Bariatric Conspiracy?

[haycreek]

I recently recieved a truly frightening direct mailing from St Joseph's Area Health Services - a regional hospital in the St Cloud ,MN area- highlighting their "successfull" bariatrics program.

The article is not available online so I have excerpted the following choice bits:

"laproscopic cameras catch every move Dr Smith makes while in the OR. Video monitors dsplay his work as he alters a patient's stomach and digestive tract with surgical precision."

"Smith performs 9 to 10 weight loss surgeries per week and his waiting list only gets longer."

"Evidently the word is out. St Joseph's Area Health Services is the place to come for gastric bypass surgery and follow-up care. Referrals from doctors throughout MN and neighboring states speak for themselves."

"People seek you out like crazy", says Smith. "It's really been a word of mouth phenomenom. We've not marketed at all, and we're on the internet in a couple of places. The patients have put us on, we haven't put it on ourselves."

"This kind of phenomenom is a boon for a rural hospital like St Joseph's and is what helps to keep it vital in terms of technology, training and service offerings. Many rural hospitals of the same size struggle merely to stay alive in today's economy."

"Most of the people that come to see us are deperate to have something done to correct their weight,Smith says. Many have older family members they saw suffer with severe disabilities or an early death because of their weight problem."

"Virtually all insurance companies cover this surgery, Smith says, although sometimes, depending on the insurance, there can be glitches. While they all cover the surgery, we have to document with them that the patient is an appropriate candidate for the procedure."

Back to the conspiracy idea. Catholic Health Initiatives (of which St Josephs is a member) seems to be a big player in the bariatric field. There's never been any shortage of "guilty feelings" in the church for either real or imagined reasons. Guilt breeds consumption of hi-carb "comfort" foods, which are omnipresent at any church gathering. The church profits when its hospitals solve the very problem it created. Loop closed.

For a very real and scary list of side effects of this surgery see http://www.sbnsurg.com/risks.htm

Makes you wonder why they hadn't gone lo-carb before rather than after.

[CindySue48]

Don't know about conspiracy....but they DO seem to be cashing in on the trend to obesity!

A hospital around here stopped a doc from performing the surgery (not sure which proceedure, there are several), but not until the local BCBS announced they would no longer pay for HIS surgeries. Not sure if it was due to complications, or maybe he wasn't honest on his patient's needs....but I do know there were several women on the news broadcast that were very upset and as far as I was concerned, NONE of them were appropriate for the surgery!

This should be a last-ditch effort, and it should only be for patients that are MORBIDLY obese, and have failed repeated attempts to loose weight, including under MD supervision.

The definition of morbid obesity is 100% above your "Ideal" weight. So if you should weigh 150 pounds, you would have to weigh at least 300 pounds to be considered "appropriate" for surgery.

I'm a nurse, graduated over 25 yrs ago, and I've seen the surgery, taken care of patients after surgery. In my opinion, the docs are not making clear just how dangerous and debilitating this proceedure can be! Oh they tell them about the after effects.....but they don't emphasize how severe they can be!

[haycreek]

Forgot to include that this same mailing references www.obesity.org. Not only do they have an interesting list of sponsors but they appear to lobby and promote the concept of obesity as a disease rather than a set of symptoms-undoubtably to rake in those insurance dollars.

[adkpam]

I've read a lot about this surgery because it astonishes me that it is offered more and more often when it is so dangerous and debilitating, but most of all because it can be temporary! It is entirely possible for the patient to stretch out the stomach again and be back to where they were before the surgery, only now with part of their intestines missing.
What I've read with honest accounts of this surgery is that what is hoped for is the patient being able (wi8th the help of nausea, vomiting, etc) to RELEARN good eating habits, or a year later the surgery stops working.
I understand people's desperation, but shouldn't they do more emphasis on the RELEARNING part? People are capable of change without such drastic risks.

[cc48510]

The definition of morbid obesity is 100% above your "Ideal" weight. So if you should weigh 150 pounds, you would have to weigh at least 300 pounds to be considered "appropriate" for surgery.

