• Why is weight loss surgery the right choice for some people?
• Who should consider weight loss surgery?
• What are the options in weight loss surgery?
• If you are interested in weight loss surgery, what is the next step?
• Will insurance pay for the surgery?

Q. Why have weight loss surgery?

A. Being too heavy is a major source of health problems in the United States. People who are more than 100 pounds overweight have an increased risk of having high blood pressure, diabetes, heart disease, severe arthritis, sleep apnea, and gastroesophageal reflux. This translates into a shorter life span with a lower quality of health for the overweight. As well, being more than 100 pounds overweight in our society has a tremendous social effect on people, and often results in a lower quality of life due to limitations in their activities and social discrimination. It has been demonstrated in scientific studies that if people lose this excess weight and keep it off, their health improves and they live longer.

Q. Who is a candidate for weight loss surgery?

A. Weight loss surgery is only considered if your body mass index (also called BMI) places you at risk for increased health problems. BMI is calculated by dividing your weight in kilos by the square of your height in meters.

If your height is	Your BMI is greater than 35 if your weight is more than	Your BMI is greater than 40 if your weight is more than
5 ft 2 in	190 lbs	220 lbs
5 ft 4 in	205 lbs	230 lbs
5 ft 6 in	215 lbs	245 lbs
5 ft 8 in	230 lbs	260 lbs
5 ft 10 in	240 lbs	275 lbs
6 ft	250 lbs	285 lbs

The National Institute of Health states that you should consider weight loss surgery if you have

1. a BMI  greater than 35 with associated medical problems or
2. a BMI greater than 40 and
3. have been unsuccessful at long-term sustained weight loss through diet and exercise programs

Diet and exercise alone rarely result in long-term sustained weight loss in people with a BMI over 35. However, weight loss surgery leads to successful long-term weight loss in more than 98% of our patients

Q. What is weight loss surgery?

A. Weight loss surgery includes many different operations that work in different ways. All bariatric surgeries can be done both "open" through a large incision, or "laparoscopically" through incisions that are less than one inch long. Bariatric surgery procedures are described as either restrictive (meaning they reduce the amount of food you can eat) or malabsorptive (meaning they let the food you eat pass through the intestine without being absorbed).

Laparoscopic Gastric Bypass is the most common procedure weight loss surgery performed in the United States. The Roux-en-Y gastric bypass (also known as RNY or proximal gastric bypass) is primarily a restrictive operation. It offers the benefit of limiting food intake with a restrictive component, the hormonal benefit of bypassing the duodenum, and the discouragement of unhealthy food choices from their effect on the Roux limb (aka dumping). The laparoscopic approach has been shown to be superior to the open approach with less pain, fewer wound problems, faster return to normal activity and smaller scars.

Laparoscopic Adjustable Gastric Banding is a purely restrictive procedure. It offers the benefit of limiting food intake with a restrictive component which is adjustable by inflating or deflating the band by injecting saline into a reservoir under the skin. There are two different bands available in the US: the LapBand and the REALIZE band.

Laparoscopic Sleeve Gastrectomy is a relatively new weight loss surgery procedure. It offers the benefit of limiting food intake with a restrictive component plus likely has a hormonal benefit associated with partial stomach removal.

Q. Is weight loss permanent after surgery?

Weight loss after successful gastric bypass has been shown to be stable over ten years, with slight weight regain similar to the weight gain seen by other people who haven't had weight loss surgery over ten tears.

Q. I know someone who had weight loss surgery and never lost very much weight. Does that mean that most patients never lose very much?

A. Almost everyone will have successful weight loss after laparoscopic gastric bypass. On average, our patients have lost 70% of their excess body weight in the first year after surgery.

All weight loss surgeries have some patients who don't lose very much weight, often

because the surgery they chose wasn't right for them or because the surgery wasn't done very well. Sometimes patients fail to lose much weight because of inadequate nutritional education before surgery. And sometimes people are unhappy with their weight loss because they are given unrealistic expectations before surgery.  This doesn't mean that you can't be successful if you have the right surgery performed well.

Q. I know someone who had successful weight loss surgery but gained it all back. Does this happen to everyone?

A. No, most patients have sustained, long-term weight loss after laparoscopic gastric bypass.

There are many reasons that people regain weight after initially losing weight with the help of surgery. The traditional "stomach stapling" called Vertical Banded Gastroplasty or VBG was often successful in the first year, only to have the staple lines open up later leading to weight regain. Even with gastric bypass, there are some surgical techniques which lead to a higher incidence of anatomic breakdown after the first year, leading to weight regain.

Q. Why come to the Institute for Laparoscopic Surgery for weight loss surgery?

A. We think our practice is unique because:

• We have been performing laparoscopic weight loss surgery in the Puget Sound area since 1999.
• We offer a laparoscopic approach to all our patients. 
• Our strict attention to detail and proper surgical technique including transection of the stomach, making a long, thin stomach pouch using  the "lesser curve" of the stomach, and using a hand-sewn technique to construct an 11 mm opening from the pouch to the small intestine results in above average weight loss for our patients.
• Our continued practice in advanced laparoscopic general and colo-rectal surgery keeps us current in new techniques in minimally invasive surgery while maintaining our expertise in bariatric surgery.

Q. I am interested in weight loss surgery. What is the next step?

A. Telephone our offices at (425) 453-7888. If you are ready to move ahead with surgery or if you simply want to get more information, you can start with an office consultation with one of our bariatric surgeons. If you don't feel ready to move ahead with a consultation but want to gather more information about weight loss surgery, we can schedule you to attend a free informational seminar.

Q. What will happen at the consultation?

A. You will meet your surgeon face to face, have a history and physical, review the indications and outcomes for surgery, and have the opportunity to ask questions. You will be given our educational material to take home for review. You will meet our office staff who will be involved in helping with the insurance approval process. The consultation will take between 60 and 90 minutes. After the consultation we will submit a request for coverage for surgery called the Letter of Medical necessity to your insurance company.

Q. Will my insurance company pay for the surgery?

A. Many insurance plans will pay for weight loss surgery if it is done for appropriate medical indications. To find out if your plan will cover the surgery, you should call your benefits coordinator at your human resources office at work or call the customer service line on your insurance card. When talking with your insurance plan, you should take detailed notes including the name, position, and phone number of the person who is giving you information. Ask the question "If my doctor feels that laparoscopic gastric bypass for morbid obesity is medically necessary for me according to the guidelines of the National Institutes for Health, will surgery be a covered benefit?".  If the answer is yes, ask what the plan requires prior to approving surgery. For example, some plans require a recent attempt at a medically supervised diet prior to approving surgery.

Q. What if my insurance company won't pay for the surgery?

A. Many insurance plans do not cover weight loss surgery, even if it is medically necessary, due to "contract exclusions". If your plan denies coverage for weight loss surgery you can appeal this decision. We can help you with the appeal or we can refer you to a company that will pursue your appeal for you. You may also consider switching insurance plans to one who pays for medically indicated weight loss surgery.

Unfortunately, the only option for some patients is to pay for weight loss surgery from their own funds. We are happy to discuss our professional fees and the estimated hospital charges over the phone or at the time of consultation. The hospital charges account for the majority of the cost for weight loss surgery. For these patients, it is important to meet with the hospital as well as with us prior to surgery, to discuss finances and payment options.