FAQ

Qualifying for Bariatric Surgery

• Do I qualify for insurance coverage for the surgery?

  Because every insurance policy is unique, it’s important that you thoroughly understand your coverage to know exactly what is and isn’t covered through your plan. Most insurance companies that cover weight loss surgery have specific criteria that must be met in order for a patient to qualify. By providing our office with specifics about your policy, we can assist you in finding out if your policy covers weight loss surgery and the policy’s required criteria. We will need all of the insurance information from your insurance card. In order to serve you better, you will want to have this card with you when you contact our office. Once it is established that your insurance policy covers weight loss surgery and their criteria is met, a letter of medical necessity to your insurance company may be necessary in order to obtain prior approval for surgery.

• What are the routine tests before bariatric surgery?

  Certain basic tests typically are performed:
  – Complete Blood Count (CBC)
  – Urinalysis
  – Chemistry screen
  – Electrocardiogram
  - Chest xray
  – Psychological evaluation
  - Pregnancy test if applicable

  Other tests that may be requested include:
  – Hemoglobin A1C
  – Pulmonary function testing and pulmonary medicine evaluation
  – Sleep study
  – Upper endoscopy
  – Cardiology evaluation

• What can I do to prepare for surgery?

  Bariatric surgery is like other major abdominal surgery. You can best prepare by knowing the benefits and risks of surgery, and by closely following your doctor’s instructions.
  - Visit your local medical doctor and have your weight loss attempts documented at every visit. Most insurance companies require this to be documented for at least 6 months before they will approve coverage for weight loss surgery.
  – Understand the surgical process and what to expect afterward.
  – Keep in mind that you’ll never be able to eat the way you did before. You will have to watch what and how you eat for the rest of your life.
  – Talk to people who have had bariatric surgery.
  – Write down your reasons for having bariatric surgery and outline your plans to maintain your weight loss after surgery.
  – Start a journal. Record how you feel now, the challenges you face, and the things you hope to be able to do after bariatric surgery.
  – Ask your family and friends for their support. Talk to them about why you want to have bariatric surgery. It helps to have people behind you, waiting to help.
  - Understand that it is imperative to have lifetime follow with Dr.King after surgery. Make a commitment to the recommended follow up in order to achieve and maintain successful weight loss. Commitment to follow up promotes better health and accountability. It helps detect any possible problems and helps you stay on track.

Morbid Obesity and Treatment Options

• What is bariatric surgery?

  Bariatric surgery is a surgery designed to give patients a tool to lose weight. It is intended for people who are 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other weight loss therapies such as diet, exercise, medications, etc. A person with a Body Mass Index (BMI) of 35 or greater and one or more co-morbid condition also may qualify for bariatric surgery.

• What is morbid obesity?

  Morbid obesity is a Body Mass Index (BMI) of 40 or more, which is roughly equal to 100 pounds or more over ideal body weight. The disease of morbid obesity interferes with basic physical functions such as breathing or walking. Long-term effects of the disease include shorter life expectancy, serious health consequences in the form of weight-related health problems (co-morbid conditions), such as type 2 diabetes and heart disease, and a lower quality of life with fewer economic and social opportunities.

• What causes morbid obesity?

  The causes of morbid obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that, in many cases, significant, underlying causes of morbid obesity are genetic, environmental, and social. Studies have demonstrated that, once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.

• What is a co-morbid condition?

  There are two definitions for a co-morbid condition: the presence of one or more disorders or diseases in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient. The primary disease of morbid obesity can lead to several co-morbid conditions.

• What is Body Mass Index (BMI)?

  BMI is a measure used to index a person’s height and weight. BMI allows healthcare professionals and patients to better understand health issues associated with a specific weight classification (classifications such as obesity and morbid obesity).

  The calculation of BMI is based on the following formulas:

  Measurement Units Formula and Calculation
  Kilograms and meters (or centimeters) Formula: weight (kg) / [height (m)]2
  With the metric system, the formula for BMI is weight in kilograms divided by height in meters squared. Since height is commonly measured in centimeters, divide height in centimeters by 100 to obtain height in meters.

  Example: Weight = 68 kg, Height = 165 cm (1.65 m)
  Calculation: 68 ÷ (1.65)2 = 24.98

  Pounds and inches Formula: weight (lb) / [height (in)]2×703
  Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703.

