Why I'm choosing bariatric surgery: Obesity education
MultiCare's director of general surgery, Jennifer Yahne, is choosing to undergo bariatric surgery. You can read her first post, covering myths around the surgery, here.
Once I made the decision to move forward with bariatric surgery, my next step was to attend a surgical weight loss seminar.
Every new patient inquiring about bariatric surgery first goes to this seminar to learn more about obesity, surgical options and whether bariatric surgery is the right option.
MultiCare offers these seminars two to three times a month at various locations in the South Sound. I attended a seminar at MultiCare Allenmore Hospital.
Bariatric surgeons present the seminars — in my case, Hanafy Hanafy, MD, who has been performing bariatric surgery in this area for the past decade.
The session started out with education about obesity. Having spent the better part of almost four decades battling my weight, I thought I already knew plenty about obesity. What more was there to know?
It turns out there is a lot.
What is BMI?
The seminar starts by introducing an important concept, the Body Mass Index (BMI). This is a measure of body fat based on height and weight that applies to adults 20 years and older.
It’s true that BMI is an imperfect measure of a person’s obesity, because it is possible for a very muscular or athletic person to be classified as overweight or obese. However, it is the measure that insurance companies use to determine whether a person is eligible for bariatric surgery.
For better or worse, that makes it pretty important.
You can find calculators online to calculate your BMI. I like this one put out by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH).
Here is what my BMI calculation looks like (and for the record, I can’t believe I’m putting this out there, but I want to be open and honest):
Height: 5’ 5”
Weight: 244 lbs
Once calculated, BMIs are then categorized as follows:
Under 18.5: Underweight
18.5–24.9: Normal Weight
30–34.9: Class I Obesity
35–39.9: Class II Obesity
40+: Class III Obesity
Sometimes you also hear the term morbid obesity, which applies to a BMI of 35 or greater, and super obesity, which applies to a BMI of 50 or greater.
Confronting the reality
Until I decided to pursue bariatric surgery, I had been in denial about the reality of my struggle with obesity. I knew my weight. I even calculated my BMI on occasion. However, I hadn’t fully grasped that I was morbidly obese, nor had I confronted the potential impact it had on my health.
In 2000, the Journal of the American Medical Association (JAMA) reported that 365,000 deaths in the United States were related to poor diet and lack of physical activity. That puts it only second to tobacco in terms of cause of death.
In 2003, JAMA published another article stating that a non-smoking 40-year-old with a BMI of 30 or greater can expect to lose three years of their life on average.
My mother-in-law passed away when my youngest daughter was almost 3. Getting to know her granddaughter was so important to her. Why would I sacrifice time with my future grandchildren?
Obesity increases the risk for a host of conditions, including hypertension, diabetes, high blood fats, high cholesterol, sleep apnea, depression, arthritis, gallstones, infertility, reflux disease and several cancers, including colon and breast.
After a lifetime of near-perfect health, I recently went to my primary care provider for a routine physical and discovered that I have pre-diabetes.
I was already considering bariatric surgery at that point, but it served to confirm the threat my weight posed to my health is real.
Who qualifies for bariatric surgery?
The next topic covered in the seminar is insurance. Most health insurance plans like mine follow guidelines published by the NIH, which recommend that a person meet the following to be considered for surgery:
BMI of 35 –35.9 with two co-morbidities (e.g., diabetes, hypertension, sleep apnea)
BMI of 40 or greater
Outside of being pre-diabetic, I do not have any of the co-morbidities, but my BMI is more than 40, qualifying me for bariatric surgery.
It is important to distinguish between what a medical insurance company considers medically necessary for bariatric surgery versus what a physician might consider medically necessary.
For example, a surgeon might assess that a patient with a BMI under 35 but with a significant co-morbidity like diabetes would benefit from bariatric surgery. That patient would have to pay out of pocket for the operation, however, because the insurance company’s medical requirements were not met.
The NIH criteria were published in 1991, so they are quite old. Over the past 25 years, there have been many improvements in the safety of bariatric surgery, and the epidemic of obesity has increased dramatically. We now have a much better understanding of its impact on health.
These guidelines may someday be updated, but for now, they are still the criteria used by most medical insurance companies.
In my next piece, I’ll write about the rest of the seminar, including the different types of weight loss surgeries.