Bariatric surgery, encompassing procedures like gastric sleeve and gastric bypass, can be a transformative investment in one's health. It presents an opportunity for individuals to regain control of their well-being and has demonstrated the potential to significantly improve overall health. However, like all surgical interventions, bariatric surgery carries inherent risks. Bariatric surgeons and hospitals meticulously assess these risks before approving a patient for the procedure. This careful evaluation is paramount, as it ensures that a patient's health is not unduly jeopardized. Understanding these risks and having confidence in a team of healthcare professionals are crucial aspects of the bariatric surgery journey.
Factors Influencing Qualification for Bariatric Surgery
Numerous factors are taken into account by doctors and healthcare systems to determine a person's eligibility for bariatric surgery. There are instances where a doctor may deem it imprudent to proceed with the procedure.
Health Considerations
As bariatric surgery is a major surgical undertaking, patients must possess sufficient health to withstand the operation. Individuals with uncontrolled diabetes, blood clotting disorders, heart-related issues, or impaired healing capabilities may face a heightened risk of complications. Those with severe respiratory ailments or autoimmune diseases may also be at increased risk. In certain situations, a specialist's clearance may be required based on the patient's overall health. If such clearance is not granted, bariatric surgery may be deemed unfeasible.
BMI Cutoff
It is crucial to note that most surgeons establish a Body Mass Index (BMI) threshold. Individuals with excessively high BMIs face an elevated risk of complications from the procedure. While specific limits vary among centers, many restrict the procedure to individuals with a BMI of 65 or lower.
Surgical History
Patients with a prior surgical history may encounter challenges in accessing care. Those who have previously undergone bariatric surgery may be disqualified from certain types of revisional surgery. Doctors will meticulously review a patient's medical history to identify any potential risks.
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Age Considerations
Most doctors and medical centers include age extremes as disqualifying conditions for bariatric surgery. Individuals under 18 years of age, even with parental consent, may be prohibited from undergoing the procedure. Age can introduce specific risks, particularly in older individuals. While there’s no specific limit to the age of a patient for gastric surgery.
Psychological Evaluation
Bariatric surgeons typically conduct a thorough assessment of a patient's psychological history to determine their suitability for the procedure. Candidates generally need to demonstrate the capacity to cope with the emotional adjustments that accompany restricted eating. A psychological evaluation is a standard component of the bariatric surgery assessment process. Mental health plays a significant role in post-surgical success. Conditions like binge eating disorder or bulimia can affect weight loss surgery outcomes. If mental health conditions are not well-managed, they can interfere with post-surgical recovery and long-term weight management.
Overcoming Limitations
In situations where limitations exist, doctors or medical providers may be willing to collaborate with patients to address these issues. For instance, they may prescribe a strict diet to facilitate weight loss before the procedure.
Insurance Coverage
One of the most significant obstacles in accessing bariatric surgery stems not from medical professionals but from health insurance providers. Bariatric surgery is frequently denied to those who need it most because their insurance company either does not cover it or does not recognize it as a legitimate need. Occasionally, insurance can deny your claim based on clerical errors, so ensure that you apply with all the proper information.
Alternatives to Insurance Limitations
Alternatives exist for navigating these limitations. Seeking care from reputable bariatric specialists in Mexico, such as Renew Bariatrics, can provide access to high-quality care at a fraction of the cost. The quality of care, procedures, and expected outcomes are comparable.
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Factors Leading to Rejection in Bariatric Surgery Candidates
To determine the factors affecting rejection of bariatric candidates at an accredited, American College of Surgeons Level 1A, bariatric program. Bariatric surgery "Centers of Excellence" use a multidisciplinary team to screen patients for eligibility for surgery using insurance, medical history, psychological evaluation findings, and the surgeon assessment. From March to September 2007, 299 consecutive patients were accepted for evaluation into an accredited bariatric program and tracked for the incidence of rejection for weight loss surgery. Of 299 screened patients, 90 (30.1%) were not accepted for surgery by the multidisciplinary team. The most frequent reason was the lack of insurance coverage (47.8%). Approximately one third of screened patients were not accepted for surgery by an academic bariatric program. Self- or social referral appeared to correlate with rejection because the BMI did not meet the criteria for surgery. This suggests inadequate information among social referral networks and/or in the media.
Medical Conditions
Bariatric surgery is a major procedure, and patients must be in relatively stable health to undergo it safely.
Heart Conditions
Severe heart conditions, such as congestive heart failure or recent heart attacks, can make surgery too dangerous.
Respiratory Issues
Conditions like chronic obstructive pulmonary disease (COPD) can increase the risk of complications during and after surgery.
Diabetes Management
While bariatric surgery often helps improve diabetes, poorly managed blood sugar levels can increase surgical risks.
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Blood Clotting Disorders
A history of deep vein thrombosis (DVT) or other clotting disorders can increase the risk of post-surgical complications. Smoking can increase your chances of complications. The reason is that nicotine restricts blood vessels.
Addiction
Ongoing drug or alcohol addiction can disqualify a patient because it increases the risk of complications and affects the ability to maintain a healthy post-surgical lifestyle.
