For a variety of reasons, patients may have to go out-of-state, or even out of the country, to have their weight loss surgery. There are some fine bariatric surgeons in Spain, Mexico, Brazil, and other places that offer their weight loss surgeries for cash prices much lower than those in the United States. On the other hand, maybe you live in a state that does not have a weight loss surgeon, or your state doesn’t offer the operation. Some weight loss surgeons and bariatric surgery centers cater to out-of-state patients by offering a package that includes hotels, airlines, transportation with the hospital stay.
However, weight loss surgery is not like having your appendix out. It requires long-term follow up.One reason for writing this book is to help primary care physicians understand what follow up care weight loss surgery patients need. Even if you have to fly or drive a couple of hours, make the commitment to return for checkups, and maintain contact with your primary care physician and your weight loss surgeon. Also, be aware that if you go out of town for your weight loss surgery, you may need to be hospitalized for longer than you anticipate—and this could be inconvenient for you and your family. Also, if you should suddenly have problems when you are at home, you may need immediate care and it may be impossible to return to your weight loss surgeon. If you are going out of town or out of state for your weight loss surgery, then first select a primary care physician who can keep watch over you, check your laboratory values and provide you with the bariatric support you need.
Bariatric hospital, university or community?
Weight loss surgery is an elective process, meaning that when and where the bariatric surgery is done is up to you, your insurance plan, and your physician.
Bariatric surgery hospitals
Bariatric hospitals are specialized places that only do weight loss surgery. The great thing about them is that they generally run with the precision of a Swiss watch. They are very organized and very friendly to bariatric surgery patients—those wide seats are available. They have done this weight loss surgery a thousand times. It isn’t something new, different, or weird. When you need an extra wide seat, or a special operating room table, or a certain diet—it is there for you. Everyone at the hospital is there for weight loss surgery or because a relative is having the procedure, and everyone who works there is sensitive to your needs. You don’t have to feel odd or different. Need transportation to the airport? It is arranged.
The downside is that if you have a complication you might need to be transferred to another facility.If you have a heart attack, there may be no cardiologist in the hospital so you might have to be transported to Our Lady of the Heart a few miles away. If you have a medical history of sleep apnea, you may need a pulmonologist who can arrange to set your CPAP machine. If you should need an intensive care unit—the bariatric surgery center might not have one.
University Hospitals are another extreme. These hospitals typically have departments for every specialty. If you run into a problem, a specialist is there to take care of it in five minutes. If you need an artery in your heart ballooned open, the cardiologist is there. If you have some strange skin reaction to the surgical prep used—the dermatologist will see you this afternoon. If you have to go back to the operating room for a leak or you have several prolonged procedures and now have a complicated wound to manage—the plastic surgeon is at your side to fix it up. If you have a complicated medical history with diseases so rare that your primary care doctor pulls down a textbook when you walk in the door, this is the place to be.
University hospitals have lots of people paying attention to you, and lots of people not paying attention to you. There is always a medical student, a resident, the attending bariatric surgeon, or some specialist to tend to your needs—but sometimes it is hard to get the nurses attention. These are great places, but there is always the fear that you will be “experimented on,” by the medical students or residents. A teaching hospital is just that—where doctors learn to be weight loss surgeons, and they will be doing their learning on you. However, they will not be doing weight loss surgery alone. I ran a bariatric surgery training program at a medical center, and every stitch put in the patient was under my direction—in fact, one of my students did so well that he is now in charge of that same hospital! This does freak some people out a bit, but teaching hospitals provide superb care, and they are on the leading edge of medicine—they have the latest and greatest equipment.
Most bariatric surgery programs are in community hospitals where you will interact with the surgeon who does your weight loss surgery. A lot of other procedures are done there besides weight loss surgery. They are busy places. These hospitals may have other specialists in their facility, or they may not, it all depends on the size of the hospital. If the hospital has an ongoing commitment to weight loss surgery, then it has made the place friendly for the plus size person’s needs. Some hospitals have their own weight loss surgery support groups and bariatric patients can attend these programs without charge.
How hospitals Compare:
|Bariatric Hospital||Community Hospital||University Center|
|Organization||Set up well for weight loss surgery patients and families||May have developed a bariatric surgery program and may not have one||University Centers can have inefficiencies in patient care|
|Availability of specialists||May be limited but may have transfer arrangements for patients with complications||Depending on the size of the hospital—can vary greatly||Excellent availability|
|Special equipment||Available||Generally available||Available|
Things to look for in a hospital:
- Weight loss surgery support groups
- Hospitals with wide availability of specialists
- If a smaller hospital, determine transfer arrangements
- Availability of specialists if you have a specific medical condition
- Commitment by the facility to bariatric surgery patients
- Radiology equipment that will accept your girth
While these items are all important in a bariatric surgery program, all of them are rarely found in every facility.
I know of one bariatric center that has special arrangements for out of town patients
It sends a bariatric-friendly van to pick up the weight loss surgery patient and family from the airportand takes them to a hotel. The hotel provides ample-size furniture and a special menu for the patients following weight loss surgery and for aftercare. The hospital picks the patients up from the hotel, brings them to its facility, and provides a shuttle service for the family. These are all very nice touches. However, the hospital stay is, hopefully, for only a few days. The key to this weight loss surgeon’s successful practice is that he is available to his bariatric patients almost anytime they have a question.
Which weight loss surgery should I have?
If I am going to be cut, which should I choose?
Choices are a great thing; this is what America is all about. Most of your choices, however, are going to be made by your insurance carrier.
The Best News
You do have a choice! The downside of living in a society with abundant food stores is that we can store food all too efficiently in our fat cells. That storage unit can have severe and long-term consequences for your health. There is good news—we don’t worry about famines. The best news is that bariatric surgery can give you a tool to take control of your life.
In weight loss surgery, we consider a 65 percent loss of excess body weight a success. What this means is that if you are 100 pounds overweight and lose 65 pounds, the procedure was a success. For all of you who lose more than 65 percent of your excess pound, give yourself a pat on your back—the weight loss surgeon didn’t do that, you did.
Calculate how overweight you are
Determine what your weight would be at a BMI (Body Mass Index) of 24 (see the all-famous BMI table). Your weight currently, minus the BMI weight, is your excess body weight. Now everyone who knows me knows that I am a nerd and I love math, and this stuff is great. Yup, I carry at least two pens in my pocket and I wear a pocket protector, but let’s not get personal here. Here is a simple math problem with this that illustrates what I am talking about. If you are 5’8” tall, then a BMI of 24 means you should weigh 160 pounds. If you weigh 300 pounds (which is a BMI of 46) then you have 140 pounds to lose to get to your goal. If you lose 70 pounds in the first year after weight loss surgery, you have lost 50 percent of your excess body weight. If you lose 91 pounds, you have lost 65 percent of your excess body weight—and this is considered a success by weight loss surgeon’s standards. If you lose more than 91 pounds, you did it!
What should your goal be?
…or, Doctor I haven’t seen that size since I was 12 years old.
Every bariatric surgery patient needs a goal,something to strive for. Our goal in weight loss surgery is a loss of 65 percent of the excess body weight, but your goal should be much more than that. I always tell my weight loss surgery patients to aim for a BMI between 19 and 24. It is like being a kid again. You can lose the pounds much easier than ever because you have a tool. Set your goal—you can make it!