Overweight people are not the only ones who need information about bariatric surgery. Sometimes doctors also need information so that they can help their patients make the right decisions about bariatric surgery or help them with the after care.
Are you a doctor with a patient who is considering weight loss surgery? Has a patient asked for your opinion or a referral for a bariatric surgeon? Do you have a patient who has had bariatric surgery and hasnow come to you for aftercare? There are several things you need to know about weight loss surgery so you can help your patient either make the right choice about the operation, or to heal quickly and achieve his or her weight loss goal after the procedure.
As you know, not all weight loss surgeries are alike. In medical school, you may have heard horror stories about the jejunal-ileal bypass, or how “stomach stapling” didn’t really work. Now you are reading about celebrities, and even politicians, who have had the procedures! Bariatric surgery has changed and advanced, but the success does not depend entirely on the type of operation that is done—often it is the aftercare. Sometimes, the most important step you can provide for the bariatric surgery patient is the aftercare.
Weight loss surgery does work, but patients often need more follow up care than many bariatric surgeons can give. As a result, the burden may fall on you, the family doctor, to help organize and manage the whole group of tests, post op follow ups, and various complaints that your patient will have.
Which patients should you refer to a bariatric surgeon?
The answer lies in the FDA guidelines: those patients who have a BMI of 30 with co-morbidities or those with a BMI of 35 with no co-morbidities. This might look like a large group of patients but you can narrow it down.The ones to refer are those that are unlikely to benefit from any long-lasting solution besides weight loss surgery The ones to refer are those that are unlikely to benefit from any long-lasting solution besides bariatric surgery.
Often the first patients a physician refers to a weight loss surgeon are patients who are “super morbidly obese.” Usually these patients are in the 500-pound club. While these patients should be referred, remember that these patients are they ones who have suffered from the ravages of obesity and will be the most challenging for the bariatric surgeon and the anesthesiologist. I had a cardiologist refer a patient with severe heart disease who weighed 400 pounds. He died before he came to the operating room. Had that patient been referred five years earlier when he weighed 300 pounds, I often wonder—would he be alive today? So, when considering referral of patients to the bariatric surgeon, remember that the FDA criteria are a good place to start.
Preparing your patients so they can get weight loss surgery
Components of a good weight loss program
- Nutritional classes or lectures
- Weekly or at least every other week, weigh-in. Calculate BMI.
- A diet plan (document attendance at Jenny Craig, for example)
- Check yearly post op labs blood levels at the start
- Physical therapy consult for planning an exercise program—safe stretching
- Water aerobics classes for patients with joint problems
- Teach the patient to take his or her pulse and set goals for heart rate with exercise
- Stress test, if needed
- Prescriptions are not necessary, but if medication prescribed, be sure to document any side effects.
Many insurance companies require a physician-supervised weight loss program of at least six months. This must be completed within two years of the referral for the operation. As you are talking to your patient about losing pounds? Document his or her scale results and begin the patient on a program for weight loss right away. Prescription drugs for weight loss are not necessary, although some patients do find these helpful. Nevertheless, the best programs involve patient nutritional classes, some counseling, and weekly weigh-ins. You don’t have to see the patient weekly, but having him come to the office and weigh on your scale is helpful to the patient.
Some physicians find “package” plans, such as Opti-fast, to be helpful. However, these are not necessary. Most insurance companies want to know that the patient, under the care of his primary care physician, has made an effort at losing pounds. Hopefully this will be successful and the patient will keep the pounds off, rendering the operation unnecessary—but, as per the consensus statement from the NIH, this is unlikely. Nevertheless, a small percent of patients will lose enough pounds that operation is not necessary.
Many diet plans and programs are available, and a lot of groups are designed to help support the patient. There are multiple types of plans, but insurance companies do not care if a patient has been to Jenny There is no magic diet, just as there is no magic food.Craig—what they want is physician supervision and intervention. While the patient is working with you, adjuncts, such as Jenny Craig, are always helpful, as the more information a patients can obtain, the better prepared they will be. There is no magic diet, just as there is no magic food. Moderation in all things, including moderation, is the key—or, eat less, move more. The reason single-food diets, or single food-type diets (Atkins) work well is that people eat multiple foods, not just one.
Physical activity is the key to success in any weight loss program, and this is one place where you can help your patients. A physical therapist can teach them to “warm up” and stretch, before starting a walking or water aerobics program. This is very helpful in preventing early injuries. Patients should learn to take their own pulse, or they should purchase one of those cute devices to check their pulse while exercising and after. Give your patient targets for pulse and heart rates, and also give them warnings.
Certainly all patients will benefit from vitamins and supplements (such as calcium), as the typical “American” diet seems to be lacking in many vitamins and minerals. It is a good idea to have patients start out with these supplements.