OBES SURG (2014) 24:692–695 DOI 10.1007/s11695-013-1140-7
ORIGINAL CONTRIBUTIONS
Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Michael Turchiano & John K. Saunders & Gregory Fernandez & Livia Navie & Luis Labrador & Manish Parikh
Published online: 5 December 2013 # Springer Science+Business Media New York 2013
Abstract Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved, unemployed patients with severe obesity. Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed. Preoperative patient questionnaires and medical records were reviewed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team. Follow-up data was obtained on all available patients (including those who did not undergo surgery), including weight and employment status. A standardized telephone questionnaire was administered to supplement details regarding employment. Changes in employment status and body weight were determined in both groups. Results Here, 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team. The vast majority of patients (>80 %) were minorities (primarily
Hispanic) and publicly insured. Seventy-two underwent bariatric surgery and 121 did not. Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively (p =0.043). There was a 10-point body mass index reduction in the surgical group, compared to 1-point reduction in the non-surgical group after one year. Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort. Future research in this area should collect detailed prospective data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment. Keywords Unemployment . Obesity . Minorities . Bariatric surgery
Introduction M. Turchiano : J. K. Saunders : G. Fernandez : L. Navie : L. Labrador : M. Parikh (*) Department of Surgery, Bellevue Hospital Center, NYU School of Medicine, New York, NY, USA e-mail: [email protected] M. Turchiano e-mail: [email protected] J. K. Saunders e-mail: [email protected] G. Fernandez e-mail: [email protected] L. Navie e-mail: [email protected] L. Labrador e-mail: [email protected]
Obese individuals are at a distinct disadvantage at the work place. Studies have demonstrated that obese subjects are more likely to face discrimination at all phases of the employment process and have higher rates of disability than their lean peers [1]. Obesity-related expenditures in 2008 accounted for 9.1 % of total US medical expenses [2]. Among full-time employees, obesity-related expenditures, including lost productivity and absenteeism, cost $73.1 billion annually [3]. Employees with severe obesity (i.e., those with body mass index (BMI) greater than 35 kg/m2) represent 37 % of the obese population but are responsible for 61 % of excess costs. Bariatric surgery is an effective treatment for obesity and related comorbidities [4]. A disproportionate number of all Americans eligible for bariatric surgery are minorities, poorly educated, or impoverished. In a nationwide analysis of
OBES SURG (2014) 24:692–695
socioeconomic characteristics of the population eligible for obesity surgery, Livingston et al. found that those eligible for obesity surgery had lower education, lower income, and greater dependence on Medicaid than their non-morbidly obese counterparts [5]. Additionally, these authors found that over 30 % of morbidly obese patients in the USA are minorities, 29 % live at or near the poverty line, and 54 % has a high school education or less. A large number of these patients are unemployed. There is a paucity of data regarding the effect of bariatric surgery on employment status, particularly in the underserved minority population. The purpose of this study was to determine the impact of bariatric surgery on employment status in a cohort of unemployed severely obese individuals seen at our urban safety-net hospital. This cohort was also compared to a group of unemployed severely obese patients who did not undergo bariatric surgery.
Materials and Methods This study was a retrospective review of all patients seen in our bariatric surgery program over a two-year period. The study protocol was approved by the Institutional Review Board (IRB). Preoperative patient questionnaires and medical records were reviewed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team. The preoperative questionnaire specifically inquired about employment status and whether or not the patient received disability payments. Follow-up data was obtained on all available patients (including those who did not undergo surgery), including weight and employment status. A standardized IRB-approved telephone questionnaire was administered to supplement details regarding employment. For the purposes of this study, “employment” was defined as fulltime employment (i.e., part-time employment did not qualify). Rigorous attempts at contacting the patients were employed,
693
including obtaining changed numbers, searching for accurate telephone numbers, internet searches utilizing directory assistance, and medical record searches. We compared the surgical and non-surgical groups at baseline. Changes in employment status and BMI were determined in both groups. Excess BMI lost (%EBL) was calculated as follows: %EBL = [((preoperative BMI − current BMI) / (preoperative BMI − 25) × 100)] [6]. Statistical analysis was performed using Student's t test and Pearson's chi-square, with p
ORIGINAL CONTRIBUTIONS
Bariatric Surgery May Improve Employment Status in Unemployed, Underserved, Severely Obese Patients Michael Turchiano & John K. Saunders & Gregory Fernandez & Livia Navie & Luis Labrador & Manish Parikh