I thought the definition was a BMI of over 40. For example, someone whose Ideal Weight (BMI: 23) is 150, that would be 263 pounds (BMI: 40.) 300 Pounds would be a BMI of 45. My Ideal Weight (based on the Charts) is 165. I reached a BMI of 40 at 295 pounds. At my highest (320-330,) my BMI was 44-46.

Al Roker had the surgery and was under 300 pounds...To have been double his ideal weight he would have to have been shorter than 5'7". Of course, this could be like "Obese" which is commonly refered to as 30% above Ideal, but in reality (when calaculated as a BMI of 30) rarely works out to exactly 30% above Ideal.

That being said, I was pretty much big enough to have gotten the surgery at my fattest. I'd tried LF Diets many times and failed. In fact, I ate less Calories [on Average] than the USDA suggested for my age and activity level for 2 years...And I still gained weight. I'd even gone to a Dietician, who made the idiotic suggestion that I fill up on Grain. I tried that one for 6 months. I stopped losing after the first month. But, I decided to give Atkins a try. If Atkins had failed, I almost surely would have eventually (within a year or two) tried to get the surgery.

[Angeline]

The thing that gets me is that when you start reading actual accounts of people who have undergone the surgery you realize one thing. They are lowcarbing !. They can no longer tolerate sugar, it makes them sick. They can eat so little at one time that they must put aside bulky and nutritionally poor carbs in favor of calorie dense proteins.

So basically this very dangerous operation simply forces people to cut portions and switch to low-carb.

[Lisa N]

Different insurance companies have different requirements regarding who would and would not be considered a candidate for this particular type of surgery. I work for an insurance company and basically we require documentation that the patient is 100 lbs or more over their ideal weight (although consideration would also be given if they were close to that, ie 90 pounds over ideal) and have failed to lose weight under a physician supervised weight loss regime. The presence of other debilitating problems (arthritis of back, hips or knees, hypertension, diabetes, etc...) is also considered but the biggest factor is how much over ideal weight the patient is and whether or not an attempt has been made to lose weight by other means first.
Gastric bypass is one such surgery, but there is another less drastic procedure that is getting much more popular called gastric banding in which a band is placed around the patient's stomach internally to shrink the size of the stomach and limit how much they are able to eat at any given time.



People are capable of change without such drastic risks.

While I agree with this for the most part, "capable" does not necessarily equate to "willing". We are all capable of changing our eating habits or other unhealthy habits, but often the effort required is more than many people are willing to make until they are forced to through one means or another and even then some people will not change.
This country is filled with people who are looking for a magic cure to their weight problem that will require little to no effort or change on their part. How many of us have seen (and even responded to) a plethora of ads claiming "take our wonderful product and lose weight while still eating as much as you want of your favorite foods"?

It's still a shame that people are willing to subject themselves to the complications and dangers of surgery rather than find a way of eating (like low carb!) that can accomplish the same results without all the expense, pain and suffering and even worse that the medical community is encouraging a surgery that is far more dangerous than low carbing could ever be while proclaiming how "dangerous" low carb is.

[NickFender]

It's still a shame that people are willing to subject themselves to the complications and dangers of surgery rather than find a way of eating (like low carb!) that can accomplish the same results...

A shame, yes, but not surprising really, is it?

[CindySue48]

CC: I'm sorry, I'm a bit out of date I guess. :blush:

This is from the Merck Manual:

Persons who weigh 120 to 130% of their desirable weight are considered moderately obese; those who weigh more than 130% of their desirable weight are considered morbidly obese. In the USA, the prevalence of obesity in men is highest during middle age, declining to 26% by age 65 to 74. The prevalence in women is highest between ages 65 and 74 (36% for whites and 60% for blacks). In nursing homes, only morbid obesity has been associated with increased mortality.
http://www.merck.com/pubs/mm_geriatrics/sec8/ch62.htm

I learned in school 100% over "ideal". So a patient that should weigh 150 would be considered morbidly obese when they hit 300. By the definition above, morbid obestity wouldn't be diagnosed until the patient hit 352(?). But yet, apparently more insurance companies are lowering their criteria.

