Weight Solutions Clinic: Bariatric Surgery Center

Weight Solutions Clinic: Bariatric Surgery Center

KEL030

"Tell me Mike, how do you expect me to face Mr. Spitzer, who has already waited ten weeks for an answer from his insurance company, and tell him that the earliest we can operate on him is in three months' time? You know that he is struggling to make this drastic commitment, and we are just making life more difficult for him," Dr. Crawler said to his head surgeon. "We urgently need to do something about this. This is not the first time that I have had to deal with such an unpleasant situation, and I am sure this will not be the last."

Dr. George Crawler, one of the leading bariatric surgeons in the country, founded the Bariatric Surgery Center at the Weight Solutions Clinic in 1988. He had performed more than 2,700 bariatric surgeries since 1979 and was recognized as a pioneer in the field.

Dr. Michael Whitmore, the head surgeon of the Bariatric Surgery Center, replied in a helpless tone, "I completely agree with you, George. But I am only a surgeon, not a hospital manager. I can't tell you exactly what needs to be done. I talked to Steven yesterday, and he thinks we need more rooms. I think we should hire another surgeon who can do this laparoscopic trick. Some of our colleagues from the care unit downstairs think we need to reallocate some of the tasks among the personnel to manage the work load. Which one of these options will help us cut down our patient lead times is not obvious to me."

Dr. Crawler picked up the three business cards lying on his desk and said, "I hear what you are saying, Mike. Neither you nor I have the time or the skills to analyze the process at the Center, so I have scheduled a meeting with some healthcare process experts with MBAs from the Kellogg School of Management. They look competent in the field of process improvement and have significant experience improving hospital operations. I am meeting them in my office at 4:00 p.m. tomorrow. Would you like to join me?"

Obesity as an Epidemic

In 1998, the World Health Organization published Obesity: Preventing and Managing the Global Epidemic, which classified obesity as a growing epidemic in the world.1 The study

1 Louis Flancbaum, MD, and Erica Manfred, with Deborah Flancbaum, MS Ed, The Doctor's Guide to Weight Loss Surgery (West Hurley, NY: Fredonia Communications, 2001).

©2004 by the Kellogg School of Management, Northwestern University. This case was prepared by Professor Sunil Chopra and Professor Canan Savaskan. Cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management. To order copies or request permission to reproduce materials, call 800-545-7685 (or 617-783-7600 outside the United States or Canada) or e-mail custserv@hbsp.harvard.edu. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means--electronic, mechanical, photocopying, recording, or otherwise--without the permission of the Kellogg School of Management.



WEIGHT SOLUTIONS CLINIC: BARIATRIC SURGERY CENTER KEL030

reported that in the United States, obesity affected one third of all Americans and was the most common chronic disease. The article also said that in Europe, Australia, New Zealand, the Middle East, and the remaining portions of the Americas, the number of people who were obese was increasing and was between 10 and 20 percent. The number of obese people in China, Japan, and many countries in Africa was still fairly low.

During the 1970s, the National Center for Health Statistics found that approximately 45 percent of all adult Americans were overweight and 14 percent were obese. These figures stayed relatively constant for more than a decade. In the mid-1990s, however, the Center found that the number of overweight people had increased to 54 percent (57 million people) and the number of obese people increased to 22 percent (40 million people). Moreover, the number of severely obese people rose from 4.5 percent to 8 percent of the population. In 1995, the Institute of Medicine referred to obesity as an epidemic in its publication Weighing the Options, and in 2000, there were approximately 127 million overweight or obese adults in the United States (see Figure 1 and Figure 2). Of these, 30 million were obese with a Body Mass Index (BMI)2 of 31 to 35, 23 million were severely obese with a BMI of 36 to 39, and 10 million suffered from morbid or clinically severe obesity with a BMI higher than 40. BMI is explained in Figure 3.

Figure 1: Distribution of Obesity Cases in the United States

During the 1980s and 1990s, the prevalence of obesity skyrocketed from slightly less than 4 percent in children (6 to 11 years) and 6 percent in teenagers (12 to 19 years) to 15 percent in both children and adolescents. As with adults, obesity in youth was associated with a number of medical problems, including type II diabetes, hypertension, asthma, sleep apnea, orthopedic problems, psychological problems, and social stigma.

2 BMI can be used to measure both overweight and obesity in adults. It is the measurement of choice for many obesity researchers and other health professionals. BMI is a direct calculation based on height and weight, and is not gender-specific. Most health organizations and published information on overweight and its associated risk factors use BMI to measure and define overweight and obesity. BMI does not directly measure percentage of body fat, but it provides a more accurate measure of overweight and obesity than relying on weight alone.

2 KELLOGG SCHOOL OF MANAGEMENT

KEL030 WEIGHT SOLUTIONS CLINIC: BARIATRIC SURGERY CENTER

Figure 2: Proportion of Adults in the United States That Are Overweight or Obese

Source: Salinsky and Scott, "Obesity in America: A Growing Threat," NHPF Background Paper, The George Washington University

In addition to genetic factors, diet and exercise also affected the onset and development of obesity. High-fat diets increased the prevalence of obesity. Similarly, a decrease in physical activity also increased obesity. For example, children reared on television, video games, and computers were more likely to become obese than those who exercised regularly.

Figure 3: BMI Ranges and Body Type

45% 40% 35% 30% 25% 20% 15% 10%

5%