  Example: Weight = 150 lbs, Height = 5’5” (65”)
  Calculation: [150 ÷ (65)2] x 703 = 24.96

  Click on our link to have your BMI easily computed for you.

• How do I know if I qualify for bariatric surgery?

  Patients should have:
  – 100 pounds or more of excess weight; or a BMI of 40 or greater
  – A BMI of 35 or greater with one or more co-morbid condition

  Other common guidelines include:
  – Understanding the risks of bariatric surgery
  – Committing to dietary and other lifestyle changes as recommended by the surgeon
  – Having a history of weight loss treatments having failed the patient
  – Undergoing a complete examination including medical tests

• Is bariatric surgery right for me?

  Talk with your surgeon about the different surgical treatments, as well as the benefits and risks.

  Remember:
  1. Bariatric surgery is not cosmetic surgery.
  2. Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
  3. The patient must commit to long-term lifestyle changes, including diet and exercise. These lifestyle changes are key to the success of bariatric surgery.
  4. Problems after surgery are rare, but corrective procedures may be required.

• What are the complications and risks associated with bariatric surgery?

  As with any surgery, there are immediate and long-term complications and risks. For more information, refer to Associated Risks.

• What is the difference between laparoscopic, or minimally invasive, surgery and an open procedure?

  Open surgery involves the surgeon creating a long incision to open the abdomen and operating with “traditional” medical instruments. Laparoscopic, or minimally invasive, surgery is an approach that allows the surgeon to perform the same procedure using several small incisions, a fiber-optic camera, video monitor, and long-handled instruments.

• Why would I have an open procedure?

  The decision to perform minimally invasive or open surgery is made by your surgeon before the operation. For some patients, the laparoscopic, or minimally invasive, technique cannot be used due to dense scar tissue from prior abdominal surgery. Also, the inability to see organs and/or bleeding during the operation can cause your surgeon to switch from minimally invasive to open surgery during your operation.

• What is Roux-en-Y gastric bypass surgery?

  Roux-en-Y gastric bypass surgery is both a restrictive and malabsorbative procdedure. In this surgical weight loss procedure, the surgeon creates a small stomach pouch and then constructs a “bypass” of some of the small intestine. The smaller stomach pouch restricts the amount of food the patient can comfortably eat, and the bypass produces malabsorption as it decreases the number of nutrients and calories absorbed.

  Click here to view our video on Roux-en-Y gastric bypass surgery.

• What is a gastric banding procedure?

  Gastric banding is a purely restrictive surgical procedure, generally performed laparoscopically, in which a silicone band is placed around the uppermost part of the stomach. The band is adjustable and can be periodically tightened or loosened depending on the patient’s needs.

  Click here to view our video on Gastric Banding Surgery.

• How successful is bariatric surgery?

  Studies show that bariatric surgery can effectively improve and resolve many co-morbid conditions. A review of more that 22,000 bariatric surgery patients showed:
  – 61.2% reduction of excess weight over time
  – Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea in the range of 70 – 90%

Co-morbid Conditions

• What is a co-morbid condition?

  There are two definitions for a co-morbid condition: the presence of one or more disorders or diseases in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient.

• What is type 2 diabetes and how is it affected by bariatric surgery?

  Type 2 diabetes is a long-term metabolic disorder where the body produces insulin, but resists it. Insulin is necessary for the body to utilize sugar.

  – 83.8% of patients who had gastric bypass surgery experienced complete resolution of type 2 diabetes.
  – 47.8% of patients who had gastric banding surgery experienced complete resolution of type 2 diabetes.
  – Patients who had bariatric surgery had lower insulin resistance, and their risk for metabolic syndrome, high blood pressure, and high amount of fats in the blood also decreased.

• What is high blood pressure (hypertension) and how is it affected by bariatric surgery?

  High blood pressure generates more work from your heart to profuse your body’s organs.
  Excess body weight is associated with an increased risk of heart disease, elevated cholesterol, and high blood pressure. These conditions can lead to heart attacks, strokes, and heart and kidney damage. Bariatric surgery reduces excess body weight over time, which decreases strain on the heart.

  – 75.4% of patients who had gastric bypass surgery experienced complete resolution of high blood pressure.
  – 38.4% of patients who had gastric banding surgery experienced complete resolution of high blood prssure.
  – Changes in diet and exercise after surgery can lead to significant improvement of cardiovascular problems.