I had a patient back in school who had surgery. One of the earlier procedures. My job, in addition to watching the surgery and taking care of her post-op, was to make sure she was well educated about what was coming....not just immediately post-op, but long term, down the road. She also had to have psychological counseling and dietary instruction prior to surgery.

Up until 3 yrs ago, I directly worked with or for dozens of insurance companies. Some were more lenient than others, some didn't cover it at all unless you had group AND a rider. But the accepted definition of "Morbid Obesity" was 100% over ideal weight. Under this, NO surgery would be approved. (Of course, a lot has changed in 3 yrs!)

I mentioned the local doc the insurance co shut off? First off, too many of the people interviewed on 4 different local channels (almost all in fact) did NOT look like they should be candidates for surgery! Secondly, isn't it sad that the insurance company shut him off before the hospital did????

I don't disagree with the surgery, as long as the patient truly needs it, is well educated in all aspects of the effects, and is committed to doing what is needed. Hey, a lot of these people have tried to diet....and maybe lost a few pounds....but on low-fat high carb diets they failed repeatedly. Not their fault, but no one seems to be willing to accept that fact!

I also don't agree with having set numbers that a person has to fall into in order to qualify! I don't remember what my patient weighed....but I do remember we had to go to the shipping area to weigh her. But this was what this lady needed! I saw her several years later and she looked great! She'd lost most of the weight during the first year and had maintained it for over 2 yrs. I knew another woman who had the surgery.....she was my babysitter....and she never got where she wanted to be and had gained a lot back! She almost ate me into the poor house!

[DebPenny]

Persons who weigh 120 to 130% of their desirable weight are considered moderately obese; those who weigh more than 130% of their desirable weight are considered morbidly obese. Actually, the calculation would be 1.3 times their ideal weight. So if their ideal weight is 150 pounds, morbidly obese would be 195 pounds.

If they had said 130% over their ideal weight, your calculation would be correct. The bar continues to lower. :mad:

[cc48510]

Actually, the calculation would be 1.3 times their ideal weight. So if their ideal weight is 150 pounds, morbidly obese would be 195 pounds.

If they had said 130% over their ideal weight, your calculation would be correct. The bar continues to lower. :mad:

Actually, I believe 30% above Ideal is one definition of Obesity. The other two are a BMI of 30 or more and a Body Fat (for men) above 25%. Overweight is a BMI between 25 and 30.

http://www.weightlosssurgeryinfo.com/pages/what_is/bmi.jsp

Morbid Obesity apparently also has a number of definitions...The primary one I was aware of was having a BMI of 40 or more.

[DebPenny]

I think they all have their pet methods of guaging obesity. It's just one more way to pigeon-hole us and limit our insurance coverage. Based on BMI over 40, I'm not morbidly obese, my BMI is 37.4. However, based on 130% of ideal weight, I am morbidly obese, and I don't even know what my ideal weight is, but it's less than 150 and I weigh more than 195. :rolleyes: Personally, I'm just going by how I feel and how I look in the mirror, and I'm not being hard on myself ;).

BTW: In my previous post, I was just commenting on the calculation: When you say X% of something, you multiply something by the percentage (i.e. 130% of 150 is 1.3 * 150 or 195). When you say X% over something, you add that percentage to something (i.e. 130% over 150 is 1.3 * 150 + 150, or 195 + 150 = 345). Can you tell I aced word problems? ;)

[alaskaman]

One thing that is truly scary about this surgical approach, I hadn't known this, but it seems that the long-term outcome is, despite being able to eat only a few bites at a time, feeling sick and full, the weight comes BACK! I could find the studies showing this, I was shocked, wonder if they tell people this? Only person I know who has done this, a clerk at a store where we shop, was having joint problems because of her weight, had presumably tried all diet approaches. At least the lowfat ones. So she had the surgery, looks thinner but miserable, I sure hope this works for her, but the literature, what the bariatric drs. aren't saying, looks scary. Bill