Obesity poses significant health risks, and if your Body Mass Index (BMI) exceeds 40, your life expectancy could be reduced by 15-20 years or more. Avera Weight Loss Clinic offers a comprehensive suite of services designed to help individuals achieve and maintain a healthy weight. With both surgical and non-surgical options, Avera provides personalized care, expert guidance, and ongoing support to empower patients on their weight loss journey.
Determining Candidacy for Weight-Loss Surgery
Typically, being 100 pounds overweight may qualify you for weight-loss surgery. However, body mass index (BMI) is a more accurate tool to evaluate a potential candidate. A BMI of 40 or more qualifies you for weight-loss surgery. Avera’s weight loss program considers several factors to determine if you are a suitable candidate for weight-loss surgery. Generally, individuals who are at least 100 pounds overweight or have a BMI of 40 or higher may be eligible.
Initial Steps
The first step involves attending one of Avera's surgical weight-loss seminars, available both in-person and online. Following the seminar, contact your insurance company to confirm that weight-loss surgery is a covered benefit. For those seeking financial assistance, Avera partners with Union Bank, a third-party loan program.
Comprehensive Evaluation
Most patients are self-referred or physician-referred. During your initial appointment, you’ll meet with a surgeon to discuss your medical history, expectations required after surgery and the pros and cons of surgical procedures based on your personal goals, needs and circumstances. You’ll also meet with a registered dietitian to assess your current nutritional status. Before your consultation, you must complete a detailed health and lifestyle assessment form for the surgeon and registered dietitian. Failure to complete the information prior to your first consult will delay the process. After meeting with a surgeon and dietitian, you will complete a psychological evaluation with a psychologist.
Team Assessment and Insurance Approval
Avera employs a multidisciplinary team approach to evaluate each patient's readiness for weight-loss surgery. The team includes surgeons, dietitians, and psychologists who collaborate to determine if you are physically and mentally prepared to be successful. Once our team agrees that you have the tools and motivation necessary to be successful, your information is submitted to the insurance company for approval.
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Surgical Weight Loss Options
Avera offers several advanced, minimally invasive surgical procedures that provide the tool you need to aid weight loss. Avera McKennan Hospital & University Health Center holds accreditation from the American College of Surgeons as a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Accredited-Comprehensive Center.
Roux-en-Y Gastric Bypass
“About 35% of the surgical procedures are the Roux-en - Y gastric bypass, done robotically or laparoscopically and those people spend about one night in the hospital typically,” said Dr. Thaemert. During this procedure, the stomach is stapled to make a smaller pouch. Then, most of the stomach and intestines are bypassed as the small stomach pouch is attached to part of the small intestine. This procedure can be performed robotically or laparoscopically, typically requiring a one-night hospital stay.
Laparoscopic Sleeve Gastrectomy
The laparoscopic sleeve gastrectomy is a surgery in which the surgeon removes approximately 85 percent of the stomach, shaping the remaining stomach into a tube or “sleeve.” This limits the amount of food that can be ingested at any given time without altering the normal absorption of vitamins and minerals. This minimally invasive resection of the stomach involves separating the greater stomach from the smaller part of the stomach. The opening between the stomach and the small intestine, known as the pylorus, remains intact, leaving behind a stomach in the shape of a tube or sleeve.
Lap Band Surgery
Lap band surgery takes approximately 30 to 45 minutes. After waking up, you’ll recover in the hospital for a few hours before receiving the approval to go home.
Risks and Considerations for Surgical Procedures
The bypass and sleeve gastrectomy procedures have a 1% risk of mortality. This risk is low compared to the risk presented by morbid obesity. Complications after surgery, while rare, may include bleeding, infection, a blockage or tear in the bowel, or the need for further surgery. Pregnancy is not recommended for at least 12 to 18 months after a gastric sleeve or bypass surgery.
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Non-Surgical Weight Loss Procedures
If you need to lose 30 to 50 pounds, consider one of our sophisticated non-surgical weight loss procedures. Avera McKennan Hospital & University Center in Sioux Falls, SD, offers several revolutionary non-surgical weight-loss procedures. During each of these minimally invasive procedures, a specially trained surgeon uses an endoscope, instead of an incision.
Endoscopic Sleeve Gastroplasty (ESG)
Endoscopic sleeve gastroplasty (ESG) is the latest development in non-surgical weight loss - available exclusively at Avera McKennan with Bradley Thaemert, MD, FACS. Thaemert creates a smaller stomach by inserting an endoscope into the stomach through the mouth and performing an accordion-link suture pattern, closing down the stomach from the bottom to the top and forming a sleeve. During this 60-minute procedure, Dr. Thaemert creates a smaller stomach.
ORBERA
As new procedures, ESG and ORBERA are not covered by health insurance. Pay with a Health Savings Account (HSA) or Flexible Spending Account (FSA).
Post-Surgery Care and Lifestyle Changes
Weight-loss surgery is just a tool, and therefore, requires lifestyle changes. Before surgery, we thoroughly explain that you must change your diet to include healthier food choices, portion control and eating in response to hunger cues rather than emotional cues. To maintain weight loss, your lifestyle changes of diet and exercise must be permanent. If you find yourself struggling to maintain your new lifestyle or if you regain some weight, contact us immediately for support. Do not allow negative emotions or shame to prevent you from reaching out for help.
