Follow by Email

Saturday, January 01, 2005

What makes this time different?

Originally published Jan. 1, 2005, in the Tracy Press.

I ask myself that question all the time. As I mentioned last week, the immediate answer I come up with is: because it has to be.

But that doesn’t really answer the question of what it is about surgical weight loss that makes me think it’ll work when every other diet on the planet has failed.
I hate to sound cliché, but there’s a lot to be said for the journey making all the difference in the world.

I consider myself in a fortunate place right now. I found myself abruptly switching insurance providers last summer just as I was exploring the possibilities of surgical weight loss.
My new insurer is a health maintenance organization with a five-year-old program devoted to weight-loss surgery.

Though weight-loss surgery has been around since the 1970s, few insurers actually have programs in place for members seeking it. It seems more common that insurers require nothing more than a doctor’s referral and leave surgery preparation up to the bariatric specialists with whom they contract.

Every member of my HMO seeking WLS must submit to a process that takes anywhere from 12 to 18 months. The process includes nutrition classes, psychological counseling and lab work — and that’s just to get a patient’s foot in the door.

Once that happens — meaning the HMO’s bariatric program agrees to accept the patient as a surgery candidate — there is still more work to be done.

Everyone must attend a bariatric orientation class at the hospital where he or she will have surgery. The orientation includes a weigh-in and a series of presentations by the hospital’s bariatric team. Patients are told the specifics of gastric-bypass surgery, its pros and cons and the most common complications. A large portion of the day is spent with a nutritionist explaining the vast differences between what patients can eat before surgery vs. after surgery.
The staff also lays down the rules for the program. The most common is a requirement for pre-operative weight loss.

I know it sounds silly, but my insurer expects all bariatric patients to lose 10 percent of their pre-operative weight before they can be cleared for surgery. I’ve heard different justifications for this requirement. Some say that weight-loss shrinks the size of liver, which is very close to the operation site and could be nicked during surgery. Others say it’s necessary because weight loss will reduce belly fat, and the amount of belly fat a person has determines whether surgery can be done laproscopically.

My opinion is that the surgery is expensive, and the HMO doesn’t want to invest its money in patients who aren’t willing to work at being successful. Requiring pre-op weight loss is a way to weed out those who are less than committed. I also believe that the insurer hopes that after losing about 30 pounds — the average patient weighs between 280 and 300 pounds — the patient will change his or her mind about needing surgery.

Some patients remove themselves from the program after orientation either because they don’t feel they can meet all the requirements or because they no longer believe that surgery is the right choice for them. Those who don’t are required to attend further meetings with bariatric nutritionists, psychologists and specialists to make sure they have realistic expectations of surgery and that they are good candidates for surgery. Being a good candidate for surgery, according to my insurer, means the patient is likely to survive the procedure.

As one surgeon told me, “If we’re going to operate, we’d like to be at least 90 percent certain that you’ll wake up when we’re done.”

Apparently, having patients die doesn’t make surgeons very happy.

It’s only after losing 10 percent of their weight and submitting to about a dozen different appointments that patients are truly cleared for surgery and a date is scheduled.

I’m in the midst of this process, and though it can be daunting, I find it comforting.
As someone who has spent thousands of dollars on diet programs, books and pills, I like the fact that I have to work at this. And every obstacle I pass in this process validates that I’m making the right decision.

I attended orientation in October and am now focused on losing about 30 pounds. I did really well in November, dropping nine pounds.

However, the stress of Christmas got the better of me, and I put a bit of that back on.
When I visited the bariatric nutritionist in early December, she told me I was an excellent candidate for fast-tracking, which means I could have the surgery sooner rather than later. She predicted I may have surgery as early as March.

However, I have an appointment Jan. 8 with the program’s medical director. She’s the one who determines whether I get put on that fast track. If I don’t have at least 10 pounds lost by the time I see her, my chances of being fast-tracked are slim.

My focus now is getting back on track. That’s not easy after two weeks of absent-minded indulgence, but it’s a challenge I’m ready to take on.

No comments: