Obesity Management Support Questions

Welcome to Obesity Management Support questions and answers. If you would like to submit your own question to be answered click here.

For more information on our Obesity Management Services please visit The Comprehensive Obesity Management Program.
 

I wanted to ask if their are any pills I can take that will allow me to lose weight instead of surgery?  I am 250 pounds and 5'5" tall. 

Moeinolmolki, MD. replies...

There are a few medications on the market that will help weight loss.  None of the medications have shown long term effectivity or consistency with degree of weight loss.  You need to be seen by a doctor to receive these medications.  The most effective one in the market is phenteramin. 

 

I feel I am in a conundrum.  I have a BMI of 41. A 6-month diet would put me below 40.  Would I end up disqualifying myself for WLS?  I have obstructive sleep apnea and depression but no other health problems.

Pat Stein, CMIS, Practice Manager replies...

To specifically answer that question we would need to check your insurance.  But you are correct that most insurance companies require either a BMI of 40 or between 35 and 40 with two co-morbidities.  Your sleep apnea would count as one, but the depression usually doesn't as it may be caused by something other than your weight.  My suggestion is that if you are truly interested in pursuing surgical weight loss I would start the process.  Sometimes as patients come through they do lose enough weight to "disqualify" themselves but they still complete the six month process as those offices visits are usually excepted by insurance for about 1-2 years.  If a patient completes the six months but no longer qualifies they sadly often regain enough weight when they stop seeing us to qualify again.  At that point we could use the six months that you had completed if it is still within 1-2 years.

 

I'm 63 and had a sigmoid resection and want to know if I qualify for weight loss surgery?

Dr. Liao replies...

It depends on your BMI (Body Mass Index). We would probably be able to do a bypass, but this also depends on why you had the sigmoid resection.

 

Under what circumstances would you recommend to a bariatric patient that they provide their own blood prior to the procedure for transfusions. If so, how much?

Per Dr. Liao, "Usual blood loss is less than 150 cc. well below the need for any transfusion. So, I would not offer to bank blood prior to bariatric surgery."  

Let me know if you have any additional questions.

Pat  Stein, CMIS
Practice Manager

 

I have had previous abdominal surgery. Lap choly and lap partial hysterectomy.  Does this previous abdominal surgery negate me from having the lap band procedure?

Per Dr. Liao, "No, prior lap surgery doesn't preclude a lap band. If there were any complications, bleeding need to open, then it could take longer."  

Please feel free to sign up for one of our information sessions at www.gbmc.org/bariatricsignup .  Once you attend the seminar and complete the new patient information packet, we will be able to make an appointment with one of our physicians.

Please feel free to contact me if you have any questions or need additional information. 

We look forward to assisting you with your weight loss journey.

Pat Stein, CMIS
Practice Manager

 
Can you scuba dive with a lap band?

Yes, you can certainly Scuba with Lap Band and you can even sky dive. There may be small fluctuation in the size of the band with regards to pressure. But most people are not eating or drinking while they are involved with those activities. Therefore it should not make a difference.

Moeinolmolki, M.D.

Babak Moeinolmolki M.D.
Greater Baltimore Medical Center
Advance Laparoscopic & Bariatric Surgery

 

Dr. Mo did my RNY surgery a little over 2 years ago.  I am now ready to start exploring plastic surgery and was wondering if there are any that are recommended by COMP.

The 2 plastic surgeons that COMP has been referring patients to for post-bariatrics surgery consultations are:  

Michele Shermack, MD
410-616-3000  

Larry Lickstein, MD
410-296-0414  

Our providers have personally met with each of these physicians and have been very happy with how they have continued to manage our patients' healthcare needs.  

Please let us know if there is any further information that you need.  Thanks again for your inquiry.  

 

I had to have my lap band removed due to slippage about 1 1/2 years ago. Will I be a likely candidate for a revision Gastric sleeve? What is the recommended BMI for revision surgery?

Thank you for your ask the expert question and for your interest in GBMC's Comprehensive Obesity Management Program.  Unfortunately, many patients do have band slippages.  Some patients opt to have the band replaced, removed, "tightened", or have full revision surgery.  The best option is on an individualized basis and the only way to assess this is through a consultation.  The key BMI numbers for this are still 35-40, however medical necessity is most important to an insurance.  For instance, you may have a lower BMI now however you band slippage could cause you more problems later on, thus an insurance company might cover the revision surgery at a lower BMI in order to prevent you from having future complications and co-morbidities. 

I think that the first step is attend one of our free information sessions.  You probably attended one of these before at your other surgeon's facilities.  Our session is designed to not only discuss the surgeries, but to "introduce" you to our program.  I think that this would be a good first step for you, as you would also be able to have a specific discussion with one our surgeons after the information session.  Revision surgery is just a tool--you need to be in the right program that will monitor your progression to ensure that the revision surgery has done its job.  Please five me a call, and I will be more than happy to speak with you further and/or register you for one of our free information sessions.  I look forward to hearing from you and assisting you.

 

What is the youngest patient on whom you operate?

Our surgeons will perform gastric bypass surgery on patients as young as 18 years of age. For patients under 20 years of age, the concern is that the patient makes the decision to pursue surgery on his/her own. It is very important for young patients to have full understanding and commitment to the altered eating pattern, which will be necessary for success.

 

Why do I have to have a psychiatric evaluation?

We do not believe that patients with weight problems are crazy! The most common reason you are required to have a psychiatric evaluation is because your insurance requires it. Also, if you are under a psychiatrist's care for any reason, we would like a letter of approval/disapproval of the weight loss surgery. What we are looking for from the psychiatrist is to evaluate the patient's understanding and knowledge of the surgery, complications and long-term care and the ability to follow the basic recovery plan. Very few people are disqualified by the psych evaluation; it is usually painless, and it may be very helpful to you in defining your goals and your decision for surgery.

 

What can I do to help the process?

First, help us to get all the information (diet records, medical records, medical tests) together in your case, so the carrier cannot deny for failure to provide "necessary" information. Letters from your primary care physician and consultations attesting to the "medical necessity" of obesity treatment are particularly valuable. When one or several physicians corroborate the necessity of obesity treatment, it will be hard for the carrier to contradict them. When the letter is submitted, call your carrier regularly (about once a week) to ask about your status. You may also be able to protest unreasonable delays through your employer or human relations/personnel office.

 

What is Dumping Syndrome?

Dumping Syndrome is caused typically by eating foods with high sugar or carbohydrate content on an empty stomach.  These substances produce a high osmotic load. Your body handles this by diluting the food particles with water, which reduces blood volume and causes a shock-like state. Sugar may also induce shock due to the altered physiology of your intestinal tract. The result is an unpleasant feeling causing you to break out into a sweat, turn pale white, feel butterflies in your stomach and a pounding pulse. This may be followed by cramps and diarrhea. This state can last 30 to 60 minutes, and it is quite uncomfortable - most people have to lie down until it goes away. It can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, is well tolerated at the end of a meal. Dumping Syndrome does not occur in patients who have the Gastric Band procedure because their intestines are not altered.

 

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