Should Medicare Cover Gastric Bypass?

Just last year, 49-year-old Paulette Zanotti tipped the scales at 248 pounds -- before gastric bypass surgery that she says saved her from thoughts of suicide.

"I was so tired of fighting this battle, of socially isolating myself, of being depressed," she said.

Zanotti is one of 140,000 Americans who went under the knife last year to restrict the amount of food their stomachs can hold.

"Compared to anything else available for weight loss, surgery is the only thing that has the longest-term outcome to keep the weight off," said Dr. Madelyn Fernstrom of the University of Pittsburgh.

The success of weight-loss surgery has compelled some insurance companies, including Zanotti's, to cover its cost, which starts at a hefty $30,000.

But those covering the procedure don't include Medicare, which only covers the surgery for overweight seniors who are suffering from an additional illness -- such as diabetes, heart disease or arthritis.

Worth the Risks?

The trouble is no studies have been done to determine whether the surgery's benefits are worth the risks for seniors suffering from obesity alone.

"There are reasons to be concerned that the effects of the surgery may be different in the elderly," said Dr. Mark McClellan of the Center for Medicaid & Medicare Services, "so we'd really like to know more about how well this treatment works."

Some experts say even if older people take longer to recover and are more susceptible to complications, the surgery still makes sense for carefully selected seniors.

"Many more people have died waiting for the surgery than have actually died getting the surgery," said Dr. George Blackburn of Harvard Medical Center. "So it's very safe relative to no treatment and staying in this severe, morbid obese state."

But if Medicare expands coverage for weight loss surgery, it could then face added pressure to cover non-surgical weight loss programs, such as Jenny Craig or Weight Watchers, and that could get expensive.

How expensive? No one knows. But some seniors want Medicare to find out.

"These people who are, you know, 50 and 60 and 70 pounds overweight are going to cost Medicare a whole lot of money somewhere down the line," Medicare patient Barbara Doherty said.

Medicare officials say they'll consider broadening coverage for weight loss surgery if it's proven safe and effective for seniors. Researchers hope to get them that proof by conducting clinical trials this year.

ABC News' Nancy Weiner in Washington originally reported this story for World News Tonight on Jan. 15, 2005.