Weight Loss Prior to Surgery

[Guest guest]

Do any of you have a weight loss track as part of your program for patient who do not qualify for surgery??

I am meeting with our program nurse tomorrow to discuss developing a program for these patients and would appreciate anyone's input as to what they are currently doing.

Thanks

Townsend, RD

-----Original Message-----From: [mailto: ] On Behalf Of Jeanne BlankenshipSent: Tuesday, May 24, 2005 8:30 AM Subject: Re: binge eating

Here is a presentation that I did on this topic last fall and one that I did in February. I would recommend reviewing some of the articles that are included -- it is a very interesting topic. Please do not upload this to the files section. Thanks!

I will e-mail under separate files because the second may be too big for .

Jeanne Blankenship, MS RD

binge eating

I meet with a patient that is 42 yr. old female that admits to binge eating on the initial Bariatric interview. She is undergoing surgery at another program not at ours. She was very open and appears honest in her responses. She has been in counseling for 12 years and works with a therapist. She states that she is improved in managing the triggers and understands she will struggle s/p surgery. Does anyone have word of wisdom or insight they could share? TIA

Gundermann RD, CDE

Manager of Clinical Nutrition Services

Good Samaritan Hospital

Bon Secours Charity Health System

(845) 368 - 5016

lgunderm@...

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[Guest guest]

I definitely comprehend the rationale for

pre-op wt loss for the surgeon and to show some effort by patient.

However, my facility is currently facing

with a dilemma with some private insurance companies.

They require 6 mo of “supervised”

wt loss program (does not need to “medically supervised”, an RD can

see pt and report or their physical activity also).

However, if the patients lose wt, they

reject them from surgery. We all know that they can diet but the long term

maint is the the problem.

What are others doing in this situation

A colleague asked one insurance company

for their requirements in writing and was told they could not sent it in

writing, their verbal word was good enough. Is this common practice or is this

not being upfront?

From:

[mailto: ]

On Behalf Of saleva25

Sent: Wednesday, November 08, 2006

11:32 AM

Subject:

Re: Weight loss prior to surgery

We defenetly require to lose 5-10% of excess body

weight.Surgeon

will not even operate if a patient didn't lose at least 5% of excess

body weight.

Benefits of preoperative weight loss

(decreases excess body weight by ~10 %)

-easier surgical procedure

-helps to reduce liver size

-reduce operative time

-fewer non-GI complications

-increased weight loss first year postoperatively

-thins out the abdominal wall

We use OptiFast(by Novartis). The diet plan cording to patients'

BMI.The higher BMI the more calories they will get.

>

> How many of you require a patient to lose weight prior to having

gastric

> bypass surgery? If you do require weight loss, what are your

> guidelines? For instance, do you focus more on the BMI or actual

pounds

> lost? Our program hasn't typically required patients to lose

weight

> prior to gastric bypass surgery, but, I think it would definitely

help

> increase post op diet compliance and decrease post op

complications.

> Any feedback would be greatly appreciated.

>

> Thanks in Advance--

> Karey Schutte, RD

> Denver Health Medical

Center

> Surgical Weight

Loss Center

> Denver, Colorado

>

>

> ----------------------------------------------------------

-----------

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>

=====================================================================

=========

>

[Guest guest]

The patient is definitely entitled to the requirement from the insurance company. They have purchased it.

The ones I have worked with and have seen have had no other requirement than following a supervised diet (although they did have to be medically supervised by a physician) for X amount of time. There have been no guidelines as to the diet itself. So I have set up a meal plan that is liberal enough to keep the pt from losing too much weight but that will show they are able to stick to a program. I haven't had a problem with the 3rd party payers with this approach and the pt just go in once a month to the doc's ofc and weigh in and I send a note to the doc and the insurance. I have, however, had some pts who could not stick with even this plan for that length of time.

Hope this helps. Bev

RE: Re: Weight loss prior to surgery

I definitely comprehend the rationale for pre-op wt loss for the surgeon and to show some effort by patient.

However, my facility is currently facing with a dilemma with some private insurance companies.

They require 6 mo of “supervised” wt loss program (does not need to “medically supervised”, an RD can see pt and report or their physical activity also).

However, if the patients lose wt, they reject them from surgery. We all know that they can diet but the long term maint is the the problem.

What are others doing in this situation

A colleague asked one insurance company for their requirements in writing and was told they could not sent it in writing, their verbal word was good enough. Is this common practice or is this not being upfront?

From: [mailto: ] On Behalf Of saleva25Sent: Wednesday, November 08, 2006 11:32 AM Subject: Re: Weight loss prior to surgery

We defenetly require to lose 5-10% of excess body weight.Surgeon will not even operate if a patient didn't lose at least 5% of excess body weight.Benefits of preoperative weight loss(decreases excess body weight by ~10 %)-easier surgical procedure-helps to reduce liver size-reduce operative time-fewer non-GI complications-increased weight loss first year postoperatively-thins out the abdominal wallWe use OptiFast(by Novartis). The diet plan cording to patients' BMI.The higher BMI the more calories they will get.>> How many of you require a patient to lose weight prior to having gastric> bypass surgery? If you do require weight loss, what are your> guidelines? For instance, do you focus more on the BMI or actual pounds> lost? Our program hasn't typically required patients to lose weight> prior to gastric bypass surgery, but, I think it would definitely help> increase post op diet compliance and decrease post op complications.> Any feedback would be greatly appreciated.> > Thanks in Advance--> Karey Schutte, RD> Denver Health Medical Center> Surgical Weight Loss Center> Denver, Colorado> > > ---------------------------------------------------------------------> CONFIDENTIALITY NOTICE - This e-mail transmission, and any documents, files or previous e-mail messages attached to it may contain information that is confidential or legally privileged. If you are not the intended recipient, or a person responsible for delivering it to the intended recipient, you are hereby notified that you must not read this transmission and that any disclosure, copying, printing, distribution or use of any of the information contained in or attached to this transmission is STRICTLY PROHIBITED. If you have received this transmission in error, please immediately notify the sender by telephone or return e-mail and delete the original transmission and its attachments without reading or saving in any manner. Thank you.> > ==============================================================================>

[Guest guest]

I have not seen an insurance company reject someone for losing weight --yet! I have dealt with insurance companies and have requested their nutrition protocol in writing. They have been somewhat reluctant but you have to insist upon getting it. Speak with a supervisor in the dept. if need be b/c every protocol is in writing. They're obviously not being upfront when they refuse to give it. Judy Carty St. Francis Hosp. Hartford, CT

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