Friday, March 23, 2007
Footing the bill for gastric bypass
Anne Durand weighed 287 pounds in 2006
When Anne Durand greeted me at the door, I thought she might be her sister. Certainly this woman wearing a size 2 suit was not Anne, who in 2006 weighed 287 pounds. But it was Anne, and she was ready to talk about her gastric bypass surgery. (Watch Video)

It seems Anne was always an active person. As a hot-shot consultant, she liked to travel both for work and pleasure. But as the years went by, she began to have a lot of pain in her joints and was eventually found to have an autoimmune disease. She stopped exercising, went on medication and began to gain weight, lots of it. She became so heavy that she had to use a motorized scooter to get around. She couldn't take walks with her husband. She wasn't enjoying her life. She was desperate. Her doctor finally suggested she think about bariatric surgery to rid herself of the weight. She had the procedure and within months became mobile and her illness went into remission.

Anne Durand is not alone. According to the American Society of Bariatric Surgery, more than 177,000 patients had gastric bypass or stomach banding procedures last year. Intended to help people who are considered severely obese or suffer from complications because of their weight, the surgeries can be expensive as well as dangerous. And those are two things insurance companies don't like to hear. Susan Pisano, a spokesperson for America's Health Insurance Plans says insurers want patients to understand that bariatric surgery is not a quick fix and that there are other alternatives.

Now, some insurance groups are insisting on more then just a doctor's opinion and a patent's desire before they'll agree to pay for these procedures. Beginning this month, Tufts Health Plan in Massachusetts is requiring some obese patients to enter a yearlong diet and counseling program before undergoing bariatric surgery. Tufts' hope is to have patients lose their weight naturally, without surgery. But some doctors feel the policy just postpones the inevitable. According to NIH research, only about 5 percent of patients, once they are morbidly obese, are able to lose weight by willpower alone. And other surgeons believe it's none of the insurance companies' business to tell people what surgeries they can or cannot have.

But Tufts Health Plan is not alone; many insurance companies say it is their business to oversee their clients' health. They insist that many patients who seek these surgeries can lose weight without going under the knife. They also stress that these procedures are risky and it's a safer tactic to wait out the surgery for a year, than to jump into an operation that many patients don't understand.

Had Anne Durand waited a year to have her surgery, chances are she would have not been able to walk. She cringes when she thinks about it. But insurers say that she's an exception and that many of those who have bariatric surgery could look to better nutrition and exercise as a solution to their obesity.

What do you think?

For more on bariatric surgery, watch House Call with Dr. Sanjay Gupta Saturday and Sunday at 8:30 a.m. ET
I have struggled with my weight all of my life. I weighed about 245 in June of 2005 and now weigh 184 on a 5"11 frame. I lost weight by portion control and exercising. I think surgery is okay, but I cannot tell you the feeling you have when you exercise and do things the "old fashion way." I know this may be difficult for some people, especially the extreme cases. It has changed my life! You feel such a sense of accomplishment and you also learn techniques that help you keep the weight off! Thank you so much for your articles on health, it has really helped me throughout the last year. God's blessings!
I have always been a bit leery on the subject of the gastric bypass. For me, I always wondered- if severely limiting the number of calories consumed causes you to lose weight.... wouldn't going on a healthy diet do the same thing (just slower)? For me it's all about prevention of getting to the point of needing it in the first place....
Yes, limiting calories through a healthy diet would cause weight loss, but many lack the willpower to do that long term. Do you think people are fat because they choose to be fat? I was fat my whole life until having the surgery in 2003. It was a miserable struggle, constant dieting, constant failure and guilt. I would lose 50 lbs, only to gain it right back as soon as I relaxed a bit, and stopped obsessing constantly about what I ate and how many minutes I sweated on the treadmill. Then the depression would come. This was a cycle I was stuck in for many years. After my surgery, I lost 120 lbs in 1 year and have kept if off, even through 2 perfect pregnancies. In May it will be 5 years since my surgery, and I can honestly say that I don't have to think about my diet. No more obsession and guilt. I eat when I am hungry, and stop when I am full, the way God intended. I think making people wait a year is mean. For most it will be another failure to add to the list. If they were able to "just go on a diet" they would have done so long before their weight problem qualified them for the surgery. This is another example of the bias toward overweight people. "You're so lazy. If you just would try harder, you wouldn't be so fat!" I am so glad my surgery is over and done with. THANK GOD!!!!
My husband had this surgery in 1975, before i knew him, but its not as easy as one would think. He lost 100# but the other issues outweigh the loss. Still after 30 years he is sick to his stomach all the time and can't eat many items. Think about it.
If the surgery would help me to be healthier and lead an overall productive life; if I was in agreement with my doctor and if I had peace with my decision, I would not hesitate to have the surgery. I think the benefits would outweigh any risks and my quality of life would probably be greatly improved.
My name is Vern Wells and I'm a recipient of gastric bypass surgery. I disagree with the insurance companies that we, the obese population, should go into intensive weight loss treatment for a year prior to surgery. If I had waited I would most certainly be dead now. I had my surgery on January 31, 2006 and have lost over 200 lbs so far. I weighed in at 530 pounds prior to surgery and I had all the medical problems that affect the obese person. I have created a web site on the internet for our support group that is a great boost for our members. It's called and deals with all issues of the bariatric patient. You will find that bariatric surgery is just a tool for weight loss. We like to say, "they operate on your stomach, not your head." Thank you for listening to me.
I agree. Patients should get second and third opinions and this is a lifelong change. I have produced two hours of radio talk shows on this subject at
I have lost 50 pounds after having the lap band surgery in June, 2006. It is a much slower pace than gastric bypass but it suited my life much better. I still have to work hard to eat the right foods, but I would not have been able to loose this on my own will power because I would have given up by now and the band won't let me give up.
I am a bariatric surgery hopeful.

People who just can't get 20-50lbs off after pregnancy don't make it very far in the process of bariatric surgery. A surgeon just won't do it. These surgeons are highly qualified and work very hard to make sure their patients are good candidates.
We study and research often for years before making the painful decision to have your insides cut up so that we might have a normal life and some relief from our painful health problems.
It is the insurance companies that deny the coverage summarily, they put up obstacles to our suceeding with the surgery and the across-the-board requirement for yet another conventional diet and exercise program has absolutely no medical reasoning behind it. It is implemented by insurance companies simply with the hopes that we will not be able to keep up with it and they can deny the surgery.
They are short-sighted though because the cost of surgery is nothing compared to the care for a person with sleep apnea, diabetes, hypertension and heart problems.
If you are interested in reading the stories of those who actually consider and eventually get the surgery I urge you to visit I think you will see that people who are clinically morbidly obese have probably lost more weight than you could imagine, we just have other conditions which prevent us from keeping it off or which eventually get us to a point where exercise of any kind is not an option.
NO ONE in this society chooses to be morbidly obese. The pain, the shame, the feeling of being an outcast and a freak is simply unbearable. We suffer from serious life threatening diseases which are frightening to us.
No one gets very far in the long decision process for weight loss surgery unless it is absolutely our last chance.
Once we are at that point, have been tested, poked and prodded by our doctors, a required psych exam and the surgeon's office we finally get to the point where we need to get certified for surgery. What we find is that some insurance won't cover the surgery at all, even if we are imminently facing death without it. Others cover it, but deny the claim summarily hoping we will go away. Many of us do give up because it is such a blow to our already fragile mental state that we don't feel deserving of a healthy "normal" life after being denied.
I am lucky that my insurance covers it, but my insurance requires a 6 month "traditional" diet and exercise program which must be supervised by a physician and a dietitian, but for which they do not provide coverage. That last hitch of trying yet another diet after a lifetime of failures is painfully discouraging to me. I will do my best, but I couldn't imagine spending a full year trying to comply with something that the business people at my insurance company have imposed and something that my surgeon says is unnecessry. Some insurance companies are requiring 24 months. The will probably be successful. Those who just can't go through one more humiliating and frustrating diet attempt may fail and go away. Their health insurance companies will spend several years paying to treat their serious medical problems and they will die (statistically 15 years less than a normal person).
Insurance companies are giving us a horrible message: fat people don't deserve a shot at good health, and a decent, productive life, their doctors and surgeons should be second-guessed by businesspeople who have never met the individual patient.

