This decision regarding how soon you go back to work after weight loss surgery will need to be made by your surgeon. He/she is best equipped to determine your return to work date since they know what procedure you had, any other health problems that you have and your recovery status. However, in general, after a minimally invasive procedure without any complications, you will be able to return to work (with lifting restrictions for 2 weeks) within 1 week after surgery. I recommend you take 2 weeks off after surgery so that you can adjust to your initial liquid diet in your own environment but I certainly have had people go back to work much sooner without difficulty. Once again, it goes back to your level of preparedness, your motivation, your healing and your mental attitude.
Life after weight loss surgery is not all about deprivation. In fact, life after surgery is quite the contrary. It’s about having an extra reinforcement so that you are better equipped to lose weight and keep it off long term. As we have said over and over, surgery is a tool but you really need to know how best to use this tool for optimal long-term results. Our society is focused on the here and now. You will have an excellent tool that will help you quickly in the here and now after surgery. More importantly it will serve you well for the long haul so you can fully experience your life in a rewarding and active way. I see dreams come true each and every day!
Sure, there will be changes and I would be lying if we said they were all going to be simple. I am not trying to be vague here but the answer to the question “Will I ever be able to enjoy my favorite foods again after weight loss surgery?” depends upon a number of things. These include the type of surgery you have and what is included in your favorite food list. Not knowing exactly what those favorite foods are, I will include those that you will need to avoid altogether or enjoy in small quantities (we always like to focus on what you can have rather than what you can’t have).
The first category you will want to avoid or enjoy in small quantities is sugary sweets. This can be in solid (i.e. candy) or liquid form (i.e. sweet tea). After weight loss surgery, you should avoid food with >8 grams of sugar (5 grams if you are diabetic) because they can cause a negative reaction in your system, particularly if you have had a gastric bypass. These foods can cause what is commonly called “dumping syndrome”. Dumping syndrome occurs when there is a rapid passage of food into the small intestines causing a shift of fluid to the small intestine. This usually occurs when you ingest foods that are too high in sugar or fat. Symptoms include diarrhea, sweating, nausea, cold/clammy skin, dizziness, weakness, flushed appearance, and occasionally headaches. You will need to stop and rest until the symptoms subside. Remember to remain hydrated (water is best). Take note of the food/foods that caused these symptoms so that you can avoid them in the future.
The second category you will want to avoid is alcohol. Alcohol is full of empty calories, dehydrates the body, and has negative effects on the kidneys and liver. In addition, because of the small size of your new pouch and the fact that food/liquid now empties more rapidly into the intestines, alcohol will be more toxic and cause a higher blood alcohol level than before surgery. For these reasons, ingestion of alcohol should be avoided after surgery. If you choose to have weight loss surgery and then ingest alcohol, please be aware that a small amount can affect you to a MUCH greater degree than prior to surgery.
After you are a month or so out from surgery, you can begin to experiment more with various foods. Introduce raw fruits and vegetables cautiously. Although many people do just fine, certain foods may be difficult to tolerate because your digestive system cannot n handle them. The following may cause problems for you and may need to be avoided:
- Tough meats, especially hamburger. Even after grinding, the gristle in hamburger is hard to digest.
- Membranes of oranges or grapefruit
- Cores, seeds, or skins of fruits or vegetables
- Fibrous vegetables such as corn and celery
- Hulls, popcorn
- Breads – Fresh breads “ball up” in your stomach and can block your pouch. Try to avoid breads/crackers/cereals as much as possible.
- Fried foods
- Milk – If you are lactose intolerant you may use “Lactaid” products or soybean milk
- Rice – tends to expand further once in your stomach and can cause pain
This list may seem daunting but realize that the further you are out from surgery, the more tolerant your system tends to be. However, it is very important that especially throughout the first year you participate in a comprehensive program which should be available with any experienced bariatric surgeon/center. A comprehensive program should include:
- Follow-up visits with your surgeon
- Individualized coaching with a nutrition specialist who understands the needs of the weight loss surgery patient
- Personal trainer/fitness center that eases you into appropriate exercise activities in a safe and comfortable environment
- Access to delicious nutritional products that support your need for 90+ grams of protein each day
- An ongoing support group for you and your family/significant others.
