Dieting & Hair Loss

Yeast Infections

 Summary

Gastric bypass (bariatric) or lapband surgery is usually performed on patients who are at least 100 lbs. over their healthy weight. It  has been gaining popularity over the past several years, and may be available to you as a tool for quick weight loss. The American Society for Bariatric Surgery and the National Institutes of Health estimates that in 2006, 177,000 Americans underwent this operation. This is up from 140,000 in 2004 and up significantly from 63,000 in 2002. Undoubtedly, the popularity of this surgery was fed by the publicity surrounding weight loss success stories related to TV weatherman Al Roker and singer Carnie Wilson. Their results were dramatic.

More women underwent bariatric surgery than men. Women accounted for 82.0% of all surgeries in 2004.

Overall, the length of stay declined 38.5% for all surgeries from nearly five days in 1998 to 3.1 days in 2004.

Insurers have not followed Medicare’s lead for several reasons. There is no incentive for insurers to think long-term. Insurers view bariatric surgery as eating into their profits, In addition, not external pressure is being applied by any grass roots consumer advocacy groups.

Coverage is far from universal. There are some pockets of the country where insurers do cover this surgery—in New York, California, and Virginia, for example. In Virginia, one can buy a rider to their insurance policy. In Oregon, Medicaid added bariatric surgery to its list of approved medical treatment for the first time.

One result is that patients are getting surgeries performed in Mexico and other Latin American nations, at a cheaper price. There are some fine surgeons practicing in these countries, such as Brazil, but there many scam operations and botched procedures as well.

In the United States, a lap band procedure by a self-pay patient may costs $13-18,000. This compares with a price of about $10,000 in Mexico, usually with airfare and a vacation thrown in. The plastic lap band device alone can cost $3,000 in the U.S.

Medicare Covers Weight Loss Surgery (Feb. 2006)

In late February 2006, Medicare endorsed three types of stomach reduction surgery, saying the controversial procedures can offer Americans safe and effective ways to treat obesity.

Under the new rules, Medicare will pay for the surgery for obese patients who are suffering from other health problems related to their weight, as long as they undergo the procedure at centers that have been certified as well-qualified by the American College of Surgeons or the American Society of Bariatric Surgery.

The decision could open the door for Medicare to cover other treatments for obesity, such as nutritional counseling, physician-supervised weight loss programs and weight loss drugs. Because private health insurers often follow Medicare's lead, several experts say the decision will have broad implications.  

In the past, weight Loss surgery was covered under Medicare if it was performed to relieve serious medical problems aggravated by weight. A Medicare committee had voted in Nov. 2004 on how effective bariatric surgery is in comparison to non-surgical weight management. In July 2004, Medicare announced that it would begin to cover obesity as a disease, rather than covering only obesity-induced diseases such as diabetes and high blood pressure.

This panel found that the evidence shows that bariatric surgeries do have a positive impact on long-term survival rates and that the surgery reduces short-term mortality, versus non-surgical medical weight management.

Major Insurers stop Weight Loss Surgery coverage as of 12/1/2005

Blue Cross/Blue Shield's abrupt decision to stop covering weight loss surgery is part of a national trend. Weight loss or "bariatric" surgery had soared in popularity until 2006. However, it's expensive, $25,000-30,000 in most cases. Insurers are now claiming that the surgery is risky and they have safety concerns. They claim that this booming business has been fueled by celebrity endorsements and has attracted surgeons with little experience in this area. Insurers are concerned with malpractice lawsuits.

The insurers do have a valid point, but BestDietForMe.com analysts are of the opinion that rising costs are probably just as big a factor in the insurers' abrupt reversal.

The end result is that many obese people that truly need this surgery may not now be able to afford it, because they may have to pay "out-of-pocket". Some liaison organizations such as The Wish Center offer installment payment plans, spread out as long a seven years. Personnel from such organizations predict that some insurers will return to offering coverage, but only for comprehensive centers (CORI Centers, The Wish Center, Barix Clinics are a few examples) that specialize in weight loss surgery.

These organizations have comprehensive staff, including MDs, psychologists, dietitians, counselors and others to prepare and support the patient before and after surgery. This is probably good for the field, since there really are no standards for this surgery and many doctors have jumped on the bariatric surgery bandwagon in recent years, undergoing minimal training and chasing the quick buck. The last thing an obese consumer needs is to be operated on by an ill-trained surgeon who learned the procedure at a weekend seminar and has a large advertising budget.

Since bariatric surgery is expensive (generally $25,000-30,000), private insurers vary widely as to whether they will cover the procedures. The objections and exclusions by insurers usually fades away with time once Medicare begins covering this surgery. However, this latest action by major insurers contradicts this. Short-term costs may be higher, but over the long term, the surgeries will lead to savings due to the reduction or disappearance of obesity-related conditions such as diabetes and high blood pressure.

Who Qualifies?