Across-the board policies like this one are made for purely financial means and do nothing but damage to the insureds. Insurance companies should stay out of personal health decisions.
The surgery is the easy way out and litte annoys me more than someone who is overweight and who complains about it, but does nothing. In most cases being overweight is the product of their own doing. Put down the fast-food and the Soda! If we all ate like our great-grandparents we'd be fine and not the over-weight nation we've become.
I was 230 pounds last May when I had my Lap Band procedure. I have lost 50# in less than a year, not a real rapid loss but one that has allowed me to discontinue my diabetes medication and reduce by half my medication for hypertension. All my life Ihave struggled to lose weight but never succeeded long term. As soon as I was off a diet the weight came back plus more. This is a lifetime tool that I now have. Health insurance companies are in the business to not pay claims. We have physicians to oversee our health. It is not the place of an insurance company. Obesity is a deadly condition fraught with greater medical expenses than the initial cost of a surgical procedure. My life has been changed for ever and I now look forward to many more years as I continue to lose weight.
In a sense, I lost the love of my life after he had the surgery. He lost 140 lbs in under a year. He was no longer addicted to food, that's true, however he developed other addictions instead. It's been 2 years since his surgery. He still can't eat any meat whatsoever, has no muscle mass even though he exercises nearly every day, and his skin feels like rubber. His diabetes did not go away and still has to deal with that as well. Knowing he was going to have the surgery, he gained almost 50 lbs in the 6 months prior to his surgery while he was going through the nutrition classes and "learning" how to eat healthy.
I have struggled with my weight all my life. I cannot tell you all of the diets I tried over the years. I have lost hundreds of pounds only to gain it all back and each time I regained more than I had lost. As my weight went up, the health problems increased. I began doing research on weight loss surgery and in the Fall of 2005, before I could bring it up, my primary care physician asked if I had ever considered surgery. I had gastric bypass in January 2006 and have lost 125 pounds. I have gone from a size 26/28 to a size 12 on a 5'3" frame. I am off of all but 2 of the 7 prescriptions I was on prior to surgery. My only regret with the surgery is that I didn't do it earlier! I think if someone has struggled with diet after diet and finally comes to a decision to undergo surgery, it should be covered like any other life saving medical procedure. Everyone I know who has had this surgery, or has made the decision to have the surgery, has struggled for years. This is not the "easy way out". Nor is it an easy decision. If I could have lost the weight without surgery I would have done it years ago. I love my life now and I know that I now have a chance to live a long, healthy and happy one.
I was overweight my entire life. I developed Diabetes type II , and had severe sleep apnea. I am 8 months post bariatric surgery (Roux-En-Y) and have lost almost 200Lbs and do not suffer from Diabetes or sleep apnea. So far I have had no ill side effects. I do think you should really think about the procedure before you commit to the lifesytle change. The surgery itself is a tool that helps you loose weight. You still need to change your eating and excercise habits. I was lucky my insurance covered almost all of my surgery. I did have to provide some history and document my weight loss attempts. My monthly prescriptions have went from 5 different medications to 1 not including the cost of a CPAP and related medical and testing supplies.
So in the long run they should save money not having to pay hundreds of dollars a month to my local pharmacy.
And an odd side note my Doctor's last name is also Gupta. (I dont think any relation)
I am a self pay patient who chose to have lap band surgery in Dec 2006. It was a truly life altering event and I am thankful every day for the opportunity to get my life back! I would have preferred to have had my insurance company, to whom I pay close to $1000 per month, to pay for my $16,000 procedure. Sadly, that was not an option. Blue Cross Blue Shield did not cover bariatrics even though my weight was the only reason stated for my high premium.

I was fortunate enough to be in the position where I could pay for my Lap Band but I realize that many others are not. They are forced to suffer with ailments brought on by their obesity. Once again, the insurance companies are not looking at the big picture...I believe they are "penny wise and pound foolish"!
Morbid obesity needs to be viewed as a separate and more serious disease than simply being overweight. Research has consistently shown that the long-term (5 year) efficacy of diet and exercise is virtually zero for morbid obesity. Our best efforts at diet drugs have similarly proved minimally effective in this patient population. Most of these patients have already made many, many attemtps to lose weight - and often have lost weight repeatedly - by these means in the past. Most who seek surgery, therefore, are doing so as a last resort.

Bariatric surgery has been shown to have long-term success for the treatment of morbid obesity. Not only do patients lose weight and maintain weight loss long term, but their health improves in dramatic ways. Most notably, the reversal of diseases like diabetes (by 92%), cardiovascular disease (50%), stroke (50%) and all cancer (59%) - are profound and should ultimately provide significant healthcare cost savings.

Weight loss surgery is not at all an easy way out for the patient. It still requires life-long management for the greatest success. I think until we have a consistently effective, less invasive option, we need to see bariatric surgery as an important medical treatment for a disease that is epidemic in our country. For insurance companies to require patients to commit additional months or years of their lives to a treatment that has been shown to be ineffective in the long run is senseless.

Finally, I have met literally thousands of bariatric surgery patients in the past five years. I know of no other procedure that creates true life transformations in this manner. Even patients who have experienced complications of surgery will tell you that they would do it again in a heartbeat. Success should be measured both by health and quality of life - and in most cases of morbid obesity treated through surgery both improve significantly.
It is my opinion that mandating a year long medical weight loss trial is not appropriate for most patients. As the director of a large bariatric surgery program, I can tell you first hand that most patients who come to us have already exhausted every other option to loose weight. Most times candidates have lost large amounts of weight in their lifetime only to gain it back plus more. When most people decide on surgery they are already facing a number serious of obesity related health problems. Each patient should have the opportunity to be evaluated individually and bypass long medical weight loss programs if they have made significant efforts in the past.

The post surgery outcomes are outstanding for the majority of patients. Postponing weight loss surgery for traditional attempts should be reserved for those who have not previously attempted a supportive program.
I had lap band surgery in late Dec. 2006 and have lost 53 pounds. It was the best decision I have every made. I would diet, loose weight and then gain it right back. The band has given me the tool I need to succeed. Making people wait a year is so unfair. Insurance companies need to realize that almost every person that is trying to have this surgery have tried every other option and that this is their last hope.
I had the roux n y gastric bypass procedure one year ago on April 4, 2006. I weighed 315 lbs when I consulted with the surgeon. I now weight 185 lbs and I'm still losing. Due to joint pain and various other problems, I could not comfortably walk before my surgery, although I was mobile. I am walking 3 miles every day now and increasing the distance incrementally. My co-morbidities prior to surgery included hypertension, sleep apnea, diabetes, asthma, etc. I had gall bladder surgery, and Achille's tendon reconstruction all due to my obesity. I had mandatory doctor visits every 3 months and blood panels run each visit because of elevated liver function due to my blood pressure meds. Add that to the EKG's, the sleep study, and all of the other associated tests I had over the years - the insurance company is saving a bundle on me since my surgery! I have had excellent blood pressure since the DAY of my surgery. I am no longer diabetic, have no sleep apnea, no asthma, and my health improves every day. It took me three years to get approval through my insurance company for the surgery. I firmly believe this has been a win/win situation for both of us. Restrict weight loss surgery? Let's restrict trans fat, fast foods, and super sizing! Yes, weight loss surgery should be the treatment of LAST RESORT, but it should always be available as a life saving alternative.
I'm so glad CNN did a story on this. It is so sad, but a lot of the insurance companies are cutting this surgery out, because of the high price. It's causing a lot of obese people who are seriously in need of this surgery to not be able to get it. I don't believe this surgery should be done, if there is a way people can lose the weight without having the surgery. I did have the surgery myself, and I have tried other forms of weight loss, but the surgery has been the most effective for me. When I was pregnant with my twins, I was put on bed rest in the second trimester and got so overweight I was overwhelmed by obesity. Before I had the surgery I gained weight so easily. I don't gain weight so easily now. My absorption level of calories and nutrients aren't as high as they used to be, and I'm much more active than I was when I was pregnant. I'll say a prayer for Anne. I've kind of been in her shoes.
So some patients are upset because their insurance companies want them to wait a mere year to have permanent, major surgery on their digestive systems? How long did it take them to gain the weight? Probably more than a year! It took me 37 years to get to my top weight, and at 330 lbs I'd definitely be a candidate for the surgery!