All of this is provided on-site or online at the Center for Weight Loss Success and truly impacts the short and long-term outcomes of our awesome patients. For those that live farther away, most services are very effectively provided online, via Skype, via webinars and other engaging ways. Short and long-term comprehensive support is essential for optimal success.
Rhonda’s Opinion: Absolutely! I enjoy food in moderation even more than before because it tastes so much better when you slow down to enjoy it.
Protein is essential with any weight loss plan. Protein is essential for muscle and tissue growth and repair. If you reduce your caloric intake without consuming the necessary amount of protein, your weight loss will be a combination of lean body mass and fat loss. With adequate protein intake (and exercise), you should be able to preserve your muscle mass, allowing the majority of your weight loss to come from fat stores. If, over time, you do not meet your daily protein needs, you may experience fatigue, loss of lean body mass, and possible hair loss.
You will need to check with your surgeon, but we recommend that our patients take in at least 90-100 grams of protein every day. As your weight loss continues, your body will still prefer using your lean muscle as a source of energy. Therefore, consuming 90-100 grams of protein daily will be a goal throughout your weight loss journey, not just during the beginning phases.
Once your weight has stabilized and you are in a maintenance phase then protein requirements may decrease somewhat into the 60-90 range depending on your weight and overall muscle mass. The higher your weight the more protein you may require in order to maintain Lean Body Mass. Men typically require more protein due to their higher total Lean Body Mass.
People seeking medical or surgical weight loss often have many questions surrounding protein intake since it is important for both situations. How many kinds of protein are there? Where can I find it? How much do I need? What is the best time to have it? Let’s try to give some straight forward answers to these questions.
The word protein is derived from the Greek word proteios, meaning “of the first quality”. Protein is essential for life (i.e. we can NOT survive without it!!!) because it contains sulfur and nitrogen, two vital elements for every cell in your body. Protein also helps produce enzymes and hormones, maintain fluid balance, and regulate numerous vital functions, from building antibodies to building muscle. The body maintains roughly 50,000 different protein containing compounds, forming the building blocks of muscle, bone, cartilage, skin, hair and blood.
As far at your diet is concerned, there are numerous kinds of proteins, each with their own set of advantages. The right kinds can make all the difference, especially if you are trying to lose weight and build muscle. Some of the best protein comes from food. Meat has about 7 grams of protein/oz., large eggs about 7 grams of protein, and milk about 8 grams of protein/8oz. In a weight loss plan, you have to watch all the extra calories (fat, carbs) that come with food sources of protein.
- Whey Protein: Whey protein is derived from milk (remember Little Miss Muffet and her curds and whey?). Many whey protein supplements have had most of the excess fat, cholesterol and lactose removed. Whey proteins are undoubtedly the most commonly used and most popular protein used in sports nutrition and with good reason. They are the highest quality protein available with an excellent balance of essential amino acids. Whey proteins are very efficiently absorbed and this is extremely important but this is also a potential problem. Because whey protein is so efficiently absorbed (i.e. absorbed quickly) it tends to not keep you feeling full or satisfied for any extended period of time. For this reason, it also tends to work better if used in small doses (10-20 gms) taken multiple times throughout the day. Your hunger can potentially return faster than with other proteins. This brings us to Casein protein.
- Casein Protein: Casein protein is also derived from milk (the curds part of curds and whey) and is essentially whey’s counterpart. It also is a very high quality protein with all the essential amino acids. While whey is absorbed very rapidly, casein forms a slow digesting gel in your stomach. This in turn promotes a feeling of fullness that can stave off hunger for longer periods of time. This steady stream of amino acids helps to protect against muscle breakdown. A good casein based protein supplement made specifically for weight loss is Weight and Inches (29gm protein/serving) which can be obtained from CFWLS.
