Fresno bariatric surgeon Kelvin Higa was alarmed to see that those at greatest risk of being hospitalized or dying from COVID-19 were patients who were the most overweight.

He wasn’t surprised when studies published 18 months into the pandemic showed how you could lower that risk by 49% with bariatric surgery. “Study upon study show that bariatric surgery is protective and that patients do better than those who did not have surgery,” even though coronavirus infection rates were the same among both patient groups, he explained.

Dr. Higa, director of the Minimally Invasive and Bariatric Surgery Program at Fresno Heart & Surgical Hospital, has performed more than 15,000 bariatric and metabolic surgeries in his career. He’s seen firsthand and documented with research the difference bariatric surgery makes in patients' lives.

“Patients live longer after the surgery with a 60% reduction in cancer risk,” said Dr. Higa, who is also a UCSF Fresno faculty member who teaches surgical fellows how to do the minimally invasive bariatric techniques he invented with partner Dr. Keith Boone. He added that after bariatric surgery, patients often ditch their diabetes and high blood pressure medicines, and see sleep apnea disappear. “The surgery is doing something systemically in the body to make people live longer.”

Now Dr. Higa can add COVID-19 to the list of diseases that bariatric surgery lessens the effects for. But the main thing bariatric and metabolic surgery addresses is obesity, which Dr. Higa asserts should be considered a symptom of a metabolic disorder.
 

Obesity increases the incidence of disease and death

Obesity affects nearly 100 million Americans and contributes to obesity-related conditions like heart disease, stroke, Type 2 diabetes and certain types of cancer. Obesity-related conditions like these lead to an estimated 374,000 preventable, premature deaths in the United States per year, close behind tobacco use.

Dr. Higa compares this to COVID-19 deaths, which totaled about 385,000 Americans in 2020. “That puts things into perspective,” he said.

An average-height American woman who is about 50 lbs. overweight has a 45% higher risk of death from obesity-related diseases. At 100 lbs. overweight, her risk of death increases three-fold. In men, Latinos and African Americans are at even greater risk of cancer, diabetes and heart failure if they’re overweight or obese.

“Nearly 65% of Americans are overweight or obese now,” said Dr. Higa, citing a myriad of causes from genetics, hormonal imbalances and a low-functioning microbiome to environmental and cultural effects.
 
As past president of the International Federation for Surgical Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery, Dr. Higa has long advocated for a different approach: “I see a bias and blaming the patient for this disease, believing their behavior causes it. Obesity should not be thought of as the problem but as a symptom of an underlying disease that needs treatment.”
 

Pandemic-delayed care may have put more at risk

During COVID-19 surges, many hospitals halted non-urgent surgeries to preserve hospital resources and space for COVID-19 patients. Dr. Higa argued that bariatric surgery should be treated as urgent since waiting can seriously affect the health of obese patients and put them at greater risk.

“We’ve seen patients who have gotten pretty sick before surgery during the prolonged phase where insurance companies make them wait,” said Dr. Higa, referring to the general practice of requiring a six-month intensive diet management before bariatric surgeries are approved. “The science has never validated that there is any value whatsoever for this wait. We’ve seen a lot of patients who were pre-diabetic actually become diabetic by the end of the six months, even though they’ve done well with diet and lost weight.”

Obesity tends to be progressive and pre-diabetes and high blood pressure require aggressive management and treatment, Dr. Higa asserted. “Can you imagine if someone had cancer and they were required to wait six months and try other things before having cancer surgery? Every diabetic professional organization in the world has recommended this surgery for diabetes, especially with a high BMI (body mass index).”

Dr. Higa is urging those with higher BMI and pre-diabetes or Type 2 diabetes to talk to their primary doctor about whether bariatric surgery might be the best treatment for them. There are many good reasons to lose weight and lower your risk of major diseases, including protecting yourself from becoming very ill with COVID-19.