Don't want to do the pre-op diet/10% weight loss/other stalling requirement? The DMHC can...
SUMMARY CONCLUSION
There is no literature presented by any authority that mandated weight loss, once a patient has been identified as a candidate for bariatric surgery, is indicated. There is a mixture of results that question whether weight or truncal obesity is a risk factor for complications after bariatric surgery. The more analytic studies have not found that body mass index (BMI) or total weight is an independent risk factor for complications or death from bariatric surgery.
No institution that has recently published data on bariatric surgery describes a protocol requiringweight loss between identification of the need for surgery and the surgery. Many institutions in California have published results of surgery with particular focus on factors that contribute to morbidity and mortality. No paper from a California institution mentions mandated weight loss before bariatric surgery. Nor does any literature regarding the treatment for the morbidly obese recommend continued weight loss during the period between identification of the need for bariatric surgery and the surgery. Mandated weight loss prior to indicated bariatric surgery is without evidence-based support.
Mandated weight loss prior to indicated bariatric surgery leaves the patient at increased risk from the patient’s comorbidities. Mandated weight loss prior to indicated bariatric surgery is not medically necessary. Mandated weight loss prior to indicated bariatric surgery would be deviant from the standard of care practiced in the United States and other published countries. The risks of delaying bariatric surgery, while not entirely known in the short-term, are real and can be measured. Any potential value of losing weight prior to bariatric surgery is theoretical and not supported by any data. An experimental study including fully informed consent to determine if there were a reduction in risks or other benefit from mandated weight loss prior to bariatric surgery is indicated.
Come on, lets face everyone of us can lose the weight, We are pros at it. Keeping it off is the hard part. That is the part we fail at. EVERY ONE of us. So do not screw your self. If you are asked to lose a few pounds before, just do it. Do NOT take the lazy way out. Most insurance ask you a take a class(s) and learn about life after surgery. Use that time to educate yourself and lose the weight.
Be smart! Not lazy! Start your new life NEW!!!
Just my two cent.
Lu
My surgeon told me that the only thing the pre-op diet accomplishes is to cause physical and psychic suffering to the patient, and delivers to him a patient on the operating table who is stressed and often malnourished -- far from an ideal patient. He said that a severe diet prior to surgery does not shrink the liver -- or if it does at all, not appreciably enough to make a difference in surgery -- and that ANY bariatric surgeon worthy of the title should expect and be qualified to deal with an enlarged fatty liver, as it goes with the territory.
Sounds like you did the program and now feel superior for having survived it, and think if you had to do it and managed to do it, EVERYONE should have to. Kind of like surviving fraternity hazing.
"Do NOT take the lazy way out." Yeah. listen to you. Isn't that what your friends and family said about you having surgery in the first place??
Here's some recent data for you -- chew on this as a part of your diet you think is so important -- because you have been BRAINWASHED by your insurance provider to think they are doing something "good for you."
Surg Obes Relat Dis. 2009 Mar-Apr;5(2):208-11. Epub 2008 Aug 27.
Number of weight loss attempts and maximum weight loss before Roux-en-Y laparoscopic gastric bypass surgery are not predictive of postoperative weight loss.
Jantz EJ, Larson CJ, Mathiason MA, Kallies KJ, Kothari SN.Department of Nutrition Therapy, Gundersen Lutheran Health System, La Crosse, Wisconsin 54601, USA.
BACKGROUND: Many insurance companies have mandated that bariatric surgery candidates already satisfying the National Institutes of Health criteria make an additional attempt at medically supervised weight loss. The objective of this study was to determine whether a correlation exists between the number of weight loss attempts (WLAs) or maximal preoperative weight loss (MWL) and the percentage of excess weight loss (%EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.
METHODS: The WLAs and MWL data were collected by bariatric medical record review. The postoperative %EWL was obtained by retrospective review of a prospectively enrolled bariatric database. Patients whose records contained 1 year of follow-up data and either the WLAs or MWL were included in the study. The data were analyzed using Pearson correlations and odds ratios.
RESULTS: From September 2001 to 2006, 530 patients underwent LRYGB. Of these, 384 met the study criteria (82.6% were women). The mean WLAs was 4.3+/-1.8. The mean MWL was 46.6+/-31.2 lb (21.2+/-14.2 kg). At surgery, the mean patient age was 43.3+/-9.3 years, and the mean body mass index was 48.0+/-5.9 kg/m2. At 1 year after LRYGB, the mean body mass index was 30.2+/-5.0 kg/m2, and the mean %EWL was 72.3%+/-15.3%. Statistical analysis revealed no correlations between the %EWL at 1 year after LRYGB and the WLAs (R2=.011) or MWL (R2=.005).
CONCLUSION: Neither the WLAs nor the MWL correlated with the %EWL at 1 year after LRYGB. Our results showed no evidence that the WLAs or MWL before surgery correlates with the %EWL in patients undergoing LRYGB.
Surg Obes Relat Dis. 2008 May-Jun;4(3):445-50.
