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Invited Critique |

Return to Work After Gastric Bypass in Medicaid-Funded Morbidly Obese Patients—Invited Critique

Bruce M. Wolfe, MD
Arch Surg. 2007;142(10):941. doi:10.1001/archsurg.142.10.941.
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In recent years, several associations with class III obesity (BMI > 40) have been described that are complex and interrelated. These include low socioeconomic status, physical inactivity, ethnicity/race (Latino and African American), and disability.1,2 All of these factors may also be associated with increased reliance on Medicaid for health care services. The report by Wagner et al regarding disability resolution among Medicaid recipients following RYGB is of interest from several standpoints. The frequency of disability is increased among adults with severe obesity, as is the frequency of obesity in the presence of disabilities.3 Thus, obesity and disability each may contribute to the cause of the other. For example, disabilities that limit physical activity may be a primary cause of obesity. Low socioeconomic status is associated with inequality in the built environment, leading to a disparity in access to recreational facilities and diminished physical activity.4 Because of this association, it has not been possible to predict the extent to which bariatric surgery might lead to disability resolution and full-time employment. The report of a 37% return to work following RYGB among disabled Medicaid patients by Wagner et al is therefore an important contribution. Just 14% of Medicaid enrollees are disabled, but they account for 42% of Medicaid expenditures.5

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