- Egg Proteins: Egg proteins digest at a moderate pace. Eggs are an excellent protein source and mimic the amino acid profile of muscle quite nicely. Unfortunately, eggs do have a relatively high amount of cholesterol and also arachodonic acid (mainly in the yolks). Some people are very sensitive to arachodonic acid worsening inflammatory processes. Egg proteins in supplement form (usually as albumin) have had most of the cholesterol and arachodonic acid removed.
- Soy Protein: Soy protein is also digested at a moderate pace. Soy protein contains all of the essential amino acids, but since soy is a plant, it tends to not have quite as good of a ratio of essential amino acids as dairy or egg based protein. Therefore, it does not tend to protect muscle mass quite as well. It can still be a good alternative for those who do not tolerate dairy based proteins.
As far as timing goes, ideally you should use smaller doses of protein multiple times throughout the day. This is especially important after weight loss surgery so even these recommendations will need to be altered somewhat during the phase immediately following surgery. Starting the day off with a good dose is always a good idea (i.e. that protein shake in the morning). An example would be 20-30 grams at breakfast, 20-30 grams at lunch and 20-30 grams at dinner. Then add two 10-20 gram snacks, appropriately spaced between meals. Positioning a protein snack prior to and immediately after strenuous exercise works extremely well to build/preserve muscle mass.
After surgery, your new stomach pouch will initially only be able to hold about 1-2 tablespoons (15-30cc) of fluid at a time. This is approximately ½-1 medicine cup. Your new stomach should eventually stretch to accommodate 6-8 ounces (3/4 to 1 cup) within the first 1-2 years after surgery. Because your new stomach pouch is so small, you need to follow the guidelines provided by your surgeon to ensure the fluid/food you put in your stomach is the most nutritious possible and does not overfill your small stomach, causing you pain and/or nausea/vomiting.
For delicious recipes that provide adequate protein and are low carb, visit us on Pinterest at: CFWLSVA
Your feelings regarding life after surgery will likely vary depending upon how far out you are from surgery, your level of preparation prior to surgery, your ability to manage change and your overall attitude/mindset. Rest assured, there is often not a dry eye in the office as goals are met/exceeded throughout the first year after surgery and beyond. It’s extremely rewarding for you and everyone involved and you hear more often than not “I wish I would have done this sooner”. As a generalization, at the Center for Weight Loss Success, we have found that most people go through a few expected phases and the timeframe for each varies:
- Phase 1: What have I done?
- Phase 2: I can do this.
- Phase 3: I am glad I did this.
- Phase 4: I wish I would have done this sooner!
- Phase 5: I need to stay on track (especially if necessary long term success habits throughout the first year after surgery weren’t developed)
At the time of this publication, the primary surgery performed by Dr. Clark at the Center for Weight Loss Success is the sleeve gastrectomy. In fact, most of these patients go home the same day of surgery since you generally recover better in your own home environment. You go through a thorough pre-operative program and your post-operative program begins right away.
When you first go home from the hospital, here are some general guidelines for what to expect. Of course, each surgeon has their own particular orders so be sure to follow whatever he/she recommends.
- With regards to your diet, you will want to make sure you are staying hydrated by sipping all day. You will usually continue with a liquid diet until you are seen by your surgeon 10-14 days after surgery. You should not have any carbonated beverages – refer to your the liquid diet instructions set forth by your surgeon. You need to stay hydrated and do your best to try to get about 80-100 grams of protein in per day with high quality protein shakes (again, follow your surgeons specific orders).
- You will want to be up and walking as tolerated and rest when you are tired. You are usually permitted to shower. Common sense comes into play here. If anything is hurting you then you probably should not be doing it yet. At the Center for Weight Loss Success, we restrict lifting to no more than 20 pounds for the first two weeks and restrict driving for 3-4 days after surgery as long as you are off of your pain medication. Getting up and moving is a good thing. Not only for your body but for your emotional state as well.
