People learn from their experiences if they approach life bravely and honestly. In this way, character develops.
in My Day by Eleanor Roosevelt
Each of us may name a few significant turning points in our life when we reflect on the past. Some were the outcome of circumstances beyond our control. Others were events that we deliberately induced to occur as a result of our own deeds. It takes guts to make decisions of this magnitude, whether it's to buy a house, change employment, or decide to take decisive action against chronic obesity.
Every patient I see has a unique narrative to share about how they came to choose to have an AGB. The realization that they've tried everything and nothing appears to work, though, is what unites each story. In the end, the majority of my patients tell me that their choice was one of those crucial turning points in their lives.
Reaching a CrossroadsObesity as a Disease: A Treatment
Many people decide to have surgery to aid with weight loss only after doing a lot of study. Others might have experienced it as a result of having personally witnessed the success of a close friend or relative. Regardless of what leads to that decision, it only makes sense if you've realized that you can't control your weight via other means.
yourself. This is difficult because whenever we have to accept that we can't do something on our own, we inevitably feel like failures.
In order to convey to me all the reasons why they haven't been successful in reducing weight on their own, prospective patients frequently begin by doing so. I halt them and ask, "Do you think you could treat your own heart attack?" before they go too far with their list. Obesity is an illness, and like all diseases, it needs medical attention. Your success will be lot simpler once you learn to see it that way and understand that participating in a weight-management program is actually a medical treatment intended to control that disease. The choice to change how you view your obesity represents the genuine crossroads—not the decision to acquire a band.
The Minimum Requirements
While your precise EMI and real weight in pounds are significant, I believe it is more crucial to consider each individual and how their weight affects their health both now and in the future. However, since everyone is preoccupied with numbers, the following is "the numbers."
Body Mass Index (BMI) and how it's used to classify obesity were topics we covered in Chapter 1 earlier. EMIs between 25 and 30 kg/m2 are deemed to be "overweight." The BMI range between 30 and 40 kg/m2 is considered "obese." EMIs over 40 kg/m2 are considered "morbidly obese," and those over 80 kg/m2 are considered "super obese." By dividing their body weight in kilos by their squared height in meters, anyone can determine their own BMI. In general, utilizing a chart like the one on page 261 of this book's Resources section makes it simpler to calculate your BMI.
The majority of doctors concur that patients must fulfill a minimal set of requirements before even considering bariatric surgery. For someone who needs to shed simply 20 or 30 pounds, this should not be done. For its members to utilize when assessing patients for weight-loss surgery, the American Society of Bariatric Surgeons (ASBS) created some generic criteria a number of years ago. According to those regulations, a patient must:
They must have at least one serious medical condition, such as sort 2 diabetes, hypertension, sleep apnea, severe arthritic changes, or gastroesophageal reflux disease, in order to have any sort of bariatric surgery, including the AGB. Additionally, the patient's obesity should have persisted for at least five years and the patient should have made a sincere effort to shed weight during that time by diets and exercise.
General Requirements for Patients Undergoing Weight-Loss Surgery Checklist
The American Society of Bariatric Surgeons founded this organization.
BMI over 40 without a co-morbid medical condition
✓
BMI more than 35 with a co-morbid medical condition
✓
persistent obesity for five years or more
✓
Efforts done within reason to reduce weight by nutrition and exercise
✓
Insurance coverage is obviously a major concern for the majority of potential patients. But the reality is that every single policy is unique, posing a very difficult set of issues. However, the ASBS recommendations have been established as requirements that must be completed before the patient may be authorized for any weight-loss procedure by practically all insurance that provide coverage for bariatric surgery. The insurance industry has chosen to embrace these principles as strict criteria for paying weight-loss surgery claims despite the fact that they were never intended to be definitive regulations for performing bariatric surgery due to the dramatically increased demand. Because the "criteria" are sometimes not followed in assessing whether a claim is paid, that can be a significant source of disagreement. Additionally, as I hinted at earlier, many policies have specific wording that disclaims coverage for any form of bariatric surgery. It's also critical to be aware that, at the time of the policy's annual renewal, the insurer has the discretion to add procedures—including the AGB—to the list of those that are not covered by insurance coverage for bariatric surgery. Just because a coverage covered the band operation one year doesn't ensure it would cover it the following. Such exclusions for bariatric surgery take effect immediately.
