Weight loss surgery takes thorough mental and physical preparation, but most important, it takes commitment
By Heather Hatfield
WebMD Weight Loss Clinic - Feature
Reviewed By Michael Smith, MD
For those who consider weight loss surgery, they are at the end of their ropes. Traditional methods of diet and exercise have had no effect, and this procedure is a last resort. But by no means is the leap from thinking about weight loss surgery to the operating table a short one.
"People need to be aware, in great detail, of the risk and benefits of weight loss surgery so they understand what it is all about," says Harvey J. Sugerman, MD, president of the American Society for Bariatric Surgery. "The procedure is not without risk, and there is a great deal of anxiety that comes with it, so it takes considerable preparation."
From checking on insurance coverage to psychological exams to support groups, preparing for this life-changing procedure takes time, physical and mental readiness, and most of all, commitment.
"From the time a person first thinks about having weight loss surgery, to the time they make the commitment to have it done is typically about two years," says James Kolenich, MD, a bariatric surgeon at the University of Pennsylvania Medical Center, Horizon. "Most people don't rush into this, they talk to family and friends, they talk to the hospital, they go home and they think about it more; it's usually a very thoughtful approach."
More than 60 million obese people are living in the U.S., according to the American Obesity Association (AOA), and about 9 million are severely obese. Weight loss surgery, also called bariatric surgery, can be successful when diet and exercise have failed, and a person's health is on the line. Overweight is the second leading cause of preventable death, after smoking, in the U.S., according to the AOA.
"The first thing a person should do is contact his insurance company to learn if he is covered for the surgery, and he should contact his primary care doctor to find out if there is documentation of his struggle with obesity," says Kolenich. "Many insurance companies want to know that a primary care doctor has tried to help the patient lose weight with psychological counseling, diet, and an exercise plan for five years, and for many patients, this is a big road block."sonally financing the procedure, they are costly: The National Institute of Diabetes and Digestive and Kidney Diseases web site states that this procedure can run from $20,000 to $35,000.
With such a hefty price tag on weight loss surgery, it pays to ensure that your doctor documents your battle with obesity early on, to open up options down the road.
When you've crossed all your t's and dotted all your i's in the insurance category, it is time to find a hospital or center, and a surgeon, that are first-rate.
Finding a Bariatric Surgeon
"When you're looking for a surgeon, ask if he or she is board-certified by the American Board of Surgery," says Kolenich. "Is he a member of the American Society of Bariatric Surgeons? What is the mortality rate of the surgeon, the morbidity rate, the success rate?"
Clearly, the surgeon you find should be well experienced in the area of weight loss surgery.
"Make sure the surgeon you choose is an experienced and qualified bariatric surgeon," says Daniel Herron, MD, chief of bariatric surgery at Mt. Sinai Hospital in New York. "It's clear that the more experienced the surgeon, the lower the risk of mortality. Ideally, you would prefer to find a surgeon who has performed at least 100 of these procedures."
What you are looking for doesn't stop with numbers and statistics -- you will also need a support system. Look for a center or hospital that offers educational seminars to those who are just beginning the process so you can learn more about the actual procedure, the benefits, and the risks. Also look for support groups, that can be utilized pre- and post-operatively.
The preparation, both physical and mental, comes next, and is as crucial to the entire process as the actual procedure.
Preparing for Weight Loss Surgery
"The single most important factor is that they have to realize the surgery is not a cure for obesity," says Herron. "It's a very powerful tool used in the fight against obesity. It needs to be considered as part of a process, and a lifelong commitment to follow up with physicians, a regular exercise program, and healthy eating. If a person doesn't understand that this is a lifelong commitment, that it's not a quick fix, then he or she is not a good candidate."
From a physical standpoint, the preparation for weight loss surgery involves meeting with doctors -- a lot of them.
"There are a number of different aspects to preparing for weight loss surgery," says Herron. "The physical is making sure they are meeting with a number of medical doctors, including cardiologists, pulmonologists, and other physicians, to make sure their health status is optimized before surgery."