- Your surgeon will have specific instructions for wound care and medications. Follow these as instructed.
- It is not unusual for you to question “What did I do?” the first days after surgery. It is a big adjustment and although you won’t likely feel hungry, just drinking liquids is a big change and can be difficult to get used to. The first few days tend to be the worst and then you get used to it. It helps to focus on your goals. This will all be worth it.
- Make sure you go to all of your scheduled follow-up appointments and call your surgeon if you have any questions/concerns.
After the first two weeks, you will generally be able to begin “mushy” foods. At the Center for Weight Loss Success, we have a thorough educational program that guides you through exactly what to do/eat which is beyond the scope of this book. Your experienced bariatric surgeon/center will likely have similar resources for you.
At approximately one month after surgery, you will begin eating more regular foods. You will want to focus on getting in an adequate amount of quality protein (at least 90 grams), staying hydrated (sometimes thirst is mistaken for hunger) and easing into a regular exercise regimen. Your experienced bariatric surgeon/center will have an entire plan set to help guide you through each phase after surgery. Remember, it is never too early to begin your habits for success. As a general rule, these include:
- Eating – Don’t skip meals. Food choices should be low fat and low sugar. Think “Protein First”. Eating should be approached as “how little can I eat and be satisfied”, NOT “how much can I fit into my new smaller stomach”. You will want to cut your food up into small pieces, use a smaller plate, put your fork/spoon down in between bites and chew slowly. It is best to eat at a table and not “on the run” so you will avoid eating too fast, overfilling your pouch and end up with unnecessary pain or difficulty.
- Drinking – Try to avoid drinking with your meals since it “washes” the food through quicker and decreases your ability to stay fuller longer. Beverages should be non-caloric and non-carbonated. Drinking 8 glasses of water each day is a good idea with any weight loss plan. Avoid alcoholic beverages.
- Vitamins – Multivitamins should be taken daily – Forever. Other vitamins and/or supplements may be needed depending upon individual needs.
- Sleeping – Make sure you are well rested. You will be most successful if you sleep an average of 7 hours each night.
- Exercise – Regular exercise is extremely important and should be done at least 3-4 times per week for at least 30-40 minutes.
- Personal Responsibility – Successful patients take personal responsibility for weight loss/weight control. It’s up to you!! No one else can lose the weight for you. The surgery is only a “tool”. You have to use this tool appropriately.
Every person recovers at a different rate. It is important to take it one day, one week, and one month at a time. Be involved in your pre-operative and post-operative educational program and try to attend a support group once a month. Being around others who are experiencing the same thing or who have a long-term success story to share is very helpful. When you get to that point, be sure to share your success as well. Celebrate your accomplishments along the way and reward yourself with something non-food related such as a massage, manicure, pedicure, golf club, fitness center membership, new piece of exercise equipment or a great piece of clothing. You will not want to invest a large amount of money in clothing because of rapid weight loss. Joining a clothing exchange with other weight loss surgery patients is helpful too.
Finally, surround yourself with like-minded successful people who support you and your goals. There are plenty of saboteurs in this world – they may even be your closest family or friends. This is a topic we could write an entire book about! In short, ask them for their support and explain the changes you want and need to make (use “I” statements and own your goals). If they continue to be unsupportive, you may need to limit your time with them. I know this is easier said than done but it is ok for you to be selfish – this is your time to shine! Go for it!
Expected weight loss after surgery varies depending upon the surgical procedure, your pre-operative weight and your commitment to following the diet/exercise recommendations after surgery. On an average, people lose approximately 70% of what they were overweight. For example, if you were 100 pounds over your ideal body weight, you would lose an average of 70 pounds – if you were 200 pounds over your ideal body weight, you would lose an average of 140 pounds.
