Weighing the issues regarding obesity surgery
THE JUXTAPOSITION of two Feb. 14 stories -- "Tufts plan will restrict surgery for obesity" (Page A1) and "Attorney calls coach's surgeons negligent" (City & Region) -- should have quieted the critics of Tufts Health Plan's new limits on this surgery. Certainly no one deserves the pain and suffering that former New England Patriots offensive coordinator Charlie Weis has endured. But, perhaps, had he been required to spend a year in a supervised program of proper nutrition and exercise (where his compliance would have been easier than for the average patient because of his access to strength and conditioning professionals), he could have lost at least enough weight to make surgery unnecessary.
Even at the lower end of the professionally accepted range for safe fat loss -- 1 pound a week -- the coach could have come under the 300-pound mark in 52 weeks instead of rushing through cursory screening and into surgery. Tufts' new guidelines simply reject the trendy thirst for diagnoses and expensive intervention for what are often behavioral and discipline problems.
CHARLA McMILLIAN
Jamaica Plain
The writer is a certified strength and conditioning specialist.
IN REGARD to Tufts Health Plan's attempt to restrict access to obesity treatment, it should be noted that the company is accomplishing three things with this plan, all of them bad.
First, it is discriminating. It is politically incorrect and against federal law to discriminate based on race, color, creed, sexual orientation, or gender, but Tufts has calculated that discriminating against fat people is just fine.
Second, it is making a penny-wise, pound-foolish choice. Tufts executives cannot make millions of dollars in bonuses if they do not squeeze their customers tightly. But in this case they are squeezing away their own bottom line. Weight-loss surgery has been shown in studies to be cost saving, meaning that it's cheaper to pay for the surgery than to pay for all the complications of obesity.
Finally, Tufts is attempting to practice medicine without a license. Corporate executives should not be making medical decisions. Dictating what therapy a patient should receive based on zero evidence or medical expertise is like trying to umpire a baseball game while wearing a blindfold.
Tufts should abandon this mean-spirited and discriminatory policy and leave medical decision-making to the people who are trained to do it: physicians.
Dr. TIMOTHY LAPHAM
Quincy
The writer is a bariatric fellow at Tufts-New England Medical Center.
AS PRESIDENT and CEO of a not-for-profit health plan nationally recognized for its high clinical quality standards, it is my job to provide access to affordable, high-quality healthcare for our members and their premium-paying employers . Tufts Health Plan's policy on bariatric surgery is a perfect example of doing just that.
Our approach is thoughtful and potentially less invasive, which medical evidence supports as far safer for patients. There is real opportunity to improve quality as the policy seeks to improve patient outcomes while reducing wide variation of surgical practice. The yearlong behavioral management program, offered at no cost to members, augments careful medical oversight and includes nutrition counseling, psychological counseling, and personal coaching, and is a perfect example of marrying high clinical quality to prudent attention to costs.
What was not highlighted, however, in the coverage of Tufts Health Plan's program was the organization's commitment to preserving bariatric services for patients who need them most. This commitment comes in an environment where large self-insured employers and major insurers are opting out of providing this coverage altogether as demand for surgical intervention skyrockets.
JAMES ROOSEVELT Jr.
Waltham 
