YOU on a Diet - Appendix C

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Factoid For Medicare reimbursement, surgical centers need to be certified by either the ASBS or the American College of Surgeons (ACS). Medicare has recently agreed to pay for bariatric procedures even if no other comorbidity was found. This could change the reimbursement landscape for growing procedures, like banding-which are sometimes offered to less heavy patients (those with a BMI of 30 and at least one comorbidity) . Band Aid Gastirc banding limits the amount of food that can enter the stomach, with an inflatable inner tube placed around the stomach. Change Paths Malabsorption is created by dividing the intestines immediately after the stomach and bypassing most of the small bowel. That way, only a short common channel remains for food to be absorbed. The high amount of nonabsorbed food can overburden

the colon and cause loose poop. Take the Bypass The compromise procedure of gastric bypass makes the stomach smaller and removes some intestine, but it leaves much more "common channel' small bowel than the duodenal switch, which is a purer malabsorption operation. YOU TIPS! Interrogate Yourself. We have nothing against using crutches when we break an ankle, tear a knee ligament, or need to trip a purse-snatcher, so there's no reason not to consider weight -loss surgeries if you qualify for them. They're effective, they're fast, and they have the potential to turn a blimp of a body into a dragster. But they don't come without risks. and potential complications, and they necessitate long-term behavioral changes. Weight-loss surgery will do more than give you the confidence to reintroduce tank tops into your

wardrobe. It can also save your life. Still, you have to know that it's not for everyone-and it can be challenging. So when you investigate options, be aware of the ways to lower your risks and increase your odds of success. Your first order of business is asking yourself these two questions: Are You a Candidate? You're eligible for surgery if you fit one of these three categories: If you're 100 pounds or more over your ideal weight. If you have a BMI over 40. If you have a BMI over 35 with hypertension, diabetes, arthritis, sleep apnea, serious lipid abnormalities, or altered body image. For all of them, you need to be willing to make the life changes-exercise and diet-that will make these procedures work. Without them, these procedures won't be successful. After an initial "bounce" downward, you could be back at marathon munching

before you know it. You will also need to be realistic about the potential side effects, like hair loss, dumping, diarrhea, and vomiting. Whom Do I Trust to Switch My Duodenum or Band My Stomach or Bypass My Gastric? You wouldn't want an orthodontist removing a tumor, an orthopedic surgeon doing a heart transplant, or a urologist doing a nose job. So the same rules apply here: Find a specialist. Ideally, you'll use a facility and team that will do the procedure laparoscopically, as opposed to open. Laparoscopy means that the surgeons will make small incisions and do the procedure through tubes (it'll appear as if they're working with chopsticks). Laparoscopic surgery means you'll heal faster with less pain, but sometimes the surgeon has to resort to the old-fashioned way. You'll want to find a hospital that does at least 150 procedures a year-such

hospitals have much lower complication rates than those that don't. Whoever your surgeon is, be sure there's an entire team of support both pre-op (to minimize complications) and post-op (to give you the best chance for success), including a nutritionist and psychiatrist. You can eat your way through-and destroy-any of these procedures. A support team can help you prevent post-op pudding backfires and give you resources to call upon as you're adjusting to your new eating habits-and new body. You should choose a hospital certified by the American Society for Bariatric Surgery (ASBS) (www.asbs.org).