Prior to selecting your surgeon/bariatric center, ask them what the average weight loss is for their clients after surgery. At the Center for Weight Loss Success, the average weight loss after weight loss surgery is 127 pounds. That takes into account weight loss for patients who began with a BMI anywhere between 33 and 50+.
Optimal weight loss results can be attained if you do the following:
- Attend your scheduled surgeon appointments before and after surgery
- Attend monthly support group meetings usually provided through your surgeon’s office
- Strictly follow the diet set forth by your surgeon and if he/she has made nutritional coaching and/or personal training visits available to you through their weight loss surgery program, participate fully and attend these sessions
- Include your support person(s) in your appointments/classes/support group as appropriate so they fully understand what you need to be doing and how to support you for optimal success
- Monitor not only your weight but your full body composition (hopefully a service provided at your weight loss surgeon’s office) as you progress post-operatively. You will want to make sure you are losing fat and not your lean body mass (muscle).
- Be sure to get in enough quality protein (check with your surgeon but usually at least 90 grams per day). This will help with your overall ability to maintain your lean body mass (muscle) which drives your metabolism. It is also important for healing and prevention of potential long term problems such as hair loss.
- Incorporate fitness as soon as your surgeon indicates it is safe for you to do so. Walking is a great beginning routine but you will want to incorporate increased cardio training and resistance training with weights. Your surgeon will likely either provide these services or provide you with an appropriate plan/resource.
- Immediately after surgery your surgeon will likely be most concerned that you are staying hydrated. Water is very important so be sure to sip all day long and in the long run get approximately 64 ounces of water in every day. In addition to proper hydration, you need to make sure you are ingesting appropriate amounts of protein as mentioned earlier.
- Take your vitamins as recommended by your surgeon and make sure they are pharmaceutical grade for optimal quality.
- Whenever you are trying to lose weight, you can improve your rate of success by journaling what you eat and drink. This also helps as you meet with your surgeon and/or the nutritional coach before and after surgery.
- Surround yourself with positive people who support your decision to have weight loss surgery.
We’re here to help you succeed! View the Online Weight Loss Surgery webinar now and then schedule your call with my Surgical Coordinator, Cat Williamson:
How to best prepare for weight loss surgery is one of those questions that might not be on the top of your list, but will contribute to your overall level of success. As you know, weight loss surgery is an important decision. If you are adequately prepared, your level of anxiety will decrease and you will be better able to manage the changes required of you after surgery. In addition, with preparation comes confidence. This is a great trait to have as you embark upon this remarkable journey.
So how do you prepare for weight loss surgery? You will want to ask questions. You will want to make sure that your bariatric surgeon/center has a very thorough educational process in place prior to and after surgery that addresses nutrition, behavior modification and fitness. These three components are critical to long term success.
You may only be thinking short term. Let’s face it, you are really busy and have many obligations at home, at work, with school and with friends that take precedence over your needs. It’s easy to tell yourself “I will figure this out” but it is a lot easier if you have a support system in place at home and with your bariatric surgeon/center prior to surgery so that you can better manage any surprises that may come along the way.
If you have already decided to have weight loss surgery, you will want to think about the positive changes you want to accomplish. Often people view surgery from a number perspective (i.e. how many pounds they would like to lose). Weight loss surgery is about so much more than that. It is about enabling yourself to accomplish things that might not have been possible in the past. It is about having an exciting life. Life you can experience to the fullest extent. It is very important to think about (and document) life goals related to your weight loss. Then you can celebrate the positive changes transforming your life. Some of the “dreams” that people have shared include:
- Walking up the stairs or to the corner of their street without getting short of breath
- Playing with their children or grandchildren
- Crossing their legs
- Painting their toenails
- Stop worrying about being able to fit into a chair at a public place or worrying that it will break when they sit on it
- Fitting in a bathtub and having water on both sides
- Shopping in a store for regular sized people
- Riding a bicycle
- Returning to a productive lifestyle
- Stop worrying about going to a restaurant that might only have booths or chairs with arms on them
- Going to a movie and fitting into the seat
Take some time to identify your “wish list” and document it. Then spend some time getting your mind and body ready. In the weeks or days before surgery, you need to consider yourself in training. Just as athletes prepare for a race, you can prepare yourself to be in top form for surgery. When you actively get your body and mind ready you likely will:
- Have fewer complications from anesthesia and surgery
- Be able to cooperate with necessary treatments
- Heal faster and feel better quicker
- Have better control of your pain
There are some very specific things you need to do to be in the best shape possible. You need to begin these things as soon as possible. We know that the very worst time to try to learn things is right after surgery when you may feel foggy from anesthesia and uncomfortable from your operation. Learn and practice these things now so that you will be able to help yourself after surgery.