It bothers me that the medical community treats obesity as a disease and not a SYMPTOM of a disease. Tracking down the underlying condition and treating that is a lot more useful, in my non-medical opinion, than turning a healthy, functioning digestive system into an unhealthy, dysfunctional bunch of complications-waiting-to-happen. There are probably as many causes of obesity as there are obese persons. This "quick fix" solution that's being marketed in splashy full-page newspaper advertisements strikes me as not only irresponsible but downright dangerous.

A coworker of mine died of liver disease because her shortened digestive system could not absorb some of the nutrients she needed. That was one year after she had a gastric bypass. She was 30. She was also bright yellow. I really, really hope patients who are considering this surgery try EVERYTHING else first to get at the underlying cause.

Myself, I'm a compulsive overeater. For years I have used food as a drug instead of dealing with life. Having a smaller stomach would not stop me from stuffing it full. I have heard of people popping staples, even gastric ruptures because they couldn't stop binge eating even after the surgery. It happens that there's a twelve-step group, Overeaters Anonymous, that can and is helping me. It's run on donations (which means it's affordable for most folks) and there are meetings all over the world. has more information. Thanks.
My husband has had weight problems all his life. He's a very active guy, he has a physically active job and everyday he comes home and works in the yard, helps around the house, etc.
Yet, he still weighs 400 pounds. I've never watched him eat a dozen eggs or 3 pizzas or the things you hear people say. He probably doesn't always make the best food choices, but I am finally coming to terms with the fact that he is fat, not cause he is lazy or unwilling, but because there is something larger causing it. He has decided to have the lap band procedure done, and although I am not 100% ok with it, I will support him. The irony in all of this is that the expense is not covered at all by our insurance, and we have one of the best insurance policies available to people as he is a gov't employee. However they were willing to pay for years of doctor visits, counseling, specialists and so forth that have cost as much as this procedure will, and did not do anything to solve the problem.
He realized he's going to have no choice but to behave differently, regardless of what his "brain and belly" tell him to. Like Vern said, people think it's your belly, but it's your brain that causes the thought process to make you keep thinking about food. If you find a tumor, you take it out, knowing that the cancer can come back. But knowing that if you do nothing, you will die. Obesity is like that too, it will kill you, and every knows that to be true, yet it's not thought of like a disease that kills, but rather a person's weak personality. Studies show overweight people don't hold as high of positions in companies or do they receive the same pay. That only adds to the depression that triggers the eating again.
I feel that bariatric surgery is simply becoming a scapegoat operation for weight loss that can done naturally. As much as people distrust and feel negatively toward insurance agencies, I think they're right to request a patient to attempt to diet before getting a still-risky procedure. In cases of imminent death or complications from morbid obesity, then bariatric surgery should be used.

But when a person can lose weight naturally, they should not run to a procedure that's not only expensive but that still might not fix the problem (since some bariatric patients regain all their weight). When a 1,000 pound man can lose weight naturally (shown recently on TLC, sadly, the man regained all his weight), why can't most obese people?
bariatric surgery is the most rehabilative treatment known to modern medicine!! i will debate this with anyone-anytime-anyplace!!! it is the only treatment ever asked to be cost effective and it is!!! it is the only medical treatment i know of that actually pays for itself.
neil hutcher
My name is Tonya, I am 47, and I am a gastric bypass success story. All diets had failed to achieve what my doctor found and helped for a continued healtly life. Gastic bypass is not for everyone, but it is for those who have the initiative and drive to be successful in life - in all ways.

BTW, I only had basically six months to live - that was five years and a lifetime ago. My life is full, active and I love every minute that was extended to devote love and care to family and friends.
I think of they could of lost weight by themselves they would of already. Waiting a year is only giving them a chance to gain more weight.
Although in the past bariatric surgery was thought to be a cosemtic procedure data is emerging that supports three important concepts: 1. Obesity is a disease with significant contribution from genetic, microbial and neurohormonal factors. 2. Weight is not about your appearance it is about your health. Carrying extra weight is associated with the major medical problems which plague americans for example: Type 2 diabetes, hypertension, sleep apnea. 3. Bariatric surgery, acknowledged even by CMS last February in the NCD, provides the only solution for millions of americans affected by this disease. Would we think to limit access to care for lung cancer or heart disease? Barriers to access to care for those affected cause desperation and encourage patients to seek care outside of the United States, or not to get care at all. Morbid obesity affects women, minorities and people in a lower socioeconomic class, will we abandon them until they are so sick from obesity associated disease that they are unable to care for themselves or their families?
The only reason the insurance companies do anything is to save themselves money. When they say it's there business to oversee their client's health, they mean it's there business to make sure they don't spend one cent more than they are absolutely forced to on their health care.

Whether or not someone requires a radical surgery of this kind is a decision that should be left to the patient and qualified medical professionals to make!
As a bariatric health psychologist, I have seen patients before and after surgery for over 5 years. Virtually every patient has been on countless diets in the past and their medical conditions are often so desperate that surgery is their last hope. It is very gratifying to see so many of them eliminate disease and improve their quality of life after weight loss surgery. Some payors will probably continue to make it challenging for patients to gain access to surgery, which is unfortunate since it is such an effective intervention.
I had RNY gastric bypass 10/2002 and I have lost 130lbs and maintained that loss. May I say that yes there are risks involved with the surgery itself, just like there is with any surgery. And yes the morbidly obese population obviously is at higher risk for ALL surgical procedures. That being said, the main risks that post-ops face is the lack of education of the surgeons and their "dietary" staff. Many many patients are told to take 1 flintstone vitamin a day and some tums for calcium.

How do these surgeons and other professionals not understand the nutritional consequences of bypassing a substantial amount of intestine. This is a malabsorptive surgery. We cannot possibly eat enough protein to remain healthy, our pouch is 1 oz. Not to mention we no longer have the gastric enzymes or the duodemun and jejunum where most nutrients are absorbed.

We MUST supplement with a good vitamin 2x/day Along with Dry E, A and D, zinc, and calcium citrate (minimun of 2000mg/day) not to mention iron, B12, and the list goes on and on. We must supplement with "pre-digested proteins" which are protein shakes with a complete string of amino acids so that we do get the protein our bodies demand.

So without patients being given correct information, yes there are dire consequences. Severe malnutrion, osteoporosis, heart failure (our heart after all is a muscle, and our body will cannibalize its muscles to obtain protein) Then there are serious neurological complications due to lack of B12, B1, B6 and any other B vit you can think of.

I would do this again in a heartbeat, I am a nurse, I am 52 years old now, I have osteoporosis, there are few pain meds that are acceptable to a fragile pouch. But my blood pressure is no longer 240/120, I do not have sleep apnea, I can move and play with my grandson. I am still working. I was lucky, I found how to research what I needed to know before the consequences got too bad, not everyone is so lucky. If you want comprehensive information on how to stay healthy for life as a post-op, there is a yahoo group of graduates (people over 1 year post op, but it is a must for pre or early post ops.