- Comment in:
- Surg Obes Relat Dis. 2006 May-Jun;2(3):417-8.
Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity.
Jamal MK, DeMaria EJ, Johnson JM, Carmody BJ, Wolfe LG, Kellum JM, Meador JG.Department of Surgery, Division of Minimally Invasive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA. [email protected]
BACKGROUND: Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002.
METHODS: The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05). RESULTS: At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups.
CONCLUSIONS: The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry.
Surg Obes Relat Dis. 2008 May-Jun;4(3):445-50.
Preoperative weight gain does not predict failure of weight loss or co-morbidity resolution of laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Harnisch MC, Portenier DD, Pryor AD, Prince-Petersen R, Grant JP, DeMaria EJ.Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. [email protected]
BACKGROUND: Success with preoperative weight loss (PWL) is often mandated by the bariatric team to assess patient compliance and has been suggested to correlate with improved postoperative weight loss outcomes.
METHODS: We performed a retrospective analysis of 1629 consecutive patients undergoing laparoscopic Roux-en-Y gastric bypass at Duke University Medical Center. Patients with a preoperative weight gain (PWG) or loss of > or =10 lb were compared. Patients with <12 months of follow-up were excluded.
RESULTS: We found no difference between the 2 groups (PWG, n = 115, PWL, n = 88) with regard to age, gender, race, preoperative body mass index, presence of co-morbidities, or interval between the initial program-entry weight and surgery (149 versus 141 d). No difference was found in the percentage of excess weight loss (EWL) at 12 months, when calculated using the patient's immediate preoperative weight (PWG group, 63.5% EWL versus PWL group, 63.9% EWL, P = NS). If the %EWL was calculated using the initial program-entry weight, the PWL did confer a transient postoperative weight loss advantage; however, this did not persist past 24 months postoperatively. At both 12 and 24 months, the resolution rates of diabetes (82% versus 83% at 2 yr; P = NS), hypertension (48% versus 42% at 2 yr, P = NS), and continuous positive airway pressure discontinuation (87% versus 87% at 1 yr, P = NS) were equivalent. No differences in perioperative complications or conversion rates were detected. The operative time was slightly longer for the PWG group (119.7 versus 104.9 min, P = .02).
CONCLUSION: The results of our study have shown that weight loss before laparoscopic Roux-en-Y gastric bypass is not mandatory and might deter patients from considering weight loss surgery. Laparoscopic Roux-en-Y gastric bypass can be performed safely with equivalent co-morbidity resolution and %EWL regardless of PWG or PWL.
Did I read some report? Nope I sure did not. But I am sure if someone, anyone, looked around enough, they will find report to back up why you SHOULD lose the weight.
Did my family and friends tell me I was taking the easy way NO! they did not. Infact, my father was my bigest support. He held on in the hospital. Waiting to make sure I had the surgery, before he passed way. So do NOT........NOT talk about my family like they don't matter. Because they do. They supported me all the way. My sister had surgery the same day. She did not have classes nor did she have to lose the weight, Would you like to know how bad she FAILED???? I am sure you don't, you see things one way, YOURS!!!!!!! And to me you do NOT matter. (Yap, that was rude, I learned from the best)
I wont take you time cut and pasted what others say. I wil end it here.
I do wish you a good day
Your sister failed for lack of the classes and diet? Really? Have you told her that? Wow, how supportive. But I guess another perspective could be that you didn't set a very good example for her either.
That was sarcasm, by the way.
You won't take time to provide information about "what others say?" Perhaps because there ISN'T such information -- in particular, there isn't such information that is as recent and comprehensive as the FACTS I have posted to help other's not be tortured with an unnecessary pre-op diet.
I am firmly in favor of "the easy way out." And not being unnecessarily tortured. I think there are a lot of people who think the same way, and would like to know that they have the option to avoid the Options program or similar mandated diets and classes, and the support of the state agency that regulates the insurance companies.
You just keep running -- from whatever it is you are running from.
Did I read some report? Nope I sure did not. But I am sure if someone, anyone, looked around enough, they will find report to back up why you SHOULD lose the weight.
Did my family and friends tell me I was taking the easy way NO! they did not. Infact, my father was my bigest support. He held on in the hospital. Waiting to make sure I had the surgery, before he passed way. So do NOT........NOT talk about my family like they don't matter. Because they do. They supported me all the way. My sister had surgery the same day. She did not have classes nor did she have to lose the weight, Would you like to know how bad she FAILED???? I am sure you don't, you see things one way, YOURS!!!!!!! And to me you do NOT matter. (Yap, that was rude, I learned from the best)
I wont take you time cut and pasted what others say. I wil end it here.
I do wish you a good day
Hit goal (Normal BMI) on 2-10-11! I LOVE my DS!!
My approval process timeline:
02/12/09 - Dr. refused to refer me for WLS
03/03/09 - Vented/whined about it on another board, planned to just wait until next year & switch plans
Let's see what happens!
**updates in blog**
~Gail R~ high wt.288, surg wt 274, LW 143, CW 153, GW164
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