- Focus on healthy eating. The better nourished you are, the more quickly your tissues will heal. Healing is WORK for your body. Good nutrition helps you tolerate the stresses on your body and to offset limits on food and fluids right after surgery. Weight loss prior to your surgery can decrease your risk and improve recovery time after surgery. This is why you should incorporate your new eating plan and individualized weight loss counseling prior to surgery as a part of your overall plan. Consult your bariatric surgeon for specific options for weight loss prior to surgery.
- If you are a smoker – QUIT! Even a few weeks of not smoking increases the safety of anesthesia. You will not be allowed to smoke while hospitalized. You will need all your oxygen for healing.
- Build your exercise tolerance. Toning your muscles and building your strength will help you bounce back quicker. Walking is a perfect exercise for you prior to surgery. It is normal to feel a little weak after surgery, but you can reduce this by toning up with daily exercise.
- Exercise your lungs! Practice your deep breathing. After surgery you will be encouraged to do this. Expanding your lungs helps your system get rid of anesthesia drugs quickly, helps prevent pneumonia, and speeds oxygen to your tissues to help you heal quickly. You will also FEEL better.
- Move your legs to prevent blood clots!!!! After an operation, the best exercise to help your circulation and reduce your chance of blood clots will be walking! The nurses in the hospital will get you up after a brief recovery period following surgery. Once you go home, follow the specific discharge instructions set forth by your surgeon. In general, you should rest as needed but also get up and walk around as much as tolerated. You can do these exercises in bed or sitting in a chair during any rest periods.
- Lying on your back in bed, “walk” your feet toward your body until your knees are fully bent. Tighten your abdominal muscles while you do this. Now let your legs slide gently back to the flat position and repeat this four more times.
- Lying in bed or sitting up, point your toes as if you were trying to bend your foot backwards. Hold for the count of five and relax. You should feel a “pull” on the muscles in the front of your legs. Next point your heels away from your body, tightening your leg muscles. Hold for the count of five and relax. You should feel this pull in the back of your legs. Repeat the pointing exercises 5-10 times.
If you have decided to have surgery, you also need to focus your mind on a good outcome. You are the most important player in this team effort, and much will depend on your ability to fully participate. Your feelings and thoughts will play a very big part in your recovery. Reassure yourself that the best people, equipment and techniques are supporting you during surgery.
Finally, if you have decided to have surgery, a good way to prepare is to use the power of your relationships to gather a support group. Enlist family and friends to help you keep your spirits up. Let friends and neighbors help with chores and meals. We all do better when we know we are supported by people who care about us and are cheering us on. Don’t underestimate the power of your emotions. Positive thinking is the biggest help you can give yourself. Think hopeful, optimistic thoughts about the experience ahead, and start NOW!
If you do all of these things, you will be best prepared for a positive experience and outcome.
We’re ready to help you achieve your dream – view our online Weight Loss Surgery Webinar or schedule the next
If your insurance doesn’t cover weight loss surgery, you are not alone. Unfortunately, according to the American Society for Metabolic and Bariatric Surgery, less than 1 percent of those who meet the criteria for surgery actually have surgery5. A big reason for this is lack of insurance coverage.
