Good Morning. Finding the middle ground...

...no, this isn't about politics, although it could be, but we won't go there. How do you know you've swung too far to the left or right with regard to your weight loss and health? Are we that have chosen WLS extremists...anarchists or realists?  How might you distinguish between the two sides?  On left you might say, "whatever floats your boat...WLS, not a problem". On the right you might say, "no, you must do it the traditional way". Where is the middle ground?

I think weight loss surgeons through the ASBMS have a pretty good middle ground established in 35-40BMI with comorbidities or above without comorbidities. Seems logical and sets a middle ground most can live with. I think they could broaden the standard a little and help establish some "outside the norm" situations such as folks under 35BMI with diabetes.

Any thoughts?

--gina

Maybe drop the "with comorbids" to 30 for the VSG and get rid of the lapband altogether. But for the DS & RNY, 35 with co-morbids is reasonable.

I think we are realists...those of us who have decided to pursue this route...we have accepted that we need a level playing field and WLS gives us that. It's not like we only had 10 lbs to lose, we WERE/ARE morbidly obese and even if we were still healthy, it won't stay that way for long. Most of us have tried the diet route, over and over and over again! We know it typically does NOT work long term.

Liz

I think the middle ground is good.  I think it is important for it to never become "just another way to lose weight" and have it not considered as a serious medical intervention.  I see too many folks anyway to don't have a clue what they have gotten themselves into regarding diet, vits, protein, etc.  I would hate for the standard of education for clients required to go down. 

I think the guidelines are reasonable.  I think education prior to surgery and follow up care should be some type of requirement.  Like Price said, I see so many people that have no clue what they are suppose to do after they have surgery - either they aren't listening and studying this or their surgeon's don't have good programs.  I had about a big binder book with all my info in it so I could look back at it when I felt confused - and got lots of help here also.

I wish there was a way to force insurance companies to cover WLS.  Ours just dropped it this year.  They only covered it for like 2 years - luckily I got in while it was covered.

I agree with Liz that maybe for the sleeve the BMI could be lower and with less comorbidities since it is not a malabsorption surgery.

I have a very good friend that WLS would be great for, but she won't hear of it.  She eats pretty healthy, but has some medical issues that could be addressed with RNY or DS.  Of course now that our insurance doesn't cover it, I'm sure it is not a possibility for her.

Linda

I had a BMI under 35 when I had my RNY done.  My insurance company will approve WLS with co-morbidities with a Peer Approval meeting with 32.5 being the lowest BMI that they'll approve.

My BMI was 33.5 when I was approved with co-morbidities of diabetes, apnea and hypertension.  I'm 4 weeks out from surgery and have stopped my BP and diabetes meds since surgery.  I am still using the CPAP machine and will go back for another sleep study in January to see if I still need it.

I'm very happy that I made the decision to have RNY and have had a very good recovery with no problems at all.  I've lost 36 lbs so far and am thinking that I'd like to lose 25-30 more.  I'm feeling very good both physically and mentally and am enjoying the new me and looking forward to living life and being more healthy.

Kateri

I think it should all be done on a case-by-case basis myself. That's how most of medicine is done. It should be between you and your doctor.

I also think, given the massive amount of data showing that once you have at least 50 pounds to lose, you are totally screwed doing it via "eat less, move more" that using a BMI of 30 (which is 50 pounds overweight) is perfectly reasonable in SOME situations.

No set of rules is going to make sense 100% of the time because everyone is different. They should just be guidelines and  then you and your doctor can decide if they apply to you or not.

 My surgeon said NIH is considering lowering the guidelines from 35 to 30.

I wonder what my insurance company will do....37 BMI but no real comorbids except stress incontinence and a family history of cancer that is statistically beyond scary. We shall see...

Great topic!  I've always been one to think that rules are more of a starting point, or a guide for making decisions.

When I started this journey I barely met the BMI qualifier, 36.1, but need to have RNY surgery to correct a surgical procedure I had done in 1999 for acid reflux.  Until this past year, I have never had a weight problem other than the nagging 10-15 pounds.  

Now that I need the surgery, it seems the insurance is so caught up on the weight loss side of the RNY procedure, they are not seeing my full medical history and therfore not approving the surgery.

So to address the question - I think the middle ground is a good place to start, but each case should be taken under consideration and all of the details reviewed and understood before a decision is made.

I'm glad there are guidelines in place for WLS because I fear too many people do think this is the easy way out - I'm thankful I'm not one of those people.  But I also think those in charge of making the decisions that have such a huge effect on the life of the patient and their families.

"I'm glad there are guidelines in place for WLS because I fear too many people do think this is the easy way out -"

People say that. And another one they say is "it should be a last resort"

But only 1% of the people who qualify for WLS under the current guidelines in the US get it. Even if the number of people who got WLS doubled, that would still only be 2% of those who qualify.

So here we have this lifesaving surgery that actually works and almost no one will make the choose to use it. And the number one regret of people who have WLS? That they didn't get it sooner!

I think this shows there is something really off in how obesity is approached in the US.