground. It is associated with diabetes, hypertension and sleep apnea, which are also risk factors for COVID-19. It introduces harmful agents into the blood that reduce immune function needed to fight off viruses. And it predisposes people to blood clots, which COVID-19 can trigger.
Doctors haven’t had to hammer the lessons home.
Dr. Vadim Sherman, a Houston Methodist bariatric surgeon, said two new reasons have emerged on a hospital form asking people why they are interested in the surgery: seeing obese people dying from COVID-19 at a faster rate was “a wake-up” call, and the sedentary lifestyle caused by the lockdown was leading to weight gain and adding to their risk.
“It pushed us to move faster,” said John Burns, an industrial cybersecurity officer who had the surgery, along with his wife, Nicole, soon after Memorial Hermann resumed elective surgeries. “We’d already done all the required preliminary work, then weren’t able to do much during the lockdown — so we decided just to cannonball into the surgery like everything else in life.”
Bariatric surgeons say the procedure is the appropriate response for obese people who cannot lose weight or keep it off. The surgery works by reducing the size of the stomach, limiting the amount of food that can be consumed and curbing appetite by altering hormonal signals between the brain and stomach. That’s why patients lose excess weight over a two-year post-surgical period.
The surgery had a checkered history, considered too risky by many in the early days of the 1990s. But thanks to refinements, its safety profile today is equivalent to natural childbirth, according to Dr. Samer Mattar, chief of metabolic and bariatric surgery at Baylor College of Medicine. Twenty years ago, the risk of complications was 1 in 100; today it is 1 in 1,000.
Surgeons performed about a quarter of a million bariatric surgeries in 2018, the latest year for which data are available. But that represents less than 1 percent of people eligible for it.
That number is expected to increase in 2020, even with nearly two months of deferred surgeries.
Dr. Jason Balette, the bariatric surgeon at Memorial Hermann The Woodlands who performed Threadgill’s surgery, dismisses the suggestion that a silver lining of COVID-19 might be the attention it has brought to bariatric surgery and to people losing weight. But he acknowledges “anytime is a good opportunity to talk about obesity and the different approaches to weight loss.”
In no need of convincing are Threadgill and John and Nicole Burns, the three of whom have lost nearly 300 pounds between them. They say the pre- and post-surgical differences are like night and day.
“I don’t mean to downplay things, but it’s felt surprisingly easy so far,” said Threadgill. “I feel great, I have more energy, I’m able to do things I haven’t done in years.”