If you find you do not have insurance coverage, there are self-pay options available (some more affordable than others). The self-pay cost of weight loss surgery procedures varies by the type of procedure and geographical area in which it is offered (urban areas tend to have a higher fee). Generally speaking, the average cost for a gastric bypass ranges from $18,000 to $25,000, while the adjustable gastric banding surgery costs anywhere from $17,000 to $30,000. The sleeve gastrectomy procedure is newer and a price range is not as readily available. A ball Park Range is anywhere from $14,000 to $22,000. The price range is also influenced by the supportive program aspects that may or may not be included, the number of follow-up visits, and for the laparoscopic adjustable banding, whether or not any adjustments are included.
The self-pay cost of weight loss surgery generally includes the cost of anesthesia, the hospital facility fee and the surgeon’s fee. There may also be additional costs for diet and fitness plans, behavioral modification therapy and nutritional products before and/or after surgery. However, some fees include these services. For example, at the Center for Weight Loss Success, our comprehensive weight loss surgery pricing including the costs for anesthesia, the hospital and the surgeon is as follows:
- Gastric Sleeve – $13,995.00
- Laparoscopic Adjustable Gastric Band – $16,995.00
- Gastric Bypass – $18,995
However, in addition, an exclusive comprehensive 12 month program is included with these fees. It is called Weight Management University for Weight Loss Surgery™ and includes the following:
You may be surprised that all of these products/services are included, but it’s the right thing to do for optimal long term results and has resulted in a high degree of patient satisfaction and improved outcomes. For those that travel for surgery, some services are offered online instead of on-site. No matter who you choose as your bariatric surgeon, make sure that there is a comprehensive program available and ongoing support prior, during and after surgery.
Also, most experienced bariatric surgeons/centers have financing options available. You will want to verify this and explore your options. How much is adding 5-7 years of quality life worth to you?
Rhonda’s Opinion: You will find a way to pay for it…I did and I did not make very much money at the time at all. You are worth it and Dr. Clark’s program is one of the most comprehensive and affordable programs available anywhere.
Self-Pay Weight Loss Surgery is common – we offer the most comprehensive and affordable options on the East Coast! Learn more at: Self-Pay Surgery
Insurance coverage for weight loss surgery varies by state and by the insurance provider. While some insurers may cover the entire bill, many public or private insurance companies will pay a percentage (usually around 80%) of what is considered “customary and usual” for the surgery as determined by the insurance company. The first step if you are considering weight loss surgery is to contact your insurance provider (use the provider number on your insurance card) and ask “Is weight loss surgery a covered benefit under my policy?” Many policies require that the employer providing the policy purchase a “Ryder” for weight loss surgery. Thus, you might also want to ask “Do I have the Ryder for weight loss surgery on my policy?” The employer must purchase this Ryder for everyone that is covered under the plan, not just a select few. There are a number of factors that play into this decision for employers. However, generally speaking, employers who understand the value of weight loss and the employee benefits (improved/resolved co-morbidities, lower health care and medication costs, less time missed from work and increased productivity to name a few) are more likely to purchase the weight loss surgery Ryder.
If your initial attempt to authorize coverage is denied, you can appeal, and you should initiate your appeal immediately. Your experienced bariatric surgeon/center will assist you with this process. It makes good fiscal sense for your insurer to foot the bill for your weight loss surgery. According to the Obesity Action Coalition, the upfront costs of weight loss surgery are paid off in three and a half years, due to hospitalization cost savings. What’s more, the cost of drugs for people with diabetes and high blood pressure plummet following weight loss surgery. Many are able to stop taking such medications altogether as their blood sugar and blood pressure return to normal levels after weight loss6.
