Pre-Op BMI

[Bianca]

So I just came back from the group Doctor appointment at Madigan and have some mixed feelings. The Doctors seem great, very knowledgeable and answered all of my questions. The only thing that left me feeling uncertain is that they were pretty insistent that they only recommend the DS for patients with a BMI of 50 or more. Mine bounces between 39.5 and 40.5, so I'm not even close.

Anyone out there have a DS with a lower BMI?

 

[Dawn]

Mines around 44 and I've been approved.

 

[aaa]

I was about a 40.5 when I had my first consult. I was a 45.5 at the time of surgery.

 

[southernlady]

Mine was 35.2 and my husband's was 38 something and we both were approved for the DS.

I REQUIRED NSAIDS which cancelled out the RNY and at the time of my surgery the sleeve was not covered under Medicare.

 

[newanatomy]

Mine was 39.8 when I first started looking into getting the DS and took the online classes required by my surgeon. I waited a further 7 months for my surgery by then, my BMI was 43.3. There is tons of literature out there supporting a DS with a BMI under 50. Google!

You can do this.

 

[Munchkin]

Many had the DS with lower BMI's. Stick to your guns!

 

[Larra]

There is so much more to this decision than bmi!!

The DS has the best statistics for percentage excess weight loss of any bariatric surgery and of equal importance, the best statistics for maintenance of that weight loss. We see so, so many people with either inadequate results from sleeve or RNY, or with significant weight regain a few years post-op.
The DS also has the best statistics for permanent resolution of almost all comorbidities of any bariatric surgery.
The DS also allows for the most normal and varied diet of any bariatric surgery. All other surgeries require a low calorie, low fat, low carb diet for the rest of your life to be successful. Some people can achieve this. Others, not so much.
The DS allows you to take NSAIDs safely (in correct doses). With RNY, NSAIDs are contraindicated for the rest of your life.

It's all well and good to talk in terms of groups of people. And certainly, for someone with a higher bmi, the DS is even more likely to be the only successful choice. But this is about YOU, and only you. Do your research. Determine which operation fits you, not just your bmi, but your overall health and your lifestyle. Then make your decision.

 

[Elizabeth N.]

Stand up and FIGHT for it. Don't let them "sell" you a procedure that is not good enough for you.

 

[Bianca]

I'm glad to see that there are others that have chosen a DS with a lower BMI. My biggest concern with other WLS is that they aren't as successful at resolving comorbidities. I personally think that there may have been a hidden agenda to push the sleeve and RNY.

 

[southernlady]

@Bianca, remind them that the WLS standards as defined by the NIH AND by Medicare are these:

http://win.niddk.nih.gov/publications/gastric.htm

Currently, bariatric surgery may be an option for adults with severe obesity. Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI > 40 or a BMI > 35 with a serious health problem linked to obesity. Such health problems could be type 2 diabetes, heart disease, or severe sleep apnea (when breathing stops for short periods during sleep).

Types of Bariatric Surgery
The type of surgery that may help an adult or youth depends on a number of factors. Patients should discuss with their health care providers what kind of surgery is suitable for them.

What is the difference between open and laparoscopic surgery?
Bariatric surgery may be performed through "open" approaches, which involve cutting the stomach in the standard manner, or by laparoscopy. With the latter approach, surgeons insert complex instruments through 1/2-inch cuts and guide a small camera that sends images to a monitor. Most bariatric surgery today is laparoscopic because it requires a smaller cut, creates less tissue damage, leads to earlier hospital discharges, and has fewer problems, especially hernias occurring after surgery.

However, not all patients are suitable for laparoscopy. Patients who are considered extremely obese, who have had previous stomach surgery, or who have complex medical problems may require the open approach. Complex medical problems may include having severe heart and lung disease or weighing more than 350 pounds.

What are the surgical options?
There are four types of operations that are commonly offered in the United States: AGB, Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with a duodenal switch (BPD-DS), and vertical sleeve gastrectomy (VSG). (See Figure 1.) Each surgery has its own benefits and risks. The patient and provider should work together to select the best option by considering the benefits and risks of each type of surgery. Other factors to consider include the patient's BMI, eating habits, health conditions related to obesity, and previous stomach surgeries.

Medicare/Medicaid criteria (does not include the sleeve, that is a different Decision Memo
Medicare/Medicaid SLEEVE Decision Memo

You are using a government facility, they should use the GOVERNMENT standards.

 

[Lilyofthevalley]

I really am hoping that in the future comorbidities will be considered more than bmi. I know people who are as big or bigger than I was, who do not have the serious health problems I had. Age can also be a factor. Excess weight works with genetics and lifelong habits to determine the extent of damage it will do to one's body. All those things need to be considered when determining which wls is "right for someone." imo

 

[brooklyngirl]

I'm glad to see that there are others that have chosen a DS with a lower BMI. My biggest concern with other WLS is that they aren't as successful at resolving comorbidities. I personally think that there may have been a hidden agenda to push the sleeve and RNY.

From all the reading I've done on various groups and forums over the past year+, it seems that there are two main ulterior motives- the sleeve and RNY are easier to perform and they can therefore squeeze more of them onto a surgical schedule for the day and make more $$$ (plus the fact that if the sleeve doesn't work, they can lure the patients back in for another surgery and more $$$) and also the fact that the possibilities of nutritional & vitamin deficiencies are higher with the DS, so people that choose this surgery need to be more vigilant about protein and vitamins than the average WLS patient and when people aren't as vigilant as they should be and get sick, it reflects poorly on that surgeon's record. That, or they just don't want their patients getting ill, I'd hope it was the latter, but I'm afraid that it's more often the former
Remember, though, this conclusion is my own, coming from anecdotal things I've read.

 

[Terri]

From all the reading I've done on various groups and forums over the past year+, it seems that there are two main ulterior motives- the sleeve and RNY are easier to perform and they can therefore squeeze more of them onto a surgical schedule for the day and make more $$$ (plus the fact that if the sleeve doesn't work, they can lure the patients back in for another surgery and more $$$) and also the fact that the possibilities of nutritional & vitamin deficiencies are higher with the DS, so people that choose this surgery need to be more vigilant about protein and vitamins than the average WLS patient and when people aren't as vigilant as they should be and get sick, it reflects poorly on that surgeon's record. That, or they just don't want their patients getting ill, I'd hope it was the latter, but I'm afraid that it's more often the former
Remember, though, this conclusion is my own, coming from anecdotal things I've read.

I agree with you. I have my 1 month post op follow up yesterday. I am 5'2" started at 295 and I saw many at the doctor's office that were so much bigger than me and I wondered how many of them just had the sleeve or RNY. It made me sad.

 

[brooklyngirl]

I agree with you. I have my 1 month post op follow up yesterday. I am 5'2" started at 295 and I saw many at the doctor's office that were so much bigger than me and I wondered how many of them just had the sleeve or RNY. It made me sad.

Or the lapband for that matter, I forgot about that one! It shocks me when I read about the horrible statistics for the lapband and it's so often the procedure that people seek out first or know the most about, myself included!

 

[Elizabeth N.]

From all the reading I've done on various groups and forums over the past year+, it seems that there are two main ulterior motives- the sleeve and RNY are easier to perform and they can therefore squeeze more of them onto a surgical schedule for the day and make more $$$ (plus the fact that if the sleeve doesn't work, they can lure the patients back in for another surgery and more $$$) and also the fact that the possibilities of nutritional & vitamin deficiencies are higher with the DS, so