However, this is really a last resort measure. Gastric bypass surgery is major surgery and, as such, has all the risks associated with any other invasive procedure. It should not be considered unless other less invasive means of weight loss have been given your full effort but still not helped you achieve a stable reduction in your weight. The Roux-en-Y is the most commonly performed gastric bypass operation. The procedure involves two steps: (1) Sectioning off a small segment of your stomach so that you can only take in small amounts of food, and (2) Cutting and reattaching a portion of your small intestine to this new small stomach, thereby reducing the amount of nutrients and calories you absorb from the food that you do eat.

To qualify for this procedure, potential patients must meet criteria set by the National Institutes of Health. For example, a person must have a minimum BMI of 40, or a BMI of 35 with associated co-morbidities. In addition, prospective patients are required to have tried other weight loss programs or treatments already.

Although you must discuss this with your doctor, and ultimately your surgeon, to know whether you qualify for the gastric bypass or lapband surgery, here are the general guidelines.

• If your Body Mass Index (BMI) is 40 or greater, and there are no medical or psychological reasons that surgery would be too risky for you, most bariatric surgeons would accept you.

• If your BMI ranges from 35 to 39.9 and you have medical co-morbidities such as sleep apnea and diabetes, and there are no medical or psychological reasons that surgery would be too risky for you, most bariatric surgeons would accept you.

Although the comprehensiveness of programs varies from location to location, one should consult a surgeon who does have a comprehensive program. Such a program would require that you meet with a Registered Dietitian and a Clinical Psychologist both in preparation for and following surgery, and have at least a year of follow-up visits with your surgeon and his or her team. In spite of the dramatic weight loss success stories publicized in the media, the truth is that the bariatric surgery does not "solve" your obesity problem. Rather, it provides you with a strong aid to changing your eating patterns – it does not change them for you. Thus, you will still have to address such issues as food preferences, emotional eating, and the challenges of socializing without overeating.

Depending on your weight and your surgeon’s program, you may be required to participate in a weight loss program in preparation for surgery. Many bariatric surgeons require this participation as a means of your demonstrating that you will be able to follow the strict dietary and behavioral requirements posed by the surgery. Also, if you are very large, a weight loss program such as a very low calorie liquid diet (such as Optifast, HMR, Medifast, etc.) may be required in order to lower your weight and thereby reduce the probability of surgical complications.

Surgical treatment is gaining in popularity because it is the best method currently available for achieving rapid weight loss and long-term weight control for the extremely obese. However, you should be clear on the fact that surgical treatment is not a cosmetic procedure. It does not involve the removal of adipose tissue (fat) by suction or excision. Bariatric surgery is a medical weight loss option that involves reducing the size of the gastric reservoir. This helps the individual reduce caloric intake and practice healthy diet behaviors such as moderating portion size, eating slowly, chewing each mouthful well, and attending to visceral signals of satiety.

In certain circumstances, less severely obese patients (with BMI’s between 35 and 40) also may be considered for bariatric surgery. Included in this category are patients with high-risk co-morbid conditions such as life threatening cardiopulmonary problems (e.g. severe sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy, or severe diabetes mellitus). Other possible indications for patients with BMI’s between 35 and 40 include obesity-induced physical problems that are interfering with lifestyle (e.g. musculoskeletal or neurological or body size problems precluding or severely interfering with employment and family function).

Who's Involved in Treating You?

There are actually three entities usually involved when you make a decision to undergo bariatric surgery, in addition to your personal physician. They are:

1) the bariatric surgeon (approximately 2,500 of them practicing in the United states)

2) a "liaison" organization that prepares and educates you about the surgery, providing support before and after the surgery and dealing with the insurance companies. These include a handful of companies such as: The Wish Center, CORI Centers, or Barix Clinics, which operate on a regional basis. None of them operate nationwide, usually in several states.

3) the hospital where the surgery is performed.

Each of these takes their cut of the typical $30,000 tab. Surprisingly, the hospital takes the lion's share of the revenues--not the surgeon. The bariatric surgeon usually gets only about $3,000-$6,000 per procedure. The liaison organizations get their cut, perhaps about the same as the surgeon. The hospital gets the rest.

Pros and Cons

The positives associated with this medical weight loss option include the fact that most patients lose weight quickly and continue to lose it for up to 18-24 months after the surgery. Most people maintain a long-term weight loss of approximately 50–70% of their excess weight. In addition, the weight loss resulting from surgery improves most obesity-related conditions such as diabetes, sleep disorders (sleep apnea), high blood pressure and joint pain.

As for the drawbacks, 10% to 20% of patients require follow-up operations to correct various complications, such as abdominal hernias. Some patients may develop gallstones. During substantial and/or rapid weight loss, the risk of developing gallstones rises. Also, nearly 30% of patients develop nutritional deficiencies such as anemia, osteoporosis, and metabolic bone disease. However, these may be averted if vitamin/mineral consumption is high enough.

The procedure itself will become less invasive and involve shorter recovery times in the near future, since laparoscopic techniques involving smaller incisions are being used more often.