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Anwers to Your Questions by BIDMC's Experts

Disclaimer: Answers provided are meant to be general in nature and are not a substitute for professional medical advice. For specific advice on your own medical situation, consult your physician.

Q. I have been unable to speak to a surgeon directly without having to attend a seminar first. Why is this, and how can this be avoided? This is a private decision and I don't want to share my business with a group of strangers. Angela, Marblehead

A. Angela, thank you for submitting your question. The  Weight Loss Surgery program's information sessions are utilized to provide some general background on what types of procedures are available, who is eligible for surgery, the benefits and risks of having surgery and some other program specifics. This provides programs the opportunity to share general information about weight loss surgery to individuals so they may determine if this is the right next step for them. In this forum, it is certainly not expected for patients to share private or personal information; patients are welcomed to ask generalized questions. At the end of most sessions, the surgeon usually stays and is available for questions. If you felt comfortable at this time, you could approach the surgeon with your question. However, it is important to note that most medical professionals will need to meet with the patient in a private clinical setting to take a full medical history and physical before giving individual treatment recommendations. If you decide to come in to meet with our team, you will have the opportunity to meet with the surgeon, bariatrician and the multi-disciplinary team to discuss your personal health issues. If you need further information or have a specific question that we may be able to have the medical team answer, please feel free to call our weight loss surgery program at 617-667-5100 and request to speak with the nurse coordinator. She will be more than pleased to assist you and meet your specific request.

Q. Any idea how long it will be before insurance will start paying for this surgery? Marsha, Brockton

A. Thank you for submitting your question. The two most common weight loss surgical procedures (gastric bypass & gastric adjustable band, also known as lap band) are usually covered by most insurance companies. We encourage all potential patients to first call their insurance company directly and ask if their specific plan covers weight loss surgery. If they do, then you should ask them which specific procedures they cover. In addition, it is also important to ask the insurance company what are their criteria/qualifications for weight loss surgery approval. Most importantly remember to document who you spoke with and the details of your conversation. If the surgery for some reason was not covered, the cost is approximately $30,000 however, as stated before most insurance companies do cover weight loss surgery. If you contact our weight loss surgery program at 617-667-5100 we can send you an information packet which includes a guideline for contacting insurance companies.

Q. I had the lap-band in 2007, lost a few pounds, but cannot control my weight because of my back problems. I hate the lap band because nothing goes down and everything gets stuck. Please help, I keep getting bigger. Joan, Wareham

A. Thank you for your question and sorry to hear about your experience with the adjustable gastric band. The lap band restricts food intake. Some patient's receive restriction at the time of surgery when the band is applied. Other patient's need further restriction. The adjustable band is then filled with normal saline in the Bariatric clinic. If the Band is filled too tight, one may experience symptoms of gastric reflux, feeling of food getting stuck, night cough and the inability to eat solid foods. A patient may even experience weight gain due to having food items that are high in calories because they are easily swallowed. The patient may need some of the fill removed to relieve these symptoms or tests that check band placement. The goal of the lap band is to have restriction that causes early satiety, feeling of fullness and desired weight loss with a balanced diet that includes small frequent meals with nutritious foods. It is important to seek follow-up care with your surgeon and Bariatric dietician to discuss these symptoms.

Q. I have Ulcerative Colitis that is under control and rarely causes me a problem. Would the new gastric sleeve be a better option for me where the band and bypass is not? Linda, Boxford

A. Thank you for your question and your interest in weight loss surgery. The  Sleeve Gastrectomy would most likely be the suitable weight loss procedure for patients with  inflammatory bowel disease such as Ulcerative Colitis. The adjustable band may be an option depending whether the condition is active with the use of steroids or in remission. The Roux-en-Y Gastric Bypass would be contraindicated due to malabsorption issues.

Q. Hello, 5 years ago I had the gastric bypass surgery. There were no support grous or much counseling that I was able to attend. In short, today, after a series of family tragedies, health issues and other problems, I find myself again weighing in at 215. Back then I was at near 300 and was never able to get below that 200 mark. What is there for me that can help me with my weight problem? I weighed 14 lbs at birth & was raised in a family of 17 kids so eating was basically an all day affair. I really hate being the way I am and find myself in an awful place with this. Can you be of any help to me please? Denise, Princeton

A. Thank you Denise for your question. With any weight loss surgery, patients can re-gain weight by eating small amounts of food throughout the day (grazing) or by drinking high calorie liquids. To achieve long term weight loss success it is important to attend all of your follow-up appointments with your surgeon and dietitian. The multi-disciplinary team encourages participation in regular exercise and activity, following a well-balanced nutrition plan, and will also assist you to find support for psychological coping.

Q. I have been reading about the new procedure Endobarrier and am very interested in it. Do you have any idea when it will be available in the US? Herb, Boston

A. The Endobarrier surgical procedure is currently not an FDA approved procedure in the United States. Unfortunately, we do not have any information at this time as to when it will be available.

Q. I have really bad sleep apnea. The surgery is supposed to rid sleep apnea. Will it reduce it if weight is not the cause of the sleep apnea? Patricia, Boston

A. Thank you for submitting your question. Surgery can either improve or completely resolve sleep apnea in Bariatric patients. A sleep study may be performed to diagnosis a patient pre-operatively. If a patient already has sleep apnea, this will be included in the pre-operative evaluation. If for some reason, the sleep apnea does not improve with weight loss, further tests can be performed to diagnosis the cause. If your BMI is lower than 35 with a diagnosis of sleep apnea, insurance companies most likely will not cover weight loss surgery. Check with your primary care physician or a sleep specialist if you suspect your apnea is not caused by excess weight.