Unrealistic Expectations
Bariatric surgery is not a quick fix. Patients who expect immediate results without lifestyle changes may not be approved. Bariatric surgery requires strict post-operative guidelines. Weight loss surgery is just one part of the journey.
Program Requirements
Many bariatric programs require multiple consultations, nutritional counseling sessions, and psychological evaluations.
Smoking
Smoking increases the risk of complications such as blood clots, infections, and poor wound healing.
Pregnancy
Women who are currently pregnant or planning to become pregnant shortly after surgery may need to postpone the procedure.
Navigating Insurance Denials
Frequently, we may be quick to blame the insurer for lack of coverage. It is important to make a clarification. In order to provide coverage for their employees, companies must purchase a “rider” for weight-loss (bariatric) surgery coverage. In this circumstance, where the company has elected to provide coverage, the insurance company now applies their standard criteria to those seeking surgery. If the employer has coverage and you meet the criteria on the plan, you are approved, right? The good news here is if your employer is self-insured with a bariatric surgery benefit and you have documentation, you meet all of the criteria on the plan and you are denied, they do not have a leg to stand on! Ask your surgeon’s office to arrange a “peer-to-peer” review. As an alternative, you may also ask the human resources director at your company to intervene on your behalf. Whatever you do, please, please do not hang your head and say, “Oh, it just wasn’t meant to be” or “God must not have wanted me to have surgery.” Please do not give the insurer that power because they will surely take it. If your employer is self-insured but they do not have a bariatric surgery benefit, please visit the OAC Web site. There, you can find a fact sheet titled, “Why it makes sense to provide treatment for obesity through bariatric surgery.” This fact sheet is designed for you to share with your employer, insurance provider, elected officials and others. It provides in-depth information on the benefits of weight-loss surgery. All of that research you’ve done on bariatric surgery? Take it too. Make sure your decision makers are informed. The majority of standard insurance plans sold to businesses do not have bariatric surgery benefits included. For smaller businesses that are not self-insured, they pay a set amount of money per employee to the insurance company; the money goes there and stays there regardless of how much is paid in claims. In most states, these small companies have no access to purchase an insurance plan that provides bariatric surgery coverage. The long-term solution is to advocate for access to care. Advocacy can often be intimidating to an individual who has never advocated for a cause; however, the OAC has made advocating to your elected officials for coverage of weight-loss surgery extremely easy. The OAC’s Legislative Action Center is designed to help you advocate to your elected officials (capwiz.com/obesityaction/home). Simply type in your zip code and you’ll instantly have access to all your elected officials’ contact information. While you are advocating for future coverage, it may not be enough to help you in your immediate goal to have surgery. In this instance, do your research; locate a Bariatric Surgery Center of Excellence program and surgeon that offer a comprehensive program at a reduced self-pay (cash) rate that includes coverage of complications or readmissions through the BLIS program (www.bliscompany.com). You and your employer will both benefit from you being a healthier and more productive employee and you do not have to go through your insurance company. Unfortunately, these statements are not uncommon in today’s world of navigating one’s insurance policy. Each day, hundreds of individuals are denied access to bariatric surgery. One of the most impactful messages that can be sent to an insurance provider, employer or elected official is a message from someone who was affected by obesity and received weight-loss surgery.
The Impact of Denied Surgery
Boston - More than 300,000 Americans die each year from conditions associated with being overweight or obese, including diabetes, high blood pressure, arthritis, heart disease and sleep apnea. To date, metabolic and bariatric surgery (MBS)-with metabolic surgery defined as weight loss surgery as targeted treatment for diabetes-has proven to be the most effective means of losing weight and keeping it off over the long term. To learn what happened to patients denied weight loss surgery, physician-scientists at Beth Israel Deaconess Medical Center (BIDMC) followed up with 107 patients who were denied the procedure in 2007. The team found that most patients who were initially turned away eventually obtained bariatric surgery, experienced improved overall health and were still living at 12- year follow up. However, 40 percent of those denied surgery in 2007 who never underwent the procedure were deceased by 2019. “Denying patients seeking bariatric surgery was a death sentence for nearly the 40 percent of patients who never obtained a metabolic operation after initial denial,” said senior author Daniel B. Jones, MD, Chief of Minimally Invasive Surgical Services and Director of the Bariatric Program at BIDMC. Using a database of patients maintained by an accredited academic bariatric program, Jones and colleagues identified 107 patients denied metabolic and bariatric surgery in 2007. A total of 64 patients consented to participate in the follow-up survey or were found to be deceased. The team found that of the 64 patients initially denied MBS, 29 of them ultimately underwent weight loss surgery. Meanwhile, of the 35 patients who never underwent weight loss surgery, 14 were deceased at 12-year follow up. “Ultimately, this sheds light on the presumed costs of treating patients with morbid obesity over the long terms with surgery versus medical treatments,” said Jones.
Hope and Alternatives
If you’ve been told you don’t qualify for bariatric surgery, don’t lose hope. In many cases, patients can take steps to become eligible. If you are denied for gastric bypass surgery or gastric sleeve surgery, do not give up. The reasons you may be denied at the present moment could change in the future.