Published online: 5 December 2013 # Springer Science+Business Media New York 2013
Abstract Background The purpose of this study was to determine the impact of bariatric surgery on employment status in underserved, unemployed patients with severe obesity. Methods A retrospective review of all unemployed severely obese patients seen in our urban safety-net bariatric surgery program was performed. Preoperative patient questionnaires and medical records were reviewed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team. Follow-up data was obtained on all available patients (including those who did not undergo surgery), including weight and employment status. A standardized telephone questionnaire was administered to supplement details regarding employment. Changes in employment status and body weight were determined in both groups. Results Here, 193 unemployed severely obese patients were evaluated by the multidisciplinary obesity team. The vast majority of patients (>80 %) were minorities (primarily
Hispanic) and publicly insured. Seventy-two underwent bariatric surgery and 121 did not. Twenty-four percent of the surgical patients and 9 % of the non-surgical patients had acquired full-time employment at least one year postoperatively (p =0.043). There was a 10-point body mass index reduction in the surgical group, compared to 1-point reduction in the non-surgical group after one year. Conclusions Bariatric surgery may improve employment status in an unemployed severely obese patient cohort. Future research in this area should collect detailed prospective data on employment prior to surgery and assess changes longitudinally to provide a more complete picture of the impact of bariatric surgery on employment. Keywords Unemployment . Obesity . Minorities . Bariatric surgery
Introduction M. Turchiano : J. K. Saunders : G. Fernandez : L. Navie : L. Labrador : M. Parikh (*) Department of Surgery, Bellevue Hospital Center, NYU School of Medicine, New York, NY, USA e-mail: [email protected] M. Turchiano e-mail: [email protected] J. K. Saunders e-mail: [email protected] G. Fernandez e-mail: [email protected] L. Navie e-mail: [email protected] L. Labrador e-mail: [email protected]
Obese individuals are at a distinct disadvantage at the work place. Studies have demonstrated that obese subjects are more likely to face discrimination at all phases of the employment process and have higher rates of disability than their lean peers [1]. Obesity-related expenditures in 2008 accounted for 9.1 % of total US medical expenses [2]. Among full-time employees, obesity-related expenditures, including lost productivity and absenteeism, cost $73.1 billion annually [3]. Employees with severe obesity (i.e., those with body mass index (BMI) greater than 35 kg/m2) represent 37 % of the obese population but are responsible for 61 % of excess costs. Bariatric surgery is an effective treatment for obesity and related comorbidities [4]. A disproportionate number of all Americans eligible for bariatric surgery are minorities, poorly educated, or impoverished. In a nationwide analysis of
OBES SURG (2014) 24:692–695
socioeconomic characteristics of the population eligible for obesity surgery, Livingston et al. found that those eligible for obesity surgery had lower education, lower income, and greater dependence on Medicaid than their non-morbidly obese counterparts [5]. Additionally, these authors found that over 30 % of morbidly obese patients in the USA are minorities, 29 % live at or near the poverty line, and 54 % has a high school education or less. A large number of these patients are unemployed. There is a paucity of data regarding the effect of bariatric surgery on employment status, particularly in the underserved minority population. The purpose of this study was to determine the impact of bariatric surgery on employment status in a cohort of unemployed severely obese individuals seen at our urban safety-net hospital. This cohort was also compared to a group of unemployed severely obese patients who did not undergo bariatric surgery.
Materials and Methods This study was a retrospective review of all patients seen in our bariatric surgery program over a two-year period. The study protocol was approved by the Institutional Review Board (IRB). Preoperative patient questionnaires and medical records were reviewed to evaluate patient employment status at the time of initial evaluation by the multidisciplinary bariatric surgery team. The preoperative questionnaire specifically inquired about employment status and whether or not the patient received disability payments. Follow-up data was obtained on all available patients (including those who did not undergo surgery), including weight and employment status. A standardized IRB-approved telephone questionnaire was administered to supplement details regarding employment. For the purposes of this study, “employment” was defined as fulltime employment (i.e., part-time employment did not qualify). Rigorous attempts at contacting the patients were employed,
693
including obtaining changed numbers, searching for accurate telephone numbers, internet searches utilizing directory assistance, and medical record searches. We compared the surgical and non-surgical groups at baseline. Changes in employment status and BMI were determined in both groups. Excess BMI lost (%EBL) was calculated as follows: %EBL = [((preoperative BMI − current BMI) / (preoperative BMI − 25) × 100)] [6]. Statistical analysis was performed using Student's t test and Pearson's chi-square, with p
