FAQs Page 2
Qualifying for Bariatric Surgery
- Do I qualify for insurance coverage for the surgery?
- What is included in the qualifying process?
- What are the routine tests before bariatric surgery?
- What impact do my medical conditions have on the decision for bariatric surgery, and how can my medical problems affect risk?
- What can I do to prepare for surgery?
- What is a co-morbid condition?
- What is type 2 diabetes and how is it affected by bariatric surgery?
- What is high blood pressure (hypertension) and how is it affected by bariatric surgery?
- What is high cholesterol and how is it affected by bariatric surgery?
- What is sleep apnea and how is it affected by bariatric surgery?
- What is acid reflux or gastroesophageal reflux disease (GERD) and how is it affected by bariatric surgery?
- What is the relationship between morbid obesity and cancer?
- What is depression and how is it affected by bariatric surgery?
- What is osteoarthritis and how is it affected by bariatric surgery?
- What is stress urinary incontinence and how is it affected by bariatric surgery?
- What is reproductive health and how is it affected by bariatric surgery?
Due to the success of bariatric surgery over the last decade, many commercial insurances have now included coverage of bariatric procedures. Every insurance policy is unique, however, and it is important that you thoroughly understand your Certificate of Coverage in order to know exactly what is and isn’t covered through your plan. You may need to call your insurance company and ask if bariatric surgery is covered or excluded on your particular policy as even policies within the same insurance company may vary.
The qualification process includes a series of tests. You will meet with Dr Shillingford, a nutritionist, psychologist/psychiatrist, and other support staff members in sessions leading up to surgery. Each healthcare professional will help you prepare for the changes and challenges that lie ahead. Their medical notes will then serve as clinical evidence of your compliance to post-operative lifestyle changes as well as your current state of health.
Certain basic tests typically are performed: Complete Blood Count (CBC) Urinalysis Chemistry screen Electrocardiogram Psychological evaluation Other tests that may be requested include: Pulmonary function testing Sleep study GI evaluation Cardiology evaluation
What impact do my medical conditions have on the decision for bariatric surgery, and how can my medical problems affect risk?
Medical problems, such as serious cardiovascular or pulmonary conditions, can increase the risk of any surgery. On the other hand, many serious medical conditions including the heart and lungs may improve or resolve after successful weight loss following bariatric surgery. Medical clearance and cardiac clearance by a qualified primary care provider and cardiologist, respectively, will address these risks.
Bariatric surgery is like all other major abdominal surgeries. You can best prepare by knowing the benefits and risks of surgery, and by closely following your doctor’s instructions.
Understand the surgical process and what to expect afterward. Keep in mind that you will never be able to eat the way you did before, and that 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 long-term. Practice the post-op diet, including the transition from an all-liquid diet, to pureed food, to a solid food diet of smaller portions with 4 ounces of protein. Start a journal to record how you feel now, the challenges you face, and the things you hope to be able to do after you’ve achieved weight loss. In the process, reach out to 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, ready to help.
There are two definitions for a co-morbid condition: the presence of one or more disorder or disease 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 comorbid conditions including hypertension and diabetes.
Type 2 diabetes is a long-term metabolic disorder where the body produces normal levels of insulin, but resists it. Insulin is necessary for the body to utilize sugar. In one study, 47.8% of patients who had gastric banding surgery experienced complete resolution of type 2 diabetes. Overall 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.
High blood pressure is when the blood pushes against the walls of arteries to deliver oxygen from the heart with higher than normal force. 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. In a recent study 38.4% of patients who had gastric banding surgery experienced complete resolution of high blood pressure. Lifestyle changes in diet and exercise after surgery can lead to significant improvement of cardiovascular disease.
High cholesterol is a disorder of lipids – the fat-like substances in the blood. Most common in incidences of high cholesterol, where the body 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, these effects can lead to heart disease and high blood pressure. A recent study revealed that 78.3% of patients who had gastric banding surgery experienced improved cholesterol health.
Obstructive sleep apnea is when breathing during sleep suddenly stops. This is due to the soft tissue in the back of the throat collapsing and closing off the airway. Morbid obesity can cause sleep apnea and other respiratory problems that may result in chronic fatigue and more serious complication. One recent study revealed that 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). A recent study revealed that 32.3% of patients who had gastric banding surgery experienced complete resolution of acid reflux/GERD.
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
Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats, sleeps, thinks, and feels and therefore how he or she interacts with others. There are many reasons people with morbid obesity experience depression. Emotional health goes hand in hand with physical health, therefore lifestyle improvements and renewed health can help resolve depression. Weight loss, combined with counseling, can be very helpful in improving mental health. A scientific study recorded that 47% of patients who had gastric bypass surgery experienced improvement of depression symptoms.
Osteoarthritis is the chronic breakdown of joint cartilage often referred to as wear-and-tear kind of arthritis. It is one of the most common forms of this disease and especially prominent in people living with morbid obesity. When excess body weight is placed on joints, particularly the knees and hips, the result is a rapid wearing and pain caused by inflammation. Bariatric surgery can, over time, be very effective in treating osteoarthritis following successful weight loss.
Especially in women, morbid obesity is a risk factor for stress urinary incontinence, or uncontrollable urine loss. A large, heavy abdomen and reduced pelvic muscle due to morbid obesity may cause weakedned control over the urinary bladder, leading to accidental leakage of urine with coughing, sneezing, or laughing. Bariatric surgery has been found to improve stress urinary incontinence by reducing the weight placed on the bladder.
Reproductive health can be a particular concern for women struggling with morbid obesity. Issues such as infertility (the inability or reduced ability to produce children) and menstrual irregularities are common among people with morbid obesity. Fertility issues include possible miscarriage, reduced success with fertility treatments, and polycystic ovarian syndrome (PCOS). Additionally, women living with morbid obesity have an increased risk of having children with certain birth defects.