Carrying around Daniel Wenzel’s excess body weight feels like the equivalent of eight 25-pound bags of dog food.

The 60-year-old real estate photographer fatigues easily. He has high blood pressure. And his lower-back pain can be immobilizing. Wenzel, who lives in Medford, stands 5 feet, 11 inches and weighs 450 pounds. His body mass index is over 60, which is 20 points above the cutoff for severe obesity.

Doctors have told him his back pain and blood pressure would be easier to manage if he lost the weight. Under National Institutes of Health criteria, Wenzel would be a candidate for weight-loss surgery. As a member of the Oregon Health Plan, he can’t qualify for surgery unless he has diabetes.

Wenzel, who lost most of his relatives to complications of that disease, believes he will eventually have diabetes, but he’s tired of suffering in the meantime. “My energy level is so low right now, it’s very frustrating,” he said.

Oregon is considering whether to open the door to weight-loss surgery for people like Wenzel. The Health Evidence Review Commission, a body that decides what Oregon’s Medicaid program will cover and under what circumstances, this spring will take up a recommended change in guidelines that would reflect the National Institutes of Health criteria. Anyone with a BMI greater than 40 would qualify. The state would also cover anyone with a BMI of 35 or greater, plus diabetes, or two other health conditions, including hypertension, coronary heart disease, mechanical arthropathy in a major weight-bearing joint and sleep apnea.

Dr. Stephen Archer, director of Bend Memorial Clinic’s bariatric weight-loss surgery program, supports the proposed change. “I would hope all morbidly obese people who have the disease would have equal access to care,” he said.

The question is whether Oregon can afford to change its policy.

Nationally, about 70 percent of people who undergo bariatric surgery don’t have diabetes, so there could be quite a jump in the number of newly eligible OHP members, said Dr. Bruce Wolfe, a retired surgeon and current researcher at Oregon Health & Science University who advised the commission. “That’s part of why the state wants to know just how many (procedures) we have been doing, and how many are we talking about,” Wolfe said. “It’s a problem for the Medicaid budget.”

The Oregon Health Authority is still working on an analysis that would show how many surgeries have been covered so far and how many more would be on the books under the proposed guidelines, spokeswoman Stephanie Tripp said.

The Oregon Health Plan has been covering bariatric surgery since 2008 but only as a treatment for diabetes. The decision to cover surgery at all was controversial, said Wolfe, who advocated for it after arriving at OHSU from California in 2006.

The current proposal is scheduled to be considered by a subcommittee Feb. 18 and could reach the full commission as early as March 10. As part of the positive recommendation, the Health Evidence Review Commission staff points out obesity-related medical care cost Oregon more than $333 million in 2006, according to a 2012 Department of Public Health report.

Another factor that could affect the state’s bottom line is obesity is more common among OHP members than the general population — 38 percent of adults covered by OHP were obese in 2009, compared with 24 percent for Oregon’s entire adult population, according to information submitted to the Health Evidence Review Commission staff.

To Wolfe, a longtime advocate of access to surgery, the obesity disparity is a point in favor of relaxing OHP’s rules. “The prevalence of obesity is more common in poor people as (in) affluent, but the number of bariatric procedures is the reverse,” he said. Most state Medicaid plans cover bariatric surgery, but Wolfe said the reimbursement rates tend to be so low there are long waiting lists for surgery. In Oregon, the reimbursement rate does not seem to be an issue. The waiting list at OHSU Hospital for people covered by Medicaid is about two years, he said.

Bariatric surgery, a category that includes several procedures, has been shown to remedy Type 2 diabetes, and researchers are even looking at whether it would benefit diabetics on the low end of the obesity range, those with BMIs between 30 and 35.

As to whether surgery resolves other health conditions, the evidence is mixed, Wolfe said. Many severely obese people who need joint replacements are told they can’t have surgery until they lose weight. So as bariatric patients undergo orthopedic surgery, the cost savings seem to disappear, he said.

High blood pressure does not always go away after the surgery, Wolfe said. “Does it make it easier to control? Yes. Does that persist at 10 years? We’re working on that,” he said.

A recent Swedish study looked at mortality rates and heart attacks and found both declined for people who underwent surgery.

Archer said almost all of his patients with a BMI over 40 suffer from some life-threatening disease, and those who are at a BMI of 35 are well on their way. Patients lose 70 percent to 80 percent of their excess body weight with gastric-bypass surgery, an established procedure that still makes up the majority of Archer’s practice.

Another procedure, gastric sleeve, is quickly gaining popularity. That procedure involves removing most of the stomach with no re-routing of intestines.

Both surgeries mean patients can eat only tiny portions of food.

Weight regain is one of the risks, and that happens with about 10 to 15 percent of patients, Archer said.

Even if the number of OHP members qualifying for weight-loss surgery doubles, advocates doubt all of those people will want surgery. There are 30 million adults in the United States with a BMI of 35 or greater, but the number of surgeries is around 200,000 per year, said Reeger Cortell, clinical director of the Southern Oregon Bariatric Center.

The biggest barrier is financial, Cortell said. Even if people can afford the surgery, they’re afraid they’ll have to miss work, she said. “They’re afraid of death. They’re afraid of complications. More than that, they’re afraid the surgery won’t work for them, or that it will work, but they’ll regain their weight.”

Obese people share many of the biases about their condition with society at large, Cortell said. They think they should be able to lose the weight on their own, even though the likelihood of regaining is high. They see surgery as the easy way out, and they’re ashamed because they think obesity is a character flaw.

“Obesity is a chronic and progressive disease,” she said. “There’s a lot of misconception about it.”

In the past year, Wenzel jumped through several hoops with the Southern Oregon surgery center in hopes of getting an exception to the OHP requirement for a diabetes diagnosis. He went through a medical weight-loss program, submitted to a psychiatric evaluation and attended support groups.

Wenzel said he’s lost weight on his own in the past, about 130 pounds, but it was very difficult, and he was much younger at the time. Apart from his blood pressure, back pain and excess weight, Wenzel said he’s healthy. He’d like to be able to keep up with his 21-year-old son and girlfriend. “I’ll probably be good for another 20 or 30 years, hopefully.”

— Reporter: 541-617-7860, kmclaughlin@bendbulletin.com