The Bellevue Hospital Weight Loss Surgery Factory

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Content note: Many of you requested this piece and I think it’s important to talk about, but I also want to let you know that today’s piece might be a tough read. It discusses the lack of care for, and harm done to, higher-weight patients by Bellevue Hospital’s weight loss surgery program. Please take care of yourself.

An expose by the New York Times has revealed that New York’s famed Bellevue Hospital is churning patients through its weight loss surgery program:

The bariatric program, led by surgeons with financial incentives to perform more operations, has become a high-speed assembly line that has endangered some patients and compromised urgent care for others. And because most of the hospital’s patients are on Medicaid or uninsured, taxpayers foot the bill.

The bill is significant at “$11,000 and sometimes much more” for each procedure… The Times conservatively estimated that Bellevue stands to earn at least $34 million this year in weight loss surgeries alone.

Lowlights of the article include:

• The hospital’s Chief Medical Officer bragging that they were on track to perform 3,000 weight loss surgeries in a single year

• “Prospective patients often receive tentative surgery dates after attending a single informational session, filling out a worksheet and speaking briefly with a doctor. Meetings to assess patients’ mental health sometimes last just 10 minutes. Many patients said in interviews that they had agreed to surgeries without fully grasping the risks.”

• Ignoring even the few guardrails that exist around who qualifies for the surgeries, including accidentally operating on a pregnant woman

• Making people who needed other surgeries wait: 

While life-threatening emergencies always got priority, patients with minor stab wounds, broken bones and detached fingers regularly waited hours for surgery because bariatric surgeons were occupying so many operating rooms, according to more than a dozen doctors and other employees. One day in October, for example, a patient arrived at Bellevue with shattered ribs but could not be operated on because bariatric surgeons were occupying multiple rooms, according to an employee who was there. (That day, bariatric surgeons performed 16 weight-loss surgeries, according to surgical schedules reviewed by The Times.) The rib surgery was pushed to the next day, the employee said.

• Operating on inmates from the Rikers Island jail with hard sell tactics and a complete lack of informed consent, even though there is “virtually no chance of maintaining the required diets after surgery”

• Two surgeons who are financially incentivized to do any many surgeries as possible were known by many employees to race each other for the most surgeries in a day – cranking out six to seven surgeries in a single day each, even when it meant using “unlicensed equipment technicians” who were not even hospital employees as surgical assistants and pushing anesthesiologists to rush patients awake so that surgeons could move them down the assembly line, “five doctors said, they saw Dr. Julia Park, a weight-loss surgeon, pinch and slap patients’ bellies to rouse them from anesthesia.”

This has been going on for a while, per the article:

Since 2008, Bellevue has performed more than 17,000 weight-loss procedures. In the first year of the pandemic, nearly 1,200 patients underwent bariatric surgery, nearly as many as the roughly 1,400 who were hospitalized for Covid — even though the hospital halted elective operations for three months of the year. Weight-loss surgeries now account for one of every five operations at Bellevue.

Bellevue is taking advantage of the issues of weight stigma in healthcare that I have previously written about – a willingness (in this case eagerness) to risk the lives and quality of life of higher-weight patients in ill-advised, non-evidence-based attempts to make them thin, a lack of care (by surgeons, researchers, and the healthcare system as a whole) about long-term complications and outcomes, blaming the bodies of higher-weight patients for the complications of the interventions foisted upon them, and blowing off any concept of an ethical, informed consent conversation based on some combination of pure greed and/or the weight-stigma driven paternalistic belief that being fat indicates that a patient should have their decisions made for them by their doctor/surgeon.

While I believe in bodily autonomy, I also believe in ethical, evidence-based medicine and I don’t believe that these surgeries meet those requirements  (I’ve written about this extensively, including a three-part series here explaining why.)  Even if someone disagrees with me, the procedure would still have to be undertaken ethically – including a robust informed consent conversation and a push for excellent long-term outcome and adverse event data, and obviously, that’s not happening here.

I’m glad that this report has exposed the horrors being perpetrated at Bellevue, but what I don’t want is for people to assume that this is an isolated case. These surgeries are commonly viewed as a Golden Goose for hospitals and dedicated surgical centers. I believe that more digging would find similar practices at many hospitals. When it comes to profiting from weight loss surgery, there are (content warning for weight stigma and what I believe are unsupported claims,) studies about it, there are guides for it, large national and global organizations (often astroturf orgs similar to the OAC and TOS) spend significant time and money lobbying for an increased market through things like chipping away at guardrails (like trying to have the surgery considered at increasingly lower BMIs and ages) and expanding insurance coverage to increase the number of people who are considered eligible for the surgeries as well as the number of people who get them.

I hope that the NYT reporting will force changes to be made at what is now Bellevue’s weight loss surgery assembly line (though they seem to be defending their program in the article) and also serve as a starting point to taking a closer look at weight loss (aka bariatric) surgery programs across the country and the world. Procedures that risk higher-weight patients’ lives and quality of life for great profit must be, at the very least,  scrutinized.

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More research and resources:
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.