Like many “techy” types in my  generation, I have started reading the Steve Jobs biography. One of the revelations that has come to light from the book is the fact that Mr. Jobs delayed having potentially life saving surgery for nine months while he tried to treat his cancer with diet and lifestyle treatments. For those of you who are not familiar with the medical issues surrounding his story, he was undergoing a CT scan for another reason when a mass was found in his pancreas. This mass had the characteristics of a cancer so very quickly he underwent a needle biopsy of the mass. The most common form of pancreatic cancer, adenocarcinoma, is very fast growing, often is only found after it has spread extensively, and has a very low surgical cure rate. This is the type of cancer that very quickly killed the actor Michael Landon. Depending on how old you are, he was ‘Little Joe” on Bonanza or the father on Little House on the Prairie.  When Mr. Jobs had his biopsy the doctors found a rarer form of pancreatic cancer called neuroendocrine tumor. These tumors tend to be slow growing, and in the early stages, often can be cured surgically. Rather than have surgery immediately as his doctors recommended, Mr. Jobs spent nine months treating his cancer with diet and holistic therapies. When he subsequently had surgery, his tumor had spread. This prompted additional chemotherapy and subsequent repeat surgery with liver removal and a liver transplant. In spite of this, his tumor returned which lead to his early death this past month.

Of course there is no way to know if his outcome would have been different if he had his surgery at the time of his diagnosis. There is a phenomenon in social psychology that shows us that when people make a choice that subsequently turns out badly, they assume the other choice would have turned out better. This of course is not necessarily the case.  Suffice it to say, however, that most medical professionals, and subsequently Mr. Jobs himself feel as though there is a chance things would have turned out better with timely surgery.

As I reflect on this story, it occurs to me that insurance companies are everyday imposing a delay in potentially lifesaving weight loss surgery.  Obesity is a serious chronic medical condition that leads to a whole host of medical problems and premature death. There are very strong genetic predispositions with multiple environmental and lifestyle causative factors. The same can also be said of cancer. Once a patient suffers from severe obesity (BMI greater than 35) nonsurgical treatments have a very low success rate. (less than 5% of people can maintain sustained weight loss). Obesity surgery is safe and effective treatment for obesity, and has been shown to prolong life and improve health.

Increasingly many insurance companies have instituted requirments for weight loss surgery that require patients to have a formalized “six month diet history” prior to approval for surgery.  This usually involves monthly visits with the patient’s physician. To make patients do a formalized “diet history” presumes that some of the patients who come to us for surgery have never tried nonsurgical attempts at weight reduction so that by making them do the six month diet history you can find that lucky 5% that will lose weight without surgery. This notion is of course ludicrous. I recently spoke on the phone with an insurance company medical director attempting to advocate for my patient who had a poorly documented diet history. This medical director indicated that he felt that the fact the patient did not have consecutive months of diet history visits was an indicator of poor prognosis with weight loss surgery. I am aware of no data that supports this assertion. A few years ago we examined our weight loss database and compared our patients who had insurances that required a six month diet history with those that didn’t. We found there was NO difference in weight loss. Insurance companies have instituted these policies with little to no data to support their benefit. This is particularly galling when you consider the tremendous amount of supportive research data that was required to have insurance companies cover weight loss surgery.

Readers of this blog will know that I am not in favor of anyone having surgery if they are not ready to make the significant dietary, activity, and behavioral modifications needed to have success with weight loss surgery
. But when they are ready, delaying surgery six months (or nine months) is not right.

This blog post typed on a MacBook Air. RIP Steve Jobs.