Although it is reasonably simple to calculate your BMI, insurance companies frequently and openly contest the existence of co-morbidities. Even if there are "written criteria," disagreements usually occur when seeking to determine the "medical necessity" for bariatric surgery. Many patients are asked to verify their weight-loss attempts in addition to receiving letters from doctors and proving their medical issues. Those attempts are then open to interpretation, as one might anticipate. Even when a physician is directly guiding and supervising a patient's specific dieting attempts, several policies raise concerns about the degree of oversight.
"Don't they understand that I am going to cost them less in the future when I no longer need medications for diabetes and high blood pressure," is the most frequent response I hear from patients when I inform them that their insurance does not cover the cost of bariatric surgery or the band in particular. Although this seems like a valid argument, insurance companies are not in the business of making investments in your long-term health. It goes without saying that losing weight has financial advantages, but those advantages take time to materialize. The insurance provider has no motivation to give coverage based on future savings because they cannot guarantee that you will continue to be covered by them after the current contract year.
The AGB is slightly distinctive in another insurance matter. The band needs to be adjusted after the treatment, frequently numerous times over a few months. Even if the operation was covered, the insurance might not pay for changes because they are not a component of the process. Similar to how most plans just emphasize surgery, they don't even acknowledge comprehensive weight-management programs. This unfairly minimizes the importance of the other factors for the patient's success.
Without a doubt, insurance coverage enables certain people who might not otherwise have the financial wherewithal to do so to receive healthcare. However, a large number of patients are being denied access to bariatric care by this system. The healthcare system has developed to the point where many, if not most, people believe that they can only access healthcare through their insurance.
insurance. As a result, people believe they have no other option if their request for obesity surgery is denied by insurance. Many surgical practices provide a variety of payment solutions for those without insurance as a solution to this issue. This gives patients the freedom to decide for themselves how they want to manage this chronic condition.
The Initial Assessment
In order to effectively disseminate information, several surgical programs offer free seminars to prospective patients. The length of these seminars can vary, from a 20-minute lecture by a nurse or other staff member to a two-hour thorough explanation by the surgeon and his or her complete team. Although the lecture has the potential to be very educational, it is not intended to offer specific advice. You might want to look elsewhere if the presentation is followed by an immediate attempt to sign you up for surgery. It's an extremely personal decision to change your life by getting an AGB, thus it should only be done after serious thought. Never allow anyone to coerce you into making this crucial choice on the spot.
Attending multiple seminars could be a good idea only to compare the differences between the different courses. You must schedule an initial appointment with the surgeon as soon as you decide to proceed. The surgeon or a staff member will carefully examine your unique condition at your initial appointment and will inform you of how they select potential patients.
The procedures used by various organizations to evaluate potential patients before approving them for surgery vary. Before a scheduled appointment to visit the doctor or another staff member is ever arranged, this screening may occasionally include insurance preapproval. Personally, I think that excludes a lot of individuals who would benefit from the program and who could be motivated to find a way to get finance even if their insurance company declines to cover it.
Each patient should at the very least be assessed by the surgeon to see if an AGB is the best course of action. Additionally, it should be mandated that subsequent consultations with a clinical psychologist and a licensed nutritionist be included in the presurgical assessment procedure. Many programs also include a standard component of having an exercise physiologist conduct an initial exercise tolerance test and a battery of body measures.
The Surgical Evaluation
The surgeon should conduct the initial evaluation. In order to give you the right medical advise on the band, he or she will obtain all the essential medical data during your initial visit. Like other doctors, they'll probably ask you to fill out a medical information form. However, there are a few aspects of the medical history that should receive extra attention for patients who have been diagnosed with morbid obesity. Among the most prevalent disorders connected to obesity include issues like diabetes, high blood pressure, heart issues, respiratory issues, sleep apnea, liver disease, and gastric reflux. Any one of those circumstances could have a major impact on your overall risks and rewards in relation to the AGB. Even though you have listed everything on the information form, make sure you specifically mention these issues to the surgeon. If he or she doesn't mention anything, don't think it isn't significant.
Conditions to Mention to Your Surgeon About the AGB According to This Checklist
(Hint: Don't assume your surgeon is aware of these issues just because you listed them on the patient questionnaire.)
Diabetes
✓
elevated blood pressure
✓
Heart issues
✓
respiratory difficulties
✓
Slumber apnea
✓
liver illness
✓
GERD, also known as gastroesophageal reflux disease,
✓
abdominal hernia