• What is high cholesterol and how is it affected by bariatric surgery?

  High cholesterol is a disorder of lipids—the fat-like substances in the blood. A common form of dyslipidemia is hyperlipidemia (or high cholesterol), the condition that exists when someone has too much of certain lipids in the blood. As these lipids build up inside the artery walls, harmful scar tissue and other debris begin thickening and hardening the walls. Long-term, this can lead to heart disease and high blood pressure.
  – 95% of patients who had gastric bypass surgery experienced improved cholesterol health.
  – 78.3% of patients who had gastric banding surgery experienced improved cholesterol health.

• What is sleep apnea and how is it affected by bariatric surgery?

  Obstructive sleep apnea is when breathing suddenly stops because soft tissue in the back of the throat collapses and closes during sleep.
  Morbid obesity can cause sleep apnea and other respiratory problems that may result in chronic fatigue.
  – 86.6% of patients who had gastric bypass surgery experienced complete resolution of sleep apnea.
  – 94.6% of patients who had gastric banding surgery experienced complete resolution of sleep apnea.

• What is acid reflux or gastroesophageal reflux disease (GERD) and how is it affected by bariatric surgery?

  Acid reflux, also known as gastroesophageal reflux disease, is injury to the esophagus caused by chronic exposure to stomach acid. It is a serious disease that can cause esophagitis, Barrett’s esophagus, and esophageal cancer (adenocarcinoma).

  – 98% of patients who had gastric bypass surgery experienced complete resolution of acid reflux/GERD.
  – 32.3% of patients who had gastric banding surgery experienced complete resolution of acid reflux/GERD.

• What is the relationship between morbid obesity and cancer?

  Morbid obesity may put you at a higher risk for several types of cancer, such as colon, breast, and kidney cancer. In 2003, an article in the New England Journal of Medicine estimated that obesity could account for:
  – 14% of all deaths from cancer in men
  – 20% of all deaths from cancer in women

• What is depression and how is it affected by bariatric surgery?

  Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats, sleeps, thinks, and feels. There are many reasons people with morbid obesity experience depression. Emotional health goes hand in hand with physical health. Lifestyle improvements and renewed health can help resolve depression. Weight loss, combined with counseling, can be very helpful in improving mental health.
  – 47% of patients who had gastric bypass surgery experienced improvement of depression symptoms.

• What is osteoarthritis and how is it affected by bariatric surgery?

  Osteoarthritis is one of the most common forms of arthritis. Known as the wear-and-tear kind of arthritis, osteoarthritis is a chronic condition in which there is a breakdown of joint cartilage. For anyone who is living with morbid obesity, the excess body weight placed on joints, particularly knees and hips, results in rapid wear and tear and pain caused by inflammation.
  Bariatric surgery can reduce much of this weight over a long period of time and can be very effective in treating osteoarthritis.
  – 41% of patients who had gastric bypass surgery experienced complete resolution of osteoarthritis pain and stablized the disease.

• What is stress urinary incontinence and how is it affected by bariatric surgery?

  Among women, morbid obesity is a risk factor for stress urinary incontinence, or uncontrollable urine loss. A large, heavy abdomen and relaxation of the pelvic muscles due to morbid obesity may cause the valve on the urinary bladder to weaken, leading to leakage of urine with coughing, sneezing, or laughing. Bariatric surgery has been found to improve stress urinary incontinence. Less weight is placed on the bladder and other physical changes take place to improve this condition.
  – 44% of patients who had gastric bypass surgery experienced complete resolution of stress urinary incontinence.

• What is reproductive health and how is it affected by bariatric surgery?

  Reproductive health can be a concern for women struggling with morbid obesity. Issues such as infertility (the inability or reduced ability to produce children) and menstrual irregularities may occur due to morbid obesity. Fertility issues include possible miscarriage, reduced success with fertility treatments, and polycystic ovarian syndrome (PCOS). Additionally, women living with morbid obesity are more likely to have children with certain birth defects. A recent study of women following gastric bypass surgery showed improvement of multiple clinical problems related to infertility and PCOS.
  – 100% of patients who had gastric bypass surgery experienced complete resolution of menstrual dysfunction due to PCOS.
  – 79% of patients who had gastric bypass surgery experienced complete resolution of excess hair due to PCOS.
  – Patients who had gastric bypass surgery experienced restored ovulation and fertility.