Tell the insurance companies to insure proper nutritional information and not the information meant for "normies" that have not had the surgery.

Off my soapbox, but this really lights my fire
Dr. Gupta,,,
I am an RN with three kids and we all had allergies, but I really want to know why MD's don't try diet first when it comes to allergies. I myself had allergies for 20 years, so when my kids got them I was not surprised. My Md did regular allergy tests and results said I was allergic to dust, pet dander, etc. but that I had no food allergies, *that was because I had so much dairy in my system* After we wer dairy free for about a year, yes, the tests showed a major dairy allergy and more.

One of my kids had constant ear infections too, so rather than have the surgery to put
tubes in, or have him on antibiotics, I tried removing all dairy, guess what happened?? My allergies and my kids' allergies completely went away, my kids ear infections completely when away, and when I added Vit C to the diet, the tonsels swelling went down. Without dairy we found out what else in their diet was bothering them. One was chicken due to the shots the gov. requires the chickens to get when they are leaving their pen for the first time, another was Citric Acid. No more smelly feet, my eczema completely when away, and all our calcium levels whet way up when bood tests were done 6 months later. Please,, try to think of healing first by trying to get rid of the cause of the problem. Our society has a pill for everything instead. The word Doctor, means to teach, but today the word means pill pusher.

For you, you should try increasing Vit C, 1000mg per day and get rid of all diary in your diet. I promise you will feel better in about 4 days. If you decided to try it, use it until you feel better, then drop the Vit C and watch all the itchy, runny nose stuff come right back. It Works !!! Nr RN
Bariatric surgery is not for the person who need to lose 30-50 pounds. It's for the person who needs to lose 100 pounds or more. A feat rarely if ever accomplished by diet alone--and if accomplished once, the chance of keeping the weight off is slim. On the contrary, bariatric surgery, be it the RNY, Lap-Band, VSG, or DS, has shown to have very good results long-term... with most patients losing at least 50% of their excess weight and maintaining it for 5+ years. In addition, comorbidities like diabetes, sleep apnea, etc. all vanish. What is needed is on-going post-surgery counseling--both psychological/behavioral as well as nutritional--to ensure success.
I have been a nurse for 14 years. Six years ago, at 35 years old, I realized my weight (330#) was seriously affecting my health (high blood pressure, joint pain, reflux) and my quality of life (playing with my kids, tying my shoes, riding on a plane). I made the decision to have gastric bypass surgery. I had NO problems, NO complications, NO hesitation and NO second guessing. Within six months, I had lost 100# and was off all of my medication for my high blood pressure and reflux; by 15 months after surgery, I had lost 160#.

For the last several years I have worked with hospital programs offering bariatric surgery to those who qualify. There are nationally recognized criteria for coverage for bariatric surgery by both the National Institute of Health AND by Medicare. There are established Centers of Excellence for bariatric surgery designated by the Surgical Review Corporation. These are the factors that should determine patient candidacy for surgery and insurance coverage-NOT the insurers and their desire to contain costs. It is extremely short sighted for any insurer to say bariatric surgery is to costly (the price tag for continuing to cover someone with extreme obesity with the additional pharmaceutical costs, specialist visits, laboratory testing and progression of obesity related illnesses-diabetes, hypertension, sleep apnea, joint disease, cardiovascular disease, etc. is much greater than the cost of surgery) and to risky (when performed at a center of excellence, the death rate and complication rate is extremely low).

We would never tolerate an insurance company stating that a patient who has diabetes, but has continued to consume high carbohydrate foods and has not lost weight will no longer have access to insulin or other diabetic supplies. Nor would we tolerate an insurance company telling a smoker with lung cancer that they have to undergo 12 months of smoking cessation classes before they will approve treatment of their cancer. We can not allow insurance companies to exclude or to severely limit access to a treatment that is not only life-saving (which should be enough to justify it's coverage) but which would also decrease health care spending over time as we can have a healthier population with surgically induced weight loss.
Thank you for allowing us to post our comments on this topic.
I am was obese and am a Bariatric Nurse, I had lapband surgery and it saved my life. I had tried diets, nutritionists, exercise and life style changes and nothing worked long term. This must be available to all obese people to save their lives.
I am also a surgery patient and believe it was a life saver for me. Otherwise I would have continued to increase in weight instead of loosing. Now I am no longer morbidly obese but rather at a normal weight range. For individuals who are morbidly obese, bariatric surgery be the only long lasting process that assures success. It also eliminates many of the other medical conditions that frequently accompany obesity. I came off of two medications that I otherwise would have taken for the rest of my life, I also avoided going on medication for high blood pressure and am no longer borderline diabetic. I know a number of fellow surgery patients that had type II diabetes who no longer need to take insulin. With these types of successful results insurance companies and employers not only should not restrict access to coverage for the surgery, or other viable medically managed treatments for morbid obesity, but should encourage it. If a patient and physician feel that surgery is what is the best treatment then it should be covered. Also, for those who think having surgery is the easy way out please be assured that while the weigh loss right after the surgery is dramatic. It takes a continued life time of eating very small amounts of a balanced diet, and daily exercise. Having the surgery makes this possible.
My name is Michelle Whitman. I had Gastric Bypass in June of 2005. I was 34 years old and weighed 300 pounds before I was able to lose 120 pounds. This is by no means the easy way to do it. I fought with this decision for five years before I realized that I was not going to take the easy way out, only gain a tool to help me find out how to eat and live healthy. I have acetabular dysplacia, and was facing a hip replacement due to the extreme weight that my body had to deal with. Also, there was the issue of tremendously painful arthritis and the fact that my body could not handle the added stress of exercise. I know that my habits also played a part in my weight gain, but they alone did not cause it. People who have never been obese, do not seem to understand the constant defeat an obese person feels, ridicule one has to deal with, or the constant self conflict that is usually involved. I agree that gastric bypass is not for everyone. Nothing is designed for the whole, rather for the portion that will benefit from it. Gastric bypass is by no means something to enter into lightly, but I don�t think that insurance companies or people, who don�t understand the procedure, should add to the defeat, ridicule, and self conflict that we already have to deal with. The procedure is safer now than it was 20 years ago and will continue to get safer. Talk to your doctor, research the facts, and be honest about what you are willing to do make this successful. I am a very proud recipient of this surgery, but I know that I don�t have a free ticket to eat as I please. There is work involved, but it has been so worth it! Thank you.
I had the Roux-N-Y procedure done April 3, 2006. It was the best decision I ever made. Prior to the surgery I was a Type II diabetic controlled by pills and SQ insulin and my BP was dangerously high (120/220). This surgery was the option I chose because of my diabetes. I was taking 11 different medications - none of which were medications that "collaborated" with each other. Doctors just kept recommending more medication. I take 1 medication today and my clothing size went from 24 to 12. Health insurance carriers should be forced to pay for a procedure such as mine and there should be no denials that they commonly do.
I had a gastric bypass surgery 3 years ago and it saved my life. I have had no medical problems. I weighed 250 lbs and now weigh 115 lbs. I have so much energy, and I'm not on my 14 medicines a day, I can also eat just about anything i want. To maintain my weight, I graze most of the day. Eating very small portions. I would do it again in a minute.
Insurance companies are just that "companies", to deny a person the right to quality of life in order to protect the bottom line is beyond contempt.
I had gastric bypass surgery 2 years ago. I weighed 360 pounds, had high blood pressure, high cholesterol, sleep apnea, elevated blood sugar levels and joint pain. I was 39 years old. I have lost over 180 pounds in the past 2 years and have had no issues or complications. This surgery saved my life and my insurance company paid for it at the time. This was a serious personal decision that was made with careful consideration of the risks. It was a last resort for me after having tried EVERYTHING over a period of 20 years, and I mean EVERYTHING. For me, this was the answer to my prayers. It is a very personal decision and should be made between patient and Dr. Insurance companies who deny this to patients ought to be ashamed of themselves. No one understands the pain of morbid obesity unless they have experienced it first hand.
Well, when most of America eats like a sumo wrestler:
I can see why insurance companies do not want to pay for surgery.

