Do I qualify for bariatric surgery?

People with a body mass index (BMI) between 35-40 who also suffer from comorbid conditions such as heart disease or type 2 diabetes, and people with a BMI over 40 without cormobidities, qualify for some form of bariatric surgery. To learn more about bariatric surgery through COMP, attend a free Bariatric Surgery Information Session.

Will my insurance cover bariatric surgery?

Insurance coverage is complicated. Check with your insurance company to find out if your bariatric surgery would be covered under your insurance plan. An insurance form is provided in your Patient Registration Packet. The first step is to attend a free Bariatric Surgery Information Session.

How can I learn more about bariatric surgery?

GBMC holds free Bariatric Surgery Information Sessions two Wednesdays per month from 5:30 to 7:00 p.m. in the Civiletti Conference Center located in the East Pavilion on the GBMC campus, 6701 N. Charles Street, Towson, MD 21204. We also offer one Saturday morning session each month, from 10:30 a.m. -12:00 p.m. Parking is available in the Iris Parking Garage that is right next to the East Pavilion. Sign up for a free Information Session.

What is the age range for patient on whom you will operate?

Our surgeons will perform weight loss 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.

Patients over 65 years of age require very strong clinical indications for surgery and must also meet the Medicare criteria for bariatric surgery, which are very stringent. The risk of surgery in this age group is increased, including the risk of mortality. In many cases, this argues against the surgery. However, weight loss surgery can be indicated and successful in patients over 65, and individual consideration will be given.

How long does it take to schedule weight loss surgery?

Surgery can be scheduled usually within 4 to 7 months of your initial visit. Insurance approval is a pre-requisite for all people. Insurance companies require a certain number of consecutive months' participation within the COMP program to qualify for coverage. Once you have completed the requirements for both insurance and your surgeon, you will be scheduled for a final appointment. You surgery date will be established at this final appointment.

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.

How can an insurance company deny coverage for a life threatening illness?

Coverage may be denied because there are specific exclusions in your policy for obesity surgery or "treatment of obesity," which is a manifestation of the attitude of our society toward obesity and the discrimination that people of size suffer. Such exclusion can often be attacked by reasoning that the surgical obesity treatment is recommended as the best therapy for the co-morbidities, which usually are covered. Coverage may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity alternative treatments are considered to exist - according to conventional wisdom - dieting, exercising, behavior modification and some medications. Usually, medical necessity denials hinge on the insurance company's demand for some form of documentation, such as 1-5 years of physician-supervised dieting or psychiatric evaluation. The best approach to these demands is to try and produce reasonable information.

Does Laparoscopic surgery decrease the risk?

No. Laparoscopic operations carry the same risk as the similar procedure performed as an open operation. The benefits of laparoscopy are typically less discomfort, shorter hospital stays, earlier return to work and much reduced wound complication and scarring.

How long does the operation last?

Typically, gastric bypass and sleeve surgery requires 2 to 3 hours in the operating room. If your family will be waiting, they should understand that the operation might not begin immediately, so they should not watch the clock. If the operation is lasting longer, the doctor may be able to send a message to the waiting party. Gastric banding typically takes one hour.

Will I have a lot of pain?

The surgeons and the Pain Management Staff will try very hard to control pain after weight loss surgery to make it possible for you to move about quickly and become active. This helps to avoid problems and speeds recovery. There are various drugs that can be used via a system called Patient Controlled Analgesia (PCA). This is an intravenous medication dispensed through a pump, which allows you to push a button and give yourself pain medication on demand, whenever you need it. Most of the patients are pleasantly surprised at how little discomfort they experience after laparoscopic surgery.

How soon will I be able to walk?

Patients will be able to walk almost immediately after surgery. Patients walk or stand at the bedside on the night of surgery and take several walks the next day and thereafter. On leaving the hospital, you will be able to care for all of your personal needs; however, you will need help with shopping and transportation.

When can I return to work?

On average, our patients return to work within two to four weeks. This is mostly dependent upon the nature of their jobs, as we have seen patients return after just one day of rest and others who need up to six weeks off because their jobs require heavy lifting.

How soon can I drive?

It is recommended that you do not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. This is for your safety and the safety of others on the road. Usually this takes several days after surgery.

When can I leave the area?

Patients who come from outside the Baltimore area for obesity surgery arrive the day of the surgery. There are local hotels you can stay in the night before surgery. You can have one support person stay in the room with you post-operatively on Unit 48. Typically, you will be discharged on the second post-op day or third day if you count the day of the surgery. Therefore, you will need transportation at that time.

For the first six weeks post-operation, it is advised not to drink carbonated beverages. Some patients try carbonation after six weeks, and it still gives them a problem such as feeling uncomfortable from the gas produced. Some patients are able to drink sugar-free carbonated beverages. However, it is recommended not to drink any beverages one hour prior to eating a meal and one hour after eating a meal.

Is pregnancy a possibility after weight loss surgery?

It is very important not to get pregnant for the first year after weight loss surgery. During this time there could be a high risk (up to 90 percent) of miscarriage due to the inability of the fetus to obtain all the required nutrients. Other forms of birth control will be necessary during this time. It has been reported that hormonal-based birth control is ineffective for the first 18 months. That would include birth control pills, injections and implanted hormones. After the first year post-operatively, studies indicate that normal pregnancy occurs without any complications.

Do I have to attend support group meetings?

It is highly recommended that you attend the support group meetings. You would be surprised how helpful it is to listen to the experiences of other people in the same situation. Many questions will arise along the way, and the best way to get them answered is by the people who have had the same experience. Various emotions will accompany the changes experienced, and it is important to process this in a group with others. Remember for some people isolation was part of being morbidly obese, and the support group will ensure no one is alone.

If I lose all this weight, how will my life change?

Of course, we can't predict exactly how your life will change after losing 100, 150 or 200+ pounds. That old motto, "everyone is an individual" is wise and true! We can ASSURE you that your life WILL change, and the changes are very likely to be quite dramatic!

Over the last two years that we have monitored our patients, we find some of the major changes to be:
Improved physical status (for example, blood pressure, blood sugar and respiratory regulation), more energy, less body aches and pains, improved sleeping
Improved psychological status, including decreased depression, improved self-esteem, improved social skills, more confidence and realistic hope for the future
Changes in relationships, including family, love relationships, friends and co-workers
In general these changes are positive and exciting. They are also demanding. In order to participate fully with the program, patients must really put their own health care choices first. This is very often a change for our patients since many have felt depressed and hopeless; they have given their own lives the lowest priority. Our patients have to learn to make assertive, healthy decisions for themselves, even when these decisions upset their loved ones. For example, they may choose to go on their exercise walk instead of sitting down and eating pretzels, OR they may have to deal with their spouse's jealousy or discomfort when they become increasingly independent.

Patients undergo incredible changes in how they see and feel about their bodies. Losing 100 or more pounds creates drastic changes in body size, appearance and related areas, such as dressing choices and feelings of being attractive and sexy. Accepting normal body image is sometimes a major challenge for weight loss surgery patients! Even though wearing a size eight dress may be a lifetime goal, some patients require some adjustment time to accept this reality, sometimes still "feeling fat" or worrying that they will gain weight back. We find that as more time passes and patients learn to become experts in managing the program guidelines with their individual lives, they experience more real success, and the new healthy body image becomes more comfortable and reliable.
Greater Baltimore Medical Center | 6701 North Charles Street | Baltimore, MD 21204 | (443) 849-2000 | TTY (800) 735-2258
© 2015  GBMC. This website is for informational purposes only and not intended as medical advice or a substitute for a consultation with a professional healthcare provider.