Yearly Archives: 2023
What Happened to The Lap-Band?
If you were considering bariatric surgery in the relatively recent past, you almost certainly came across the laparoscopic adjustable gastric band. This surgical system goes by the brand name Lap-Band. FYI, there was also a competing band known as the Realize Band, which is no longer on the market. Gastric banding was a revolutionary procedure when it was first devised. For one, it didn’t require any stomach stapling and was adjustable and reversible. Patients who were not losing enough weight could have saline (saltwater) inserted into the band and tightened, while those experiencing symptoms from a tight band could have it loosened with a simple procedure to remove some liquid. This was revolutionary compared to the permanence of most stapled bariatric procedures.
How Wegovy and Ozempic Have Changed the Face of Weight Loss
Incredibly, less than 10% of obese patients who try to lose weight through traditional diet and exercise can maintain that weight loss over the long term. Despite the billions of dollars spent on diet and exercise programs, some of which may offer questionable value, we don’t seem to have made any progress toward solving the obesity epidemic in the United States. With 2/3 of adults in the US overweight and approaching 40% obese, it’s no wonder that “miracle” drugs (known as Semaglutide or GLP-1 receptor agonists) have become so popular to the point of nationwide and even worldwide shortages.
Can Your BMI Be Too High for Bariatric Surgery?
We must always discuss minimum qualifying criteria for bariatric surgery with our patients. For insurance coverage, a patient’s body mass index or BMI must be at least 35 with one or more obesity-related comorbidities or 40 or more regardless of comorbidities. Recent guidance from ASMBS and IFSO has reduced those recommended BMI levels, but insurance has yet to cover lower BMI surgery. That said, we discuss the upper limits of BMI far less commonly because no official guidelines to that end exist. With TV shows showing extreme BMI patients going under the knife (Think “My 600Lb Life) it’s certainly worth discussing because we see more high BMI patients than ever before. So, what are the challenges of working with a very high BMI patient?
Insurance Tips for Bariatric Surgery
When we think of any surgery, particularly bariatric surgery, we may wonder how to pay for it. Bariatric surgery is the only long-term proven solution for obesity, a disease that has reached pandemic status yet remains woefully under-treated. As a matter of policy, many people, even insurance companies, still consider it an elective procedure. As such, the insurance process is not as straightforward as other essential medical coverages, and some insurance companies do not cover bariatric surgery at all. One of the most significant barriers to bariatric surgery adoption is the insurance process and the paperwork required for a pre-authorization. While we try to guide our patients through the process as best we can, most of the work ultimately relies on them getting their medical clearances quickly and filling out their paperwork accurately.
To help, we have developed these five tips to make the insurance process more accessible and remove some uncertainty from what is otherwise a very exciting and hopeful journey.
New 2022 Guidelines for Weight Loss Surgery
You may have heard the big news about bariatric surgery. The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity (IFSO) updated bariatric procedure guidelines at the end of 2022. This was the first update in over 30 years. Body Mass Index or BMI was, and still remains, the primary determinant of whether someone qualifies for bariatric surgery. However, the BMI ranges have been updated to better reflect what we know about obesity and its effects.
To fully understand the implications of this new guidance, we must know more about the body mass index or BMI. Body mass index is a relatively simplistic calculation of height versus weight to estimate a patient’s ideal weight. According to the index, patients can be underweight, normal, overweight, or obese. First and foremost, these BMI numbers cannot accurately predict the diseases associated with morbid obesity. For example, some patients with a BMI of 30 may have significant comorbidities, while others with a BMI of 35 may have fewer and less severe problems. When we reach the higher BMIs – 40 and over – most patients have one or more comorbidities. Also, the BMI does not consider gender differences, muscle mass, body structure, and other critical factors that can help us determine if a patient is a good candidate for surgery. For example, a bodybuilder will often classify as obese when they certainly are not.
How Quickly Can You Get Bariatric Surgery?
Many of our patients are excited when they decide bariatric surgery is the right option for their weight loss and future health. For most, it is a decision, years or even decades in the making. Many have tried and failed with diet after diet, finding themselves frustrated, regaining weight, and sometimes putting even more on. This weight loss, weight gain cycle can foster disappointment and eventually resign them to thinking that they are stuck with a lifelong weight issue and the diseases that come with it. It’s also important to acknowledge that the cost of bariatric surgery, whether using insurance or not, is significant and requires emotional dedication. There is a potential and major financial investment associated with weight loss surgery.
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