Medicare, the U.S. government health plan as know today for people 65 years of age or older states it will pay for three types of weight loss surgery for patients who are treated in “high-volume” centers that achieve low mortality rates. The three types of surgeries as we know it today include:
- The Roux-en-Y bypass
- Open and laparoscopic biliopancreatic diversions
- Laparoscopic adjustable gastric banding
An experienced bariatric surgeon/center can guide you through the Medicare requirements that need to be documented prior to scheduling surgery. Medicare does not pre-authorize weight loss surgery so you will need to make sure all requirements are met prior to surgery and submitted properly with your claim. Some private insurers require a letter of medical necessity from a doctor before they will agree to pay for weight loss surgery. However, Medicare does not require pre-certification and does not pre-authorize weight loss surgery. As a result, many surgeons may ask Medicare patients to sign a contract stating that they will pay for any costs that Medicare does not cover after processing the claim. You can find out your specific requirements regarding diet history by contacting your local Medicare provider. However, at the time of this publication, weight loss surgery is an option for Medicare beneficiaries if they have a body mass index (BMI) of 35, with at least one health problem related to obesity such as heart disease or diabetes. As you are aware, governmental insurance is currently under debate and potential revision. Thus, you will want to work closely with your experienced bariatric surgeon/center.
6Obesity Action Coalition website. Fact Sheet: Why it makes sense to provide treatment for obesity through bariatric surgery.
Rhonda’s Opinion: It wasn’t covered by my insurance – that’s ok – just do it and move into the future. As I said earlier, you should qualify yourself instead of letting a stranger at an insurance company make your health decisions for you.
Dr. Clark and the Center for Weight Loss Success offer the lowest cost options on the East Coast. Learn more at: Self Pay Surgery
Is weight loss surgery reversible? The answer is “yes” and “no” depending upon the type of weight loss surgery procedure that is performed. Again, the purpose here is not to create confusion, but the bottom line is that you should not go into weight loss surgery with the mindset that it is reversible. First time (primary) weight loss procedures have risk. Secondary operations have a much higher risk primarily due to potential scar tissue, potential hernia formation and the fact that your anatomy has already been altered to a certain degree depending upon the type of primary operation performed.
Weight loss surgery may be reversible for the adjustable gastric banding procedure since the device can be removed. With the gastric bypass, it is anatomically reversible since the parts of the stomach and small intestine can technically be put together again, but it is not recommended and carries a higher degree of risk. For the sleeve gastrectomy, this procedure is not reversible since the portion of the stomach that is removed in order to create your new “medium banana sized” pouch cannot be replaced.
You have to go back to your need, your desire and your motivation for surgery. It’s a commitment that can reap benefits beyond your imagination. Fear is natural and you have to make sure you have done your research and you are as comfortable as possible with your decision. A certain amount of anxiety is actually desirable. It usually means that you realize you are making an important decision that will require a behavioral change (which is scary) but if you choose carefully and surround yourself with supportive people and proactively prepare for the potential obstacles, success will follow.
Rhonda’s Opinion: I don’t want to ruin a great thing!
You may think this is a strong statement but…ABSOLUTELY NOT! However, weight loss surgery shouldn’t be your first option either. The purpose here is not to create confusion but to reinforce the fact that for people who are morbidly obese and have tried other nutritional, behavioral and fitness programs without success, weight loss surgery can be a great option.
An ideal candidate is someone who is somewhere between 75 and 150 pounds over their ideal body weight. As your weight increases, generally so does the incidence of other health problems. With the additional weight and health problems, your risk for weight loss surgery increases significantly as well. Thus, you take the risks associated with surgery and increase them which is not the most desirable situation for your or your surgeon.
The fear and negative connotations surrounding weight loss surgery has significantly decreased since 1994 when I began my weight loss surgery career. Thank goodness! In addition, the procedures have evolved and become safer and more effective. However, the higher your BMI and co-morbid conditions (other health problems) the higher your surgical risk will be. In addition, the higher the BMI and co-morbid conditions, the higher the possibility is that you may not be a candidate for weight loss surgery.
Rhonda’s Opinion: I should have done surgery a long time ago before I yo-yoed all those years.
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