The cheaper route would be joining a gym or obtaining equipment at home, hiring a good personal trainer, a nutritionist, eating healthy, performing resistance exercise, and performing cardiovascular exercise.
That would be much less risky.
Please, do the companies really think we'll believe that they are trying to "oversee their clients health?" The only reason they don't want the surgery is because it costs A LOT of money. But if they're really smart, they'd realize the long-term cost of having a obese person and just fork over the dough in the first place.
I live and work in Riyadh, Saudi Arabia, and in December 2005 I had Gastric Bypass surgery here. I weighed at 125kgs, suffer from Asthma, Foot Drop, Chronic Back problems, Rheumatoid Arthritis and was a candidate to develop Type 2 Diabetes like my sister. I have over the past 20 years yoyo dieted, losing the weight and putting it all back on again. I finally made the decision for my health to have the bypass. Today I now weigh a healthy 80Kgs, which both my surgeon and Spinal Consultant agree is my optimum weight. My rheumatoid is in remission, my asthma is nearly non-existent, my foot drop has improved to the extent that I walk with the gait of someone with normal gait and not lopsided as before and my back problems are nearly non-existent. I don't have any problems with the less calories, as I now eat healthily. My bloods are always within the required settings, and therefore am no longer on extra vitamins. To me it was the only decision to take, the fact that it was done under part of my Medical Care where I work (in a Military Hospital) made things a lot easier for me. I do not like the idea of Insurance Companies playing God with peoples lives. This kind of surgery is a last resort because you have tried all other avenues and they haven't worked. How would they like it if this was done to them or a member of their family, who 'God forbid' died before getting the chance of adding years to their life rather than losing their life.
At 38 years-old, struggling with being overweight for the last 20 years, and weighing 266 lbs, I drove down to Mexico from Dallas last week and had the Lap Band procedure. My husband's insurance is self-funded through the State of Texas that covers 250,000 members with a written exclusion against any kind of weight loss surgery, regardless of medical necessity. After a month of arguing back and forth with the powers that be in Austin, I decided to not put my life on hold any longer and go to Mexico and have my surgery. The cash price for Lap Band in Dallas is $15,000. I got the same exact surgery in Mexico for $6500.

My procedure across the border was uneventful, everything went wonderfully and I couldn't be happier. For check-ups and adjustments on the lap band, there are many doctors in the Dallas area they work with Mexican patients. My surgeon was experienced, knowledgeable and one of the most compassionate human beings I have ever had the opportunity to meet. In fact, my husband, a local community college professor, having high blood pressure and diabetes, is scheduled for Lap Band with him in July and other family members are considering it as well with this surgeon.

The lack of safety of Mexican doctors and their facilities is mostly a myth as there are hundreds of American's crossing the border daily by auto or airplane to have weight loss surgeries by very qualified and experienced surgeons in Mexico with the same risk of complications as they would find in the U.S.

Right now there is a bill introduced into the Texas legislature to require the State of Texas to no longer exclude weight loss surgery called HB 2668. My husband and I decided not to put our health on hold for another few years to see if insurance will pay for this. We have been together for 10 years and have lost and subsequently gained back the same 30 or 40 lbs over and over again through various commercial and doctor suggested diets that our internist finally suggested Lap Band as a solution.

The 5-year results of Lap Band and Gastric bypass are nearly identical with research showing weight loss of 75% of excess weight. Lap Band is considerably safer, with no cutting or rerouting of the stomach, no malabsorption concerns, and the weight loss is slower than bypass which for me was a plus so that hopefully I won't have to have plastic surgery to get rid of the excess loose skin.

Did I mention that in just 3 short weeks I have lost 16 pounds already?? Only 80 or so more to go!! Yippee!!
Everyone in america is looking for a quick fix cure. Why take responsibility and take action against obesity when you can turn to doctors, surgery, and pills to fix a problem for you? Obesity is a NEW epidemic, brought on by people not exercising, watching too much TV, wasting hours on computers, and eating like pigs. This surgery has no place in medicine as its risky and its something that people need to take responsibility about on their own. Obesity is a choice. You put food in your mouth, you sit on couch.
These people need help. Fat Camps, Counseling, Diet coordinators; but working in healthcare and seeing people with horriffic complications (fistula formation, colostomies, anemia, rupture, infections, to name only a few) is not what i enjoy doing
To me, this is cosmetic surgery, and insurance companies should either stop reimbursement or start covering liposuction and breast augmentation while we're at it.
Stop putting food in your face and you will lose weight. Get off the couch, and on the treadmill. Take the stairs. I've battled weight my whole life, and I win because i choose to accept responsibility, unlike the obese americans who turn to surgery and say they have a "medical" problem. Bull. This country has ceased to take personal responsibility for their lives, and this is yet another showcase of it.
I say cut the insurance, and do it now. Then cut my premiums so when i NEED surgery to cure a critical disease i am not paying a fortune for it on top of my insurance premium.
Bottom line, no matter what the procedure insurance co's perfer to either delay or not pay irregardless or the urgency. They should have no say, and should be left up to the professionals. The Dr.s
My name is Richard McCarthy, and I am a personal trainer in Central Massachusetts that works with clients suffering from cardiovascular and metabolic issues. I can include in my client base several individuals with BMI's in the 40's and higher. During my initial consults, many of these clients have discussed bariatric surgery as a means to lose their excess bodyfat.

While I agree that bariatric surgery is an effective tool for removal of excess fat, it is still just a tool, and not the only one. Many of these individuals considering this surgery didn't gain the weight overnight, but often think it can be lost that way. The surgery (in their minds) promises an easy way to lost the fat.

Those of you reading this blog and having done the surgery know that it's not easy, and know the surgery is not without complications.

Follow-up surgeries are common. Needs for follow-up include infections, leakage, and for many, excess skin removal (due to rapid weight loss, skin can hang off the body, and for some can present its own infection issues). Depending on the amount of skin removed, there will be scarring, and scarring of this nature is permanent, and for some remains readily visible for life.

Additionally, the surgery have no significant effect on other aspects of health, such as improving cardiovascular health and efficiency. And some people still believe that the changes, once done, are permanent. You can still eat too much (the stomach is a muscle - even reduced, it can still stretch), or eat poorly, and regain some of the weight lost.

While I often do not agree with insurance companies regarding their decisions, I believe that programs that encourage monitored lifestyle changes will have a greater impact on fat loss and health improvement. Does this mean it should be mandatory for all members of the obese "population" to do this. No. There will always be exceptions - exceptions that should be identified by qualified personnel, such as physicians and appropriate medical specialists. For the rest - it is not going to be easy. It never is. Nothing worthwhile ever is.
There is definitely a risk with bariatric surgery but there is also a significant risk with unabated obesity. The problem is that the percentage of obese people who actually get weight off and keep it off is less than 2% apart from surgery. Severely obese people are not in a neutral position - they are on the train track and need to get off the track. If diets have not worked they need to seriously weigh the risks of both surgery and their progressive health issues from obesity.
The concerns expressed by the Tufts Health Plan and similar insurers run contrary to the available medical data.

The vast majority of patients who are interested in bariatric surgery have sincerely tried every available weight loss therapy other than surgery more than once. In this highly selected group, it would be optimistic to suppose that even 5% of patients could achieve significant sustained weight loss with the �alternative treatment� proposed by the insurer. Meanwhile, 95+% of the patients who must wait for an extra year are suffering the progressive medical damage caused by the weight. In addition to progression of their health problems, patients in the waiting program face at least double the risk of sudden death as people of normal weight.

