When it comes to dropping weight, most everyone is looking for that magic pill. Ever since Carnie Wilson videotaped her miraculous gastric bypass surgery for public display on the Internet, it seems like anyone who has some weight to lose is jumping on the bandwagon.

But, the bandwagon has a load bearing capacity that’s just about maxed out, and it’s time for some folks to hit the trail. Starting in 2006, insurance companies are going to begin cutting coverage of this procedure due to the numbers of people who are taking advantage, and where they are not going to cut coverage, they are going to incorporate new restrictions to add to the already overwhelming list of limitations.

Why Gastric Bypass?

Gastric bypass surgery is not a weight loss strategy. It is a medical necessity for thousands of individuals who have a serious health condition related to severe obesity as well as a genetic predisposition to heart conditions of various kinds, and diabetes. It is a procedure for those people who are beyond trying all of the fad diets and exercise programs in order to control their weight, and therefore, their health. Because of genetics or something out of their control, they simply cannot lose weight.

Requirements

Due to its potential for complications, the insurance companies generally require doctors and patients to jump through a series of proverbial hoops in order to validate coverage, about 9 months worth of hoops, in most cases.

First, the prospective patient must fall into most of the following categories:

• Have a body mass index of 40 or more, or be overweight at least 100 pounds
•  Have a serious, life threatening or debilitating illness related to excessive obesity (i.e. high blood pressure, high cholesterol, heart condition, diabetes, etc.)
• Have a family history of heart problems, high blood pressure, diabetes, or high cholesterol, including parents who died early as a result of one of these conditions
• Have been obese for a minimum of 5 years
• Be between the ages of 18 and 65
• Not have a history of alcohol abuse, depression, or other major psychiatric disorder

The surgery is a serious one that could result in complications. So, it’s vital that the patient know what he or she is getting into. The second hoop they must jump through is a psychiatric evaluation, which discovers their motivation for dropping the weight – whether it is one of vanity or survival. It may also address the patient’s attraction to food, and determine whether there is an underlying emotional disorder or a history of abuse that causes them to eat.

In addition to a psychological evaluation, many insurance companies require group therapy. During group therapy, patients get to meet each other and see how other patients deal with their situations. There are a variety of patients present during these sessions – everyone from 260 pounds on up to those who cannot function without the use of a wheelchair. It is an extremely emotional environment, in which people share their deepest hurts related to being overweight, and the factors that caused them to become clinically obese.

Doctors may also require proof from the patient that they’ve made several attempts to lose weight. This may mean keeping a journal for several months, or attending weight loss groups such as Weight Watchers or Jenny Craig. Usually, this also means discussing your weight issues with your physician long before you ever mention gastric bypass surgery.

In addition to the psychological aspect, the physician is required to evaluate the patient’s medical history. They must perform upper and lower GIs to be sure that the patient is relatively healthy in other aspects besides high blood pressure, high cholesterol or diabetes.

What is Gastric Bypass?

Gastric bypass is a surgical procedure by which a surgeon will create a small pouch at the top portion of the stomach with a plastic band or surgical staples. Then this smaller stomach area is re-routed to the middle portion of the small intestine. This is the most common procedure, known as Roux-en-Y gastric bypass. What it does, ultimately, is allow food to bypass part of the small intestine, therefore causing fewer calories to be absorbed into the body. Fewer calories equals weight loss.

The incision is about 4 or 5 inches long, just as long as the surgeon's hand in the normal procedure. Another option, though not widely used as yet, is the laparoscopic approach, which uses much smaller instruments and a camera, therefore resulting in a smaller scar and possibly less complications. Generally, in either case, the scar is not significant compared with the obesity itself, or with any of the follow-up procedures to eliminate excess skin, such as a tummy tuck.

Depending on your size, you will need to lose at least 10 pounds right before the surgery. For a person who is 400-pounds plus, this is usually about 30 pounds of pre-op weight loss.

What is Recovery Like?

Following the surgery, a patient will be in the hospital for 4-6 days, given that there are no serious complications. That person will be expected to walk 1 mile within 2 hours of surgery as often as possible and remain sitting up from 8:00 a.m. until 8:00 p.m. while in the hospital bed. Considering the vicinity of the incision on the body, this is no easy task.

Weight loss starts at about 30-60 pounds within the first month, depending on the patient’s size. After that, it varies from person to person, but 20 pounds per month is to be expected, until the patient is at his or her pre-obesity weight.

The person will no longer be able to eat sugar, greasy, fatty foods, or drink caffeinated or carbonated beverages or alcohol, and only approximately three ounces of food or drink per sitting. Physical sickness (known as Dumping Syndrome) will result if the patient exceeds that quantity, eats too quickly, or eats the wrong foods. Over time, the person will get to know what his body can handle, and will learn to avoid those foods that result in sickness. The patient, however, will experience a miraculous change from their pre-operation sensation, one that may be entirely foreign to him – he or she will never feel hungry again, and at certain times, may not even be aware that he needs to feed himself. This could result in dizzy spells and headaches. At some point, however, the weight will level off; the patient will not become anorexic.

It is not unheard of that within the first month the need for blood pressure and cholesterol medications will no longer be needed, as the dramatic weight loss changes body chemistry quickly.

Other surgeries such as tummy tuck might be necessary to remove unwanted skin. Amazingly, insurance will only pay for the tummy tuck if you have at least a foot of skin to remove.

What are the Risks and Side Effects?

As with all surgical procedures, risks are imminent. However, with gastric bypass, they are not just possible, they are common. Risks and side effects include:

• Vitamin deficiency and anemia
• Infection in the incision
• Leaking from the stomach into the abdominal cavity or at the point where the intestine is joined
• Pulmonary embolism (blockage of blood flow within the lungs)
• Gallstones
• Osteoporosis
• Hernia
• Staples pulling loose
• Nausea, vomiting, hiccups, diarrhea, or bloating
• Death in 1.5% of cases

End Result

Patients will lose weight for many months following their operation. In most cases, their lives will be extended many years longer than they could have imagined prior to surgery. This is a miracle to those people who have gone through it.

Despite all the hoopla lately surrounding gastric bypass surgery, it is definitely not for the faint of heart. And those who are just looking for a quick fix to their weight problems will be sorely disappointed. But, gastric bypass, despite the controversy, the risks, and the long list of prequalification, is a life-saving procedure for those people who are suffering the malady of obesity with no other solution in sight. Let’s hope that the “quick fix” population doesn’t ruin this life-saving procedure for those who have no choice. Let’s hope that the insurance companies will continue to help pay for this procedure when a person’s survival is at stake.