A person also needs to meet with a nutritionist, to begin to better understand the elements of healthy eating, and how eating habits need to change before and after the surgery.
"By getting into a proper nutritional mindset before surgery, such as learning to eat smaller portions, eating slowly, paying closer attention to the nutritional makeup of meals, a person is better adapted for the major changes in their lifestyle after the surgery," says Herron.
And, in many cases, it will mean they lose weight before the procedure, which helps their cause, and underscores his or her commitment to change.
"Some surgeons request that a person try to lose 15-30 pounds prior to the surgery as demonstration of their commitment, if they can," says Kolenich. "A person also might be required to quit smoking, both for their health, as well as to improve the outcome of the operation."
Understanding the Risks
Understanding the possible outcomes of weight loss surgery, including the risks, is an important part of preparing for the procedure.
"Education is a tremendously important part of the preoperative process," says Herron. "There is no question that there are major risks associated with the operation. However, those risks can be minimized by having a thorough preoperative workup so there aren't surprises during the procedure, and by making sure the surgeon is experienced and qualified."
Nonetheless, dealing with the emotional toll of this procedure can be difficult, especially when considering the possibility of death.
"There have been good studies looking at the risk of dying after weight loss surgery, showing that although there is a risk of death with surgery, the overall survival rate is improved with surgery compared to not having the surgery at all, and living with obesity," says Herron.
It helps that most centers and hospitals and insurance companies, require psychological evaluations prior to the allowing the procedure -- which benefits both patient and doctor.
"You have to fill your mind with as much optimism and positive thinking as possible," says Joe De Simone, PhD, a psychiatrist in private practice in N.Y., who works with patients preparing for weight loss surgery. "Basically, the preparation is to become more conscious of what you are thinking and feeling, and start preparing yourself to think of food and your life in a different way. This is a courageous step for people to take, and it's not just about weight changing -- it's about life changing."
While weight loss surgery does have a major impact on a person's life, it requires, like any surgical procedure, some recovery time.
"The recovery period is quite variable," says Herron. "I have some patients who take a week off and are back full time, and others who take three to four weeks to recover. While it's certainly physically possible to be back to 90% of capacity after a week, most people take longer to adjust to the new lifestyle."
New techniques have also helped to lessen recovery time. Today, the procedure can be performed minimally invasively via small incisions. In a few centers around the country it can even be done on an outpatient basis.
Patients also need to remember weight loss surgery is not a cure.
"It's not a magic bullet, but is an amazingly powerful weight-loss tool," says Herron. "A person will find they will lose about a pound per day for the first month or so. Then they'll lose between 50%-75% of their excess body weight typically during the first 12 months after surgery."
What follows is dedication to a healthy diet and exercise regimen, continual follow-up with doctors to monitor progress, and commitment to a new life.
Ask yourself these questions, from the National Institute of Diabetes and Digestive and Kidney Diseases, if you are considering weight loss surgery. If you answer yes to many or all of them, start by calling your primary care doctor and insurance company.
- Unlikely to lose weight or keep weight off long term with nonsurgical measures?
- Well informed about the surgical procedure and the effects of treatment?
- Determined to lose weight and improve your health?
- Aware of how your life may change after the operation (adjustments to the side effects of the operation include the need to chew food well and inability to eat large meals)?
- Aware of the potential for serious complications, dietary restrictions, and occasional failures?
- Committed to lifelong medical follow-up and vitamin/mineral supplementation?
Published Feb. 25, 2005.
SOURCES: Daniel Herron, MD, chief, bariatric surgery, Mt. Sinai Hospital, New York City. James Kolenich, MD, bariatric surgeon, University of Pennsylvania Medical Center, Horizon, Pittsburgh. Joe De Simone, PhD, psychiatrist, private practice, New York City. Harvey J. Sugerman, MD, president, American Society for Bariatric Surgery, Sanibel, Fla. American Obesity Association web site. National Institute of Diabetes and Digestive and Kidney Diseases web site.
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