Bariatric Surgery -- Is It Right for You? (cont.)

Patients that lose 200 pounds, however, almost always have redundant skin, either in the abdomen or under the arms or around the thighs. Patients that have excess skin certainly qualify for plastic surgery.

Essentially a new specialty within plastic surgery has developed as a result of bariatric surgery. But again, the challenge is for patients to get funding for these procedures. Most insurance companies will not cover plastic surgery.

You can imagine if many insurance companies don't cover bariatric surgery, they are certainly not going to cover plastic surgery. So it's usually up to the patient to pay for these operations and the plastic surgery on their own.

Now, sometimes they can get coverage by the insurance company if they are considered medically necessary. For example, if it's abdominal excess skin and it's causing infections or hygiene problems.

Can you look in your crystal ball and tell us what you see for bariatric surgery?

It's quite exciting. In the immediate future, what I see is improved results across the country due to improved training of surgeons and hospitals. Right now there are many excellent centers that offer bariatric surgery with very good outcomes. However, results vary dramatically.

So I see in the next five years standards being established that will enable virtually any patient to go to a center within a reasonable distance from their home and have high-quality surgery. We're not quite there yet, but that is within the next five years.

The other exciting area is that these operations are going to become even less invasive. It's very likely that the bariatric operations will be performed without incisions. Yes, without incisions. Some of these operations will be performed through the mouth with an endoscopy procedure. This will dramatically reduce the pain and recovery and perhaps allows patients to go home the same day and go back to work the day after the procedure. That's probably five or ten years away.

"Although obesity is a severe problem, there is therapy that is quite effective."

I must also say, although I'm a surgeon, I'm very interested in any therapy that improves long-term weight loss. And there is no doubt that some time, perhaps a decade or so from now, there will be medication that is much more effective than what we have today. The medications we have today include Meridia and Xenical and unfortunately they are not very effective long term.

Anybody out there who has severe obesity and has major medical conditions, my advice would be to not wait in the hope that a magic pill comes by in the next year or two. That's probably a decade or so away. Right now only bariatric surgery has predictable long-term results.

Dr. Schauer, do you have any final comments for us?

I think our audience and the American public needs to clearly understand that obesity is a severe disease that is increasing at an alarming rate and is causing dramatic ill effects to our society and the health of the average American.

Patients who have severe obesity with 100 pounds or more of excess weight are developing enormous health problems such as diabetes, high blood pressure, cardiovascular disease, and sleep apnea.

Currently surgery is the only effective therapy that consistently results in long-term significant weight loss. There are two operations, gastric bypass and lap band, that are relatively safe and effective.

These operations are not without risks, but in general, the risk of the operation is much less, for many people, than the long-term risk of severe obesity. Any patient interested in seeking surgery, I would highly encourage that they do their home work and research and identify a highly qualified, skilled surgeon, and a team of physician and health care workers who work at that bariatric center, to provide them with the support that is essential for long-term success.

Although obesity is a severe problem, there is therapy that is quite effective. Hopefully over the next several years, high quality bariatric surgery programs will be much more broadly available to the public. I wish all the audience members and listeners today the best of luck in seeking their solution to severe obesity.

Our thanks to Dr. Philip Schauer from the Cleveland Clinic. For more information, please visit The Cleveland Clinic bariatric surgery center at surgery.

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