The ABCs of weight loss surgery

With so many interventions being promoted for weight loss these days, it’s difficult to know which ones really work. Overweight and obese people desiring to lose weight are finding there are as many voices touting different weight loss methods as there are religions claiming the truth.

So in this and a series of upcoming articles, I’ll be tackling some important weight loss topics. These will include weight-loss surgery, psychology, diet, supplements, hormones that must be balanced, the hCG weight loss method, lab tests to consider and more. Hopefully this will help to provide some clarity to the subject.

The topic of how to lose weight and keep it off remains a hot one. Why? I believe it is because there are so many different methods, such great variability between individuals and such a dearth of doctors schooled in the subject.

In the doctor’s office, the discussion about how to lose weight typically doesn’t go very far, and there aren’t enough bariatric doctors to see all the patients who are overweight or obese. Clearly we are not taught this in our medical training, plus we know it takes a great amount of hand-holding and psychology (i.e. medical coaching) to get good results. I define results of weight loss by how much a person loses and how long they remain healthy and thinner afterwards. But today, two out of every three adults in the U.S. are overweight. For this reason, I have long had an interest in the subject of weight loss.

Obesity is the most prevalent health condition of all, and it is associated with an increased risk of many secondary illnesses that cause suffering or even early death. Yet, despite the existence of evidence-based guidelines, the proportion of primary care physicians who actually take the time to learn about it and then take time with patients to implement counseling or treatment strategies is very low.

What about weight loss surgery (bariatric surgery)?

There are now several different gastric bypass procedures available. They not only treat obesity, but also type 2 diabetes, high blood pressure, sleep apnea and other associated suffering caused by obesity (arthritis, depression, back pain, etc.). They all quite effectively reduce the stomach size (so you feel full quickly and don’t eat so much) and change the way food gets digested (to reduce food calorie absorption).

The four common weight loss surgical procedures are:

• Roux-en-Y gastric bypass: Done via the laparoscopic method, a small pouch is created at the top of the stomach so you cannot eat much food at one time. This small pouch is connected to the small intestine to allow food to flow, while the lower portion of the stomach is left to secrete digestive juices by being attached to the small intestine downstream in a second connection.
• Laparoscopic adjustable gastric banding (Lap-band): A band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place, creating a small stomach pouch above the band. A narrow opening is left to the rest of the stomach. A port where fluid can be injected is then placed under your skin on your abdomen, which is connected to a tube that goes to the band, allowing you to adjust the band size. It thus restricts the amount of food you’ll eat, much like gastric bypass. It doesn’t reduce food absorption.
• Sleeve gastrectomy: (the best option): Part of the stomach is cut out to form a tube-like shaped stomach which cannot hold much food. Another beneficial effect is that this largely cuts out the amount of ghrelin secretion (an appetite-regulating hormone), thus lowering appetite. It doesn’t affect the absorption of food in the intestines.
• Duodenal switch with biliopancreatic diversion: A large part of the stomach is cut out as with sleeve gastrectomy, but with some special re-routing of intestines so that food bypasses most of the small intestine (limiting food absorption), while bile and pancreatic digestive juices are allowed to be present for proper digestion.

Costs and drawbacks to bariatric surgery

The cost of gastric sleeve surgery typically comprises of anesthesia fees (yes, anesthesiologists are one of the highest paid specialties in medicine), operating room fees, surgeon fees, lab and X-ray fees and follow-up appointment fees. Some good news is that prices are generally dropping to because of competition and increased demand.

With this in mind, you can expect an uncomplicated Roux-en-Y to range from $25,000 to $35,000 or more. The lap-band and duodenal switch with biliopancreatic diversion procedures both cost between $17,000 and $25,000. The sleeve gastrectomy (my favorite) averages $15,500, but a range has been reported of from $9,500 to $24,000 depending on where you go. You can read reviews from patients who had gastric sleeve surgery at realself.com.

Does insurance pay for it (minus deductible and copays)? It all depends on your insurance. With the Affordable Care Act (ACA) confusion, such as whether you will or not have pre-existing condition clauses, you’ll simply have to explore this for yourself with the physician and insurance company.

First, get the billing code from the surgeon. For example, a billing (CPT) code for the Roux-en-Y gastric bypass is 43846. If your insurance company says that code is not covered, then ask about similar codes or procedures that are.

A bariatric surgery alternative

You should know about an alternative to bariatric surgery that can give quite a similar end result–but without going under the knife–and at a very reasonable price. It is a safe powder you consume that is touted to create an immediate gastric bypass effect of limiting your stomach space for 10-16 hours.

When done daily for three to six months, you can expect your stomach to shrink. During that time you can change your brain’s chemistry that controls unhealthy food cravings and work toward adopting healthy eating habits.

This formula by Roca Labs contains beta glucan that is known to lower cravings for sweet and snack foods, lower cholesterol and blood pressure, and balance blood sugar levels. The Roca Lab company boasts a 90 percent success rate (from their website), and the cost is only $480 (with insurance) or $640 full cash price. You’ll have to maintain your new improved dietary lifestyle just like it is required following bariatric surgery if you plan to keep the weight off. Learn more at www.gastric-bypass-alternative.com/.

In my next article I’ll discuss the mindset and passion required for successful permanent weight loss.

To feeling good and living in peace,

Michael Cutler, M.D.

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