Are you thinking about having weight loss surgery?

So you're thinking about having weight loss surgery.  What should you do first? And how soon should you do it?  I'm writing this post because I didn't do it right and ended up delaying my surgery by a full 12 months. So please, learn from my mistake.

START A PHYSICIAN SUPERVISED DIET -- First, get an appointment with your primary doctor. Call TODAY and set this appointment for as soon as you can get in. At the appointment you will discuss your dieting attempts of the past and what you will do in the future. Start a diet and have your doctor document this diet. Ask for his/her recommendation on which food plan you should follow, what it should consist of and discuss what behavioral changes you'll be making including exercise plan, psychological counseling or changes, food logging, etc. It doesn't matter what the diet is, it matters that your discussing it and that your doctor is writing it down in your medical chart.  Be sure he documents your weight, your BMI, blood pressure and other vitals. Get it all in writing.  Tell him you're considering weight loss surgery and discuss your options.

CALL YOUR INSURANCE -- Do this when you get off the phone with the receptionist at your PCP's office and have the answers before you see your doctor. Call the number on the back of your insurance card and before you start asking questions, make sure they ask you for your policy number and identify you by name. This ensures they are telling you information based on your specific policy and what is covered under your plan. Here are the questions you need to ask:

• Is bariatric surgery a covered procedure? (Do not call it weight loss surgery.  Do not call it a treatment for obesity. Call it bariatric surgery.)
• What types of bariatric surgery are covered? Roux-en-Y, Gastric Band, Vertical Sleeve Gastrectomy, Biliopancreatic Diversion with Duodenal Switch -- know all of the different surgeries your insurance covers even if you don't think you'll consider all of them. Know what all your options are from the very beginning.
• What is the criteria for insurance approval for each of the surgeries?  Is the criteria the same for all or is there specific requirements for some that don't apply to others?
• The criteria that you'll likely hear include (as outlined by the NIH):
• Candidates should have a body mass index (BMI) of 40 or higher. (calculate your's here)
• Candidate with a BMI between 35 and 40 - surgery may be considered if they have co-morbidities such as cardiopulmonary issues, severe sleep apnea, diabetes, metabolic syndrome, etc. 
• Physician supervised diet attempts to include regular weigh-ins, diet and behavioral changes, exercise therapy, pharmacological considerations, etc. 
• Psychological evaluation
• Medical clearance based on specific co-morbidities
• Medical history (2 to 5 years) indicating chronic morbid obesity
• After you hear the specific information from the insurance representative on the phone, get a copy of the exact criteria in writing. Some insurance companies have it available on their website - if so, ask the rep to walk you through the site to find the section while you're on the phone so you can print a hard copy. If it's not available online, ask for a hard copy to be mailed to your home - this might take a couple weeks, but that's OK, as long as you get a hard copy of these guidelines in the your hands. This will become your  checklist for fulfilling the criteria.  DO NOT rely on anyone else to get this information for you, get it yourself and having hard copies of this information for your own files. Share copies of this information with your PCP and your surgeon.  
• Each insurance policy is different and this information is essential for YOU and your own policy. Even if you have the same insurance company as someone else... unless they work at the desk next to you in the office and chose the same coverage you did, your policy is not going to be the same as someone else's. Each employer negotiates their own policy with the insurance company.  I have Blue Cross Blue Shield of Michigan and my employer covers bariatric surgery.  But someone else with BCBS-MI, might not have coverage for WLS because their employer decided to not pay for that additional coverage. 

START YOUR RESEARCH -- Notice that this is #3 on the list.  That's by design.  Those first two things need to happen before you are 100% decided about having surgery or not.  If you're even thinking about it a little bit, get those first two things done right now!  

There are two books I highly recommend you buy and read cover-to-cover (preferrably more than once).  Weight Loss Surgery for Dummies and The Emotional First Aid Kit. These two books together will help guide you through your decision making process --- for which surgery to choose and for how to choose a surgeon and bariatric clinic. They will also help prepare for what life will be like post-op in terms of eating, follow up care and how to handle the emotional stuff that comes along with the whole journey.  Remember to research ALL four surgeries. Know as much as you can about each one and understand which one is the right fit for you - they are all good surgeries, but not all are good for every person. 

Read as much as you can get your hands on.  Not just books and magazines about WLS, but also the stories of those who are living the life.  I started my blog on the day I decided to have bariatric surgery more than 3.5 years ago and I chronicled my journey through the insurance maze and life leading up to surgery and afterward. There are others who have done the same thing. I have a blogroll in the right navigation bar, go visit all of those WLS people and read their story. Read, read, read... and when you think your eyes are going to fall out, read some more. And don't just read the good stuff.  Read the scary stuff, read about complications and death and regaining the weight -- know what others struggle with and how they overcame those struggles. Learn from them.  Soak it all up.  Even if you don't think something applies to you, read it anyway, learn it anyway because one day, it might apply to you and by knowing it might happen, you'll be prepared to deal with it when it does. Go read.  

There's a really cool feature of Google search that many people don't know about.  It's called Google Scholar. It's a search engine that only searches scientific publications like the New England Journal of Medicine or associations like the American Society of Bariatric and Metabolic Surgeons.  You might not be able to get to full reports on some stuff without a subscription, but there is plenty of information out there that you can read. See what the scientists are saying about WLS and what their studies are telling us. For this type of research you're going to need your thinking cap and a dictionary ... but it's worth it. 

INTERVIEW SURGEONS AND CLINICS -- Make a list of ALL the bariatric surgeons in your immediate area.  Decide how far you're willing to travel to see your surgeon or how far is too far for an emergency. Some people feel comfortable traveling out of state. I personally wanted my surgeon much closer - within an hour's drive. You have to decide what you feel comfortable with.  Then start researching those surgeons on your list and attending their free informational seminars (nearly all clinics have these).  Attend as many as you need to attend until you find the surgeon and clinic who is right for you.  

It is important to find a good surgeon with a good record and lots of skill and training. But remember that the surgeon is really only important for the first day of your journey when you're on the operating table.  You must also take a very close look at the aftercare you'll receive and the clinic where that surgeon practices.  Do they have support group meetings?  Is there a nutritionist on staff available for your every question (and there will be a lot of them)?  Is there a psychologist and medical doctor associated with the clinic who are available to patients?  Is the nursing staff knowledgeable and friendly and accessible? Does the clinic want to see you annually for the rest of your life or do they only care about the first 90 days?  What is the success rate of the clinic as a whole?  What is the complication rate?  Is the office staff attentive, friendly and prompt in returning phone calls?  These are the questions you need to be thinking about as you choose a surgeon and clinic.  Surgery lasts one day... aftercare is forever. 

JOIN THE COMMUNITY -- I attended a local support group for 13 months before I had my surgery. Since the first meeting I attended I've only ever missed one meeting (and that was just a couple months ago). Find a support group -- whether it's peer-based or medical based -- and attend regularly.  Make friends and ask questions and listen to their advice. Also join an online community.  www.ObesityHelp.com is an excellent resource and support.  Get involved in your local state forum and make friends. Surround yourself with the people who understand what you're going through and know how to help you through the process. And stay surrounded.  Studies show that post-op patients who are involved in support group meetings are have a higher long-term success rate than those who are not involved.  

This is an exciting and terrifying journey. If you get started in the right direction from the beginning ... it will be less scary and more exciting. 

~Pam