Thus, it is important to balance the risk of surgery against the risk of continued morbid obesity. The risk of death from bariatric surgery that is derived from the most recent statistical analysis is 0.2% - when balanced against the risk inherent in living with morbid obesity, this is a risk that many patients and physicians feel is quite reasonable.

Most surgeons, like Dr. Shikora, believe that diet and exercise ARE important ingredients in the formula for success with bariatric surgery. Most of us believe that we can serve our patients better by creating individualized programs of diet and exercise that fit each patient, rather than having an extreme, rigid, �one size fits all� solution imposed from the headquarters of the health insurance company.
I think it should be limated. Basicly they're taking a short cut and short cuts can be worse than the long way. With the potential risks I'd rather gett off my rear end and go to the club and lift wieghts and eat right. Might take abit longer but there are far less health risks. To me they're just too lazy to go to the club and do abit of work to get the weight off and keep it off.
I hate that the day has come that the insurance companies now have this say and control in our own health care decisions.
I am a 41 year old nurse and mother of 2 young children and I have been contemplating weight loss surgery for several years. I now have an appointment in May finally after waiting months then may have to wait another 6 months when I don't have proof of 'medically supervised weight loss'. The companies are asking more and more of the obese and though it can be quite a few hoops to jump through, if you research it thoroughly and know what you are getting into then I know it can be life changing.
I hope so. I am 5'6" and weigh 285 lbs and have new onset asthma and an aortic valve that needs replacing within the next 10 years. I have lost some weight but the fatigue and shortness of breath are REAL. I want to be HEALTHY and know that bypass or lapband surgery is not a cure all but a TOOL to get my life back.
Good for Ann, there are many of us out here just like her who just need our lives back. It's ok to ask for medical help. Go to for further support and info on weight loss surgery. It's helped me a lot!
Every facet of our culture revolves around quick fixes and convenience. This translates into higher demands for "cures" in the realm of medical care. We do not place much emphasis at all towards disease prevention, management, and education. Yes, most people who try to lose weight with diet and exercise fail in the long run. There needs to be a certain degree of accountability that is placed on the person but we as a society need to do more to create strong support networks. The money used for gastric bypass would be better spent on education and support for the children and young adults in our country who are at risk for becoming overweight. We still do not fully understand the long term risks associated with bariatric surgery and we may find out down the road that we have created a monster. Plus, what is the hurt in requiring a bariatric surgery candidate to undergoe intensive diet and nutritional counseling prior to going ahead with surgery? If they succeed in losing weight w/o surgery then that's great. If they can't they still will have increased the chances of surgical success by arming them with the knowledge of proper diet and exercise.
Excellent question.

I am a surgeon specializing in prostate cancer and robotic surgery, so I am naturally biased against insurance companies.

I can certainly see them getting a 2nd opinion, but having to wait 1 year serves one main purpose in my opinion.

It allows the insurance company to avoid paying for an operation for 1 year, and I would guess that a significant percentage of the patients would not want surgery after the 1 year (not because they lost the weight).

Bariatric surgery has been shown to help patients loose weight more effectively than other methods and I am against the 1 year restriction.

Readers would be surprised at how many hoops doctors have to jump through to even get simple tests like CT Scans ordered.

Excellent work on your blog!
Dear Dr. Gupta,
I am the husband of a recipient of a gastric bypass operation. Before my 5'10" wife's surgery, I watched her balloon from 200 pounds to well over 300 pounds. I saw first-hand how all her extra weight handicapped her. Her mobility declined due to her extra weight. She developed arthritic knees and hips. She became a borderline diabetic. Her endurance declined to the point she couldn't walk more than 15 minutes without having to stop for a break to catch her breath. She developed sleep apnea. I saw her become afraid of sitting in a chair in the restaurant for fear of them breaking under her. I saw her need a seat belt extender when riding in a vehicle and an airplane. I saw the looks other people would give her when passing her while out. I heard the insensitive comments others would make about her size.

My wife had tried every diet under the sun; many several times in an effort to loose weight. You know, there's a reason there are so many diets are out there. They're betting on you failing and coming back; again and again and again. They make lots of money off your failures. Look at the small print at the bottom of their TV commercials. It reads, "Results not typical." They play on the low self image obese people have. Our society holds up skinny, 'size 6' people as role models for our young people to look up to. But, that's not realistic when the majority of clothes sold to women in the US are size 14 and higher.

I, for one, believe that WLS (weight loss surgery) is a wonderful TOOL to assist people in their endeavor to loose weight. It's not for everyone, though. My wife had to go through a battery of physical and mental tests before her surgeon (not our insurance company) would do her surgery. Unless you are willing and capable to accept the changes associated with WLS, then you shouldn't have it done. I know of several people who even after having the surgery, refused to change their eating habits and were unsuccessful at loosing their weight. Your "pouch" CAN be stretched out and you CAN regain any weight lost, plus more. However, the vast majority of WLS patients follow their doctor's advice.

There's one related item needs to be addressed here and that is attendance in a WLS support group. Just like AA, NA, and O-EA, WLS patients need the support and encouragement of their piers. Another requirement of my wife's doctor's program was that she (and I if possible) attend pre and post-surgery support group meetings. In my opinion, they are what made her the success she's become. We thank God every day for the support she received from her program coordinator and the others in her group. When my wife first thought about having the surgery, we attended a couple of meetings. Those in attendance included pre-op and post-op people. The post-op people proved invaluable. They could answer the questions as well and sometimes better than the "experts," who, in some cases, had never had WLS. Experience is hard to beat when it comes to learning. From listening to these folks, my wife and I learned a great deal about what to expect, both good and bad, from the surgery.

Our insurance company (BC/BS) did the usual insurance company stalling routines, but, in the end, finally approved the surgery.

It's now been 2 years since my wife's WLS. She lost 140 pounds due and has managed to remain within 5 pounds of her goal-weight.

Another thing that people considering WLS need to keep in mind is that once the weigh is off, that's only part of the battle. The other part is what to due with all that excess skin that will be left over after the weight is gone. Oddly enough skin won't shrink very much when stretched for several years. My wife recently completed 2 cosmetic operations to have her "shar-pei" look removed. A total of 10 pounds of skin was taken of her body. Her's was a minimal amount of skin. It's not unheard of to have around 20 pounds of skin removed. Unfortunately, most insurance companies refuse to pay fore these surgeries as they are deemed "cosmetic" and not related to a health risk. Their logic escapes me, especially since they will cover the WLS and they know what one of the results will be. Developing skin problems, such as ulcerations, rashes, and infections frequently occur in WLS patients who, for whatever reason, can't or don't have their excess skin removed.

My wife could be a poster-child for WLS success. She sticks to her dietary regimen and exercises now that she actually can. Since her plastic surgeries, she has a figure most 27 year-olds would die for (My wife is 47.) Her energy level is off the charts, she wears anywhere from size 10 to size 14 clothes (depending on the maker and style), all her blood work indicates "normal" levels and her sleep apnea is gone.

Any news journalist can single out a few exceptions on any side of a story and make them appear to be the norm. Also, you'll find nay-sayers abound on any topic. And, if given enough air-time, you'll let them convince some people who would benefit from WLS be talked and/or frightened out of seeking and getting the help they so desperately need.