Q. I had gastric bypass surgery 5 years ago and had lost approximately 70 pounds. I have gained 35 pounds back. I am not dieting; I know what to eat but find myself craving and eating carbohydrates almost daily. I am so sad that I let myself gain the weight. Could my stomach have stretched? I seem to be able to eat quite a bit more than a few years ago. Is one able to have the same surgery again? I am 49 yrs old and my current weight is 210 pounds+. Help! Thank you for any answers and advice that you can offer! Susie, Brockton

A. It is normal to regain some of your weight after surgery. It's also important to have at least annual visits with a dietitian to review labs/blood work, current eating patterns and food cravings. Many people struggle with re-weight gain after surgery and you are not alone! Don't give up, get connected! Get into a support group, visit with your doctor or dietitian or check online for support resources. Also, it is normal for your stomach to stretch years after surgery. But, it is also very important to have a balanced diet that includes lean protein at every meal and snack. Carbs/sweets are metabolized very fast and often lead to increased cravings. Emotional eating (out of stress, boredom, anxiety, sadness, happiness, etc.) must be managed for long term success. A therapist specializing in food/eating behaviors can be very helpful too. Doing a revision or another surgery is risky and there is limited data suggesting that it will improve weight loss.

Q. Do I need a referral from my PCP to talk to someone about information on the process of weight loss surgery? Jean, Boston

A. While a referral is not necessarily required in order for you to get some information on weight loss surgery, our recommendation would be to contact your primary care physician and let them know you would like to look into weight loss surgery as a potential option to improve your overall health. Once joining a program your primary care physician may need to be contacted for insurance referrals and it is always best for them to be involved in any changes to your care plan. In the meantime, you are welcome to visit our website at www.bidmc.org/wls or contact our weight loss surgery program at 617-667-2845 to receive a free information packet in the mail. This will give you some background information about surgical options, eligibility criteria, etc.

Q. I am actually inquiring for my daughter. What does this surgery cost and how would she go about having it covered by insurance. She is a 49 yr old single mom of an 11yr old and she has been taking medication for high blood pressure. It is my guess that she is about 150-200 lbs overweight. Thanks for your help lbs overweight. Evie, Foxboro

A. Thank you for submitting your question. The two most common weight loss surgical procedures (gastric bypass & gastric adjustable band, also known as the lap band) are usually covered by most insurance companies. We encourage all potential patients to first call their insurance company directly and ask if their specific plan covers weight loss surgery. If they do, then you should ask them which specific procedures they cover. In addition, it is also important to ask the insurance company what are their criteria/qualifications for weight loss surgery approval. Most importantly remember to document who you spoke with and the details of your conversation. If the surgery for some reason was not covered, the cost is approximately $30,000, however, as stated before, most insurance companies do cover weight loss surgery. If you contact our weight loss surgery program at 617-667-2845 we can send you an information packet which includes a guideline for contacting insurance companies.

Q. My daughter wants to know if the Lap-band procedure is covered by insurance? Thank You. Diane, Whitman

A. Thank you for submitting your question. The Gastric Adjustable Band (also know as the Lap Band procedure) is usually covered by most insurances. We encourage all potential patients to first call their insurance company directly and ask if their specific plan covers weight loss surgery. If they do, then you should ask them which specific procedures they cover. In addition, it is also important to ask the insurance company what are their criteria/qualifications for weight loss surgery approval. Most importantly remember to document who you spoke with and the details of your conversation. If you contact our weight loss surgery program at 617-667-2845 we can send you an information packet which includes a guideline for contacting insurance companies.

Q. I had gastric by pass 4 years ago and I lost 200 lbs. now I am gaining it back. I have gained 54 lbs back can I have another surgery. I need help.I can't carry this extra weight. can you help me? Jo-Ann, Dedham

A. First, we want to congratulate you on your 200lb weight loss! Our recommendation would be to follow up with the program you originally had your surgery with and meet with them regarding your concerns and need for support. If this is not possible, you are welcome to join our program and be evaluated by our multidisciplinary team. Together we will establish a new care plan focused on getting you back on track. Please feel free to visit our website at  www.bidmc.org/wls target or contact our weight loss surgery program at 617-667-2845.

Q. I met with a physician at the weight center in Worcester and he told me I wasn't a good candidate because my BMI "should be higher"....meanwhile on the chart, my BMI was right on the money of 218 lbs standing at 5'2", he said it should be "more like 225lbs"...please let me know why the chart indicates one thing and the doctor said another. I have no huge health issues other than intense back, hip and lower joint pain in addition to high cholesterol...could someone help with clarification on this issue? Laura, Worcester

A. Thank you for submitting your question. Standards for qualification for weight loss surgery can vary from program to program. For this reason, responses to weight, BMI, and how co-morbidities factor into decision making can be very program specific. For the majority of accredited programs, an individual's BMI needs to be greater than 40. However, a patient with a BMI between 35-40 could also qualify if the patient has additional medical conditions related to weight, such as diabetes, sleep apnea, hypertension or heart disease. If you are looking to calculate your exact BMI, a helpful online calculator can be found at www.nhlbisupport.com/bmi. You are welcome to learn more about our program's eligibility criteria on our website at www.bidmc.org/wls; we also invite you to contact our weight loss surgery program at 617-667-2845 to request an information packet.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted January 2010

Contact Information

Weight Loss Surgery Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 3rd Floor
330 Brookline Avenue
Boston, MA 02215
617-667-5100

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