Nutritional Guidance
Your post-surgery diet is the most important element for your weight loss success. That’s why you’ll receive the guidance of a registered dietitian. Immediately after surgery, you begin a special diet of mostly liquids, gradually increasing to your normal diet. Your first meal after surgery will be clear liquids (water, broth, sugar free Jello, etc.), sipping on approximately 1 ounce every 20 minutes. If you received the lap band, you should be able to eat about a cup of food over 30 minutes after about four to six weeks. Eating out within the first couple of weeks after surgery should be avoided. It can be tricky, so knowing what’s on the menu and planning your meal beforehand is helpful. We recommend a protein and a carbohydrate, such as a fruit or vegetable. Restaurant portions are large, so take home at least half of your meal. A card from your surgeon even allows you to order half portions from the menu.
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Recognizing Hunger Cues
There are two types of hunger: head hunger, where you see and smell the food, and physical hunger, where there is an actual feeling of hunger. Listen to your body for physical hunger cues.
Multidisciplinary Support Team
Avera offers a full team of experts ready to guide you for lifelong success. The team includes dietitians, psychologists, nurses, pharmacists, doctors, health coaches and physical therapists. After bariatric surgery, you benefit from ongoing follow-up appointments, mostly for counseling. During this time, you can discuss challenges and receive the professional support you need to help you maintain weight loss.
Psychological Support
Surgery is often the easy part, but it is the lifestyle changes that can be very difficult. The psychological assessment is required and will occur following your initial consult with the surgeon. It will provide you and your surgeon with a valuable objective determination as to whether you are ready to make lifestyle changes.
MyWeighForward Health Plans
With MyWeighForward health plans, you’ll have access to health coaching and weight loss medications that can help you be successful long-term. These plans are now available in all networks, through on-exchange (through Marketplace.AveraHealthPlans.com) and off-exchange. MyWeighForward individual and family plans offer the same comprehensive coverage of our plans but with added benefits for those who need coverage for weight loss services and medications. Work with health coaches through several paths based on your needs. Employers who want to promote long-term health for their employees can offer the MyWeighForward plan for those who need coverage of weight loss medications. These plans offer the same comprehensive coverage of our Direct Network plans. Our programs promote healthier lifestyles and happier, more engaged teams. Employees will have access to health coaching through a number of programs based on what is best for their needs to help sustain a healthy lifestyle long-term. Boost your team’s health and productivity with MyWeighForward plans. You must live in Brown, Minnehaha and Lincoln counties of South Dakota to sign up for a MyWeighForward plan.
Coaching Program
Following your intake, you will be assigned to a service based on your needs. This may include a health coach or nurse. You must complete one coaching session monthly with your health coach or nurse. You must meet with the coach once monthly for coverage of weight loss medications to continue. You may be assigned weight management medications as part of your coaching.
Medication and Step Therapy
Avera Health Plans follows step therapy. Step therapy uses the most cost-effective and safest drug available for a specific medical condition. To receive step therapy drugs, your provider must prescribe certain drugs before trying others. A GLP-1 medication would be considered a step 2 drug and your prescriber would try step 1 options first. If you are currently prescribed a GLP-1 prescription, your provider can submit a preauthorization request to Avera Health Plans. You can participate in a coaching program through several venues. You’ll work with your health coach to create accountable goals and assess progress every month. If you miss a meeting and cannot reschedule it within the month, you must watch an online video and follow up with a health coach or nurse to confirm you viewed the video. Three attempts will be made to reach you after missing a meeting. At that time, you will be sent a closure letter.
Comprehensive Coverage
Not all plan members need to use the weight loss services and coverage. The MyWeighForward program includes comprehensive coverage for preventive, emergent and other services.
Personalized Approach and Additional Services
Losing weight is personal, and it requires a personalized approach. At Avera’s weight loss clinic in Sioux Falls, SD, our team empowers you to achieve your goals with losing weight to help you look better and be healthier. When you visit our clinic, we’ll take time to go through your personal health situation and explain your options. Many patients see improvement in their health with as little as 5-10% weight loss (10- to 20-pound weight loss for a 200-pound person). We want to help you win big with small successes! We partner with your existing primary care provider or care team, and together we can address conditions often connected with a higher body weight. In partnership with the Avera McKennan Laboratory Genetics team, providers at this clinic can use the GeneFolio Vitality test. An analysis of your genes provides guidance on fitness and nutrition planning to help you meet your weight management and well-being goals.
Optimizing Health Before Surgery
We have a team of medical providers who will help you get physically healthier before surgery. Decreasing your health risks prior to surgery promotes the best outcomes possible. You will have blood work completed, recommendations will be made regarding vitamins and mineral supplementation, work on pre-surgery weight loss, and work on improving any chronic health conditions that you might have. The amount of time that you will work with this team varies greatly but you can anticipate this process taking several weeks to months prior to surgery.
Support Groups
Support is essential to long-term weight loss success. You, and your family and friends, are invited to join a weight-loss support group. Each month, a speaker will present a topic relevant to weight loss. Speakers may include fitness professionals, dietitians, psychologists, plastic surgeons and patients who have already had a weight-loss surgical procedure. You can also share weight-loss experiences, encourage one another and ask questions.
Insurance Approval Assistance
Getting insurance approval for weight-loss surgery can be a long and challenging process, but we’re here to support you. Ask for the criteria that your insurance company requires to approve/qualify a person for surgery. Provide your insurance company with any previous documented weight loss attempts, a psychological evaluation and a meeting with a dietitian. Be your own best advocate - even after your surgeon submits all of your information to the insurance company for surgery approval. You may also be able to take advantage of tax deductions to help with the cost.
Success Stories
Numerous patients have experienced great success in losing inches and pounds through gastric sleeve and Roux-en-Y gastric bypass procedures. “I’m down 130 pounds from my highest,” Mehlhaff said. Her successful weight loss is thanks to bariatric surgery. “We had talked about weight loss surgery off and on and I didn’t know if I wanted to go down that route, so then I thought maybe I need to have those conversations and start meeting with the team. I’ve always heard great things, so I made an appointment.