All I can say is, from my perspective WLS is a wonderful tool to help people loose weight. It's morbidity rate is among the lowest of any elective surgery and it's a proven tool to help people become successful at loosing weight. For a person with a BMI (body mass index) of >40 you know of one certainty, at some point, they will die of a weight-related morbidity. With WLS, they have a much better chance of survival to a ripe old age than without it.
Having the surgery should be a patient's decision, whether or not it is a foolish choice. That being said, insurance companies need to protect themselves from the risk of complication and have a vested interest in ensuring the total health of their patients. I've had two cousins receive the surgery: one without complications, one with. As for me, I have lost eighty pounds on my own - without surgery - simply by forgoing any food that comes from an animal and taking a sport at my local community college. Losing the weight isn't as hard as everybody likes to make it out to be; we are simply a society demanding instant gratification, no matter what the price.
The decision should be up to the patient in an ideal world. However, if the patient is enrolled in an insurance plan, then she needs to accept whatever rules she agreed to, upon joining it. The real problem is that licensing in medicine is anticompetative, and needs to be awarded solely according to skills and knowledge. Patients need to be able to opt out of being able to sue for malpractice. The cost, time and liability of new drug approval needs to be about 95% lower. Without those extra costs, people could just afford medical services without insurance.
Having had by-pass sugery in 9/06 and now being down 125 LBS. I can tell you that there are both positives and negitives that go along with surgery. And no one is every realy ready for the life change that surgery brings. But the one thing I can be clear about is it saved my life, my job and my family. Isurance played the same games with me making me wait alomst a year, in that time things with my health got worse and worse. Once I had reached the end point of the insurance merry-go-round, they approved the surgery and my new life had started. One thing I know to be true is that until you have the surgery there is no way you truly know what your getting into. If insurance keeps you from having the procedure, take that time and find people that have had the suregery and ASK questions. You are better off knowing what is comming then not. For the insurance company, I am now on about 1/2 of the medications I was one before surgery and of those all are now generics not the name brands I needed before the procedure. So I know I am now saving the insurance company money now and in the future.
I don't know much about bariatric surgery, nor about obesity firsthand I'm at the opposite end - underweight trying to gain), though I do have sympathy for those who have honest trouble with their weight (I have met some people who ARE just lazy, but they seem to be the minority). But anyway, on surgery, I don't know much about it, but I DO know that I don't much trust insurance companies. A patient going on diet and exercise doesn't cost the insurers anything, and if the patient dies, unless they also offer life insurance policies, that's somebody else's job to pay.

If a company actually IS concerned about patient welfare, that's great! But I have a message for the insurers out there: YOU'RE NOT DOCTORS. Insurance companies trying to dictate things like that annoy me.

On the upside, I would assume (and maybe this is being too optimistic) that for those of you concerned, having tried diet and exercise beforehand with poor results, that surely the insurance companies would count that as your one year. But again, that's being very optimistic on my part.

I think perhaps the problem is, people are assuming it's all a cosmetic thing, when most people are in fact doing it for their health (I'm not sure I know of a doctor who would recommend it let alone perform the surgery on somebody who didn't really need it). Granted, it sometimes confuses me how people can get that far along that they need drastic measures.... but then I remember what all they stuff into our food these days and it makes more sense (seems like it doesn't even have to be your typical processed foods anymore to be pumped full of unhealthy extras).

That and the fact that society today is much different from 100 years ago. Most jobs nowadays involve sitting at a desk for 8 hours, or just a lower level of activity in general. And the human body has not yet adapted to cope with the modern lack of manual labor. And working all day, while still trying to get enough sleep to work tomorrow and keep on top of the house chores, gives you much less time to spend hours just being active (which, ironically, seems to also contribute to insomnia in myself and a few others I know). Even kids seem to be getting longer hours at school, and recesses are being cut. And we wonder why the problem is growing.

No wonder so many of us can go a whole day working like mad, yet not feel the least bit productive.

But as far a I'm concerned, the insurance companies need to stop thinking they're the medical experts, and work more fluidly with the DOCTOR'S recommendations. Feeling like a slave to these companies every time something goes wrong gets old after a while. It's already bad enough that people often have to leave ther favorite doctor because - whoops! Their employer changed insurance plans and that doctor is no longer covered.
I also had gastric by-pass, bled from it that evening so I had 2 trips to the or in a day. I have lost 150 and am thin now, and my life is much better.
I also, developed gallbladder problems, so another not uncommon surgery for by-pass patients. Then I developed severe b12 anemis, because my regular MD did notknow that is also common. I have been a very sick woman, but now on the mend.
I vomited several times a day for 3 years. Most patients vomit a lot at first, some vomit longer.

I wish I had not taken the easy way out I would be a healthier person. Now I watch my adult son fight obesity. Not an easy issue.Carol
As more surgeons do bariatric surgery, I believe the procedure will become safer and new techniques may be developed that will also make it safer. I would think in long run it would be less expensive for insurance to pay for surgery once than insulin and high blood pressure meds for an unknown number of years. If willpower was all it took to lose weight, no one would be obese. Our society has made becoming obese quite easy (remotes, driving everywhere, bad food is cheaper than good food), so I believe this drastic procedure may be necessary.
I completely agree with April. Currently, I'm 270 at 5'6". I've been yoyo dieting since I was 14 years old. I'm now 33 and have decided to undergo the lapband surgery. Sure, I can lose 50 pounds, but then I only regain the weight and then some. It's a lifelong struggle and after giving myself one year (on my own, not because of insurance) to lose the weight (which I did, but then gained back again), I've decided I needed surgical help. I need the extra benefit of being prevented from overeating. All of us who are overweight don't need training on how to eat. We are pros. Our problem is the constant tug of war between the desire to lose weight and the desire to be thin. Food is our drug and unfortunately we cannot go cold turkey the way people on drugs can. We have to eat to live. But we struggle with living to eat. The lapband will help me eat to live instead of living to eat. Unless someone has go through this struggle their entire life, they will never understand.
I don't think insurnace companies should be calling the shots. We are talking about a persons life. No one wants to be fat they did not intenationally plan it that way. The bottom line is when it comes time to pay the insurance companies are fighting against it as usually. They are constantly raising rates and are right there for their payments but God forbid if you lose your job and can't pay, you are thrown right off! The bottom line is they don't want to pay! and gastric bypass is an extreme life saving operation for many people. Its easier for people to die than pay up. When people die, its over no more expensive health costs whereas gastric bypass is initially expensive but in the end it is cost effective really.
I have worked with patients that have undergone gastric bypass and lapband and the one thing that many people forget is that after time many people can put the weight back on. It does not cure obesity. It at first forces you to be able to only eat certain foods and in small amounts, but over time your body can adjust to the surgical changes. This can allow you to eat more and more food and eat foods that you may not have been able to tolerate right after your surgery. Many times there may be underlying reasons why a person overeats and these issues have to be resolved before the surgery occurs. The time the insurance company is requiring before surgery may be an opportunity for some to explore these underlying reasons. The insurance companies do not want to pay for this procedure to have to patient gain their weight back in 5 years.
I believe Insurance companies are a bit worried about the increase in commonality of these surgeries. We're finding ways to get around our unhealthy lifestyles that cost more (it'll probably cost us more as well in the long run--insurance never really gets 'cheaper'). I like the idea of having some timeframe where the person needs to show that they tried a more natural approach. Granted, there will be exceptions (like Anne), but there's always exceptions to a rule. The key is wording the policy or coverage in a manner that allows cooperation between the insurance company, the doctor(s), and the potential patient.
I had gastric bypass surgery on 1/17/06 and lost 110 pounds. I have been in therapy for years and been on every diet and exericse program there is. Of course there is no magic bullet. I get up at 4:30 AM and go to the gym and watch what I eat, but I never would have lost this weight without the surgery. The very fact that insurance companies want to make prospective gastric bypass patients wait a year just highlights their total lack of understanding of the complicated causes of morbid obesity and the struggle those who suffer from it endure.
I think participating in a supervised medical weight loss program is important because patients are able to learn tools to manage their weight long term. It's easy to lose weight, it's difficult to maintain that loss because people tend to resort back to old behaviors.
I believe a year long nutrition program prior to surgery would be beneficial.
I had the lap band two years ago and have lost 110lbs; good for me health wise but I am an emotional eater so not so good mentally. My opinion, the eating was a symptom to a bigger problem and the lap band was not the solution. I still want to eat to console my feelings. If I had the year maybe this would not be an issue. Without the band I would be 330 plus pounds and still gaining and struggling emotionally. I am physically healthier now but still struggling mentally. I don�t think waiting a year is an option for everyone, the other health risks that the surgeries solve art to scary to put on hold but I do believe that good therapy should be mandatory to go along with which ever surgery is chosen.
Although I am not considering lap band or gastric by pass for myself, I am surprised at the mindset of people who do not understand obesity.

Do you not realize that just like Anorexics starve themselves to death, people can also eat themselves to death? Anorexics however are able to get treatement and it's covered by insurers. Obesity on the other hand is not.

Now, if you or someone you loved acquired diabetes, or high blood pressure, or another direct problem from weight and your dr said to you "Well, tell ya what, you go home and eat better, and it'll be fine in a year or so." What would you think of your Dr then? Most people are not choosing to live their lives not being able to sit at a booth, fit behind a steering wheel, avoid shopping for clothes, etc.

I wonder if those same people who have issues with "fat" people think of the fact that they probably go to the Dr expecting some type of help. Do you wear glasses or contacts? You could have just taken 'better care of your eyes' couldn't you? No. It's the same mentality. Fat people don't like being fat. And yes, 100 years ago there was less obesity perhaps, but at the same time the life expectancy was much shorter- they however ate a very high fat/protein diet, not fast food, but it was all homemade goodies.

When was the last time you had a fever and didn't bother to take something to help? Even when you reach for Nyquil, or Advil, you're looking for something to help you medically. You could have just "avoided germs".
It's like telling someone who's fat to just 'eat less and take a walk". You have to understand, this is not "a little chubby" and these people put on weight at unnatural speeds- and not because thet eat like Sumo wrestlers!!

I again ask you why anorexics are considered "sick" and in need of medical intervention but not someone who is going to eat themselves to death? Do you think it's natural to eat yourself to death? It's not natural to starve yourself either.
Think about it.
I worked in a bariatric institute as a dietitian for almost a year and counseled clients regarding their readiness for surgery and history of dieting, etc.... It was a rare patient that had a comprehensive weight management program with a team of professionals (not self proclaimed diet experts or dieting program that give you foods to eat, severely restrict, etc...) - but a team that has an exercise expert, psychologist, dietitian, doctor, etc providing support and education weekly for an extended period of time... Majority of my clients had been on and off diets all their lives - could this be one of the factors that hinders their success. Isn't it true that when you lose weight rapidly and regain over and over again - you end up heavier than when you began. I feel the medical system does not deal with the obese client very well - if every hospital had these comprehensive programs it could help. But, patients have to be willing to pay for them as currently insurance often does not cover these programs, but covers a 25,000 dollar surgery. I feel patients should attend these programs presurgery to ensure their readiness - surgery may be a tool, but patients must continue to diet/exercise after surgery for best results and prevent weight regain. Most patients did not come back for the follow up appointments since it was not required. This is why the education needs to be required before surgery.
I had gastric bypass surgery a year and a half ago after tring every diet known to man over the course of about 20 years. I have lost a total of 125 pounds which would not have been possible without this life saving surgery. I was 37 years old living with diabetes, hypertension and high cholesterol just to name a few illnesses caused by morbid obesity. I am now free of medication for all three and manage through diet and exercise and living a healthier lifestyle that was impossible at 271 pounds.

It was far cheaper for insurance to cover my surgery than to cover a lifetime of expensive medications for the diseases that morbid obesity causes.
I am the director of a surgical weight loss program as well as a surgical weight loss patient myself. No one supports pre-operative preparedness more than I do. The available procedures are not to be taken lightly or thought of as a magic solution. However, once you're 100 pounds overweight or more the likelihood of losing the weight "the old fashioned way" and keeping it off is painfully small. I have lived with the physical and emotional pain of being obese. It's something I would not wish on my worst enemy. Of the 3000+ patients I've overseen during their weight loss surgery journey, not one, NOT ONE has expressed regret to me. Certainly there are frustrations along the way and outcomes are not always perfect. The vast majority of obese individuals have already tried every diet in the world. To require yet another diet is essentially only prolonging the inevitable. A comprehensive program with a heavy emphasis on diet, exercise and good mental health combined with the tool of weight loss surgery is the recipe for success. Another diet is not.
I'm a 59 year old grandmother and retired. We travel full time in a motorhome which we may have had to give up because I could no longer fit into the bathroom or shower. I am diabetic, have high blood pressure, sleep apnea, joint problems, etc. I weighed 345 pounds by the time I was able to see the gastric by-pass surgeon for the first time. We wanted me to lose 30 pounds before surgery to insure it could be preform laproscopically.

I had surgery in July 2006 and have lost 120 pounds. I have had no complications. I am still diabetic but take insulin only once a day; my last A1C was 6.2 down from 7.9. The other comorbidities should go away when I can discipline myself to exercise more. I have no regrets. I feel great.

The only advise I have is that people need to realize that they will never be able to make eating the center of their lives again. Which is a good thing but leads to failure in some. If bread and pasta are the mainstays of your existance, forget about the surgery.

My new credo is: Nothing ever tastes are good and being thin(ner) feels.
I had the surgery 1 year ago last April. I was diabetic and had multiple problems besides the fact I couldn't even go shop anymore without getting a wheelchair because my back hurt so bad. I have lost all but 10 pounds of my goal and feel better, more energetic, can walk and no longer have to take diabetes related medication. It was the best thing I ever did. I had tried everything to lose weight and even though my own insurance required 6 months of verifiable diet and doctor visits I still couldn't lose the weight. When are insurance companies going to see it is cheaper in the long run to cover this surgery becaue of the fact alone you can cut out most of your "fat people medication"? Not to mention all the extra doctor visits and knee surgeries etc. I can now enjoy going to the mall, even hiking. As far as the risk of the surgery, I was surely going to die from the many complications of being overweight. I'm much healthier now. It's just another instance of people controlling our lives who don't know what they are talking about. I think if someone is over 100 pounds overweight, the insurance companies should look at the benefits they will receive when that person is much healthier. I had the surgery at the age of 58, it is never too late to get healthy...Thanks
I believe there is a lack of information and education when it comes to food and nutrition. People need to stop DIETING, and change their lifetyles a step at a time. This including food choices and excercise. There are so many benefits to eating hearlthier! The key is to know and be informed on what and why is better.
forcing a person to wait a year for gastric bypass surgery is ridiculas. if diet had worked these people would not be obese. believe me they have tried many diets and many doctors to try to lose. but have failed many times. by the time they look into gastric bypass their health is deteriated to the point that it has become a life or death issue. it is cheaper in the long run to approve the surgery because after the surgery they don't have to take most of their medications anymore and their health improves to the point that the constant dr. appointments for health related problems decrease immensely. take it from someone who knows. i myself have had the surgery and in 6 months time i'm no longer on diabetic medicine, high blood pressure medication, and no sleep apnea machine. i no longer am in pain with my knees,( i'm disabled in them) so please quit this unreasonable request. do what is best for your clients. give them the ok for surgery and help them to save their live.
Gastric bypass was a god send for me. Thank god by insurance helped with the surgery. The insurance companies needs to be put in our place, by having to live with the inability to excerise because of the extreme overweight condition. Then being told we are just lazy.
I had gastric bypass surgery on November 10, 2006. As of today, April 4, 2007, I have lost over 80 pounds. My back and my feet do not hurt anymore. I take long fast walks everyday. I can stand for hours a day at work. I can climb stairs without being short of breath. I can play with my great neices. In other words, I feel GREAT! I would have this surgery again tomorrow if necessary. Before having gastric bypass I weighed close to 300 pounds. I hurt all the time. My quality of life was greatly diminished because I could not do the things a woman of 47 years old should be able to do. Thank God the insurance company agreed to cover my surgery. I look forward to my future and losing more weight. I am going to plant a flower garden this summer. All the little things that make life worth living have been returned to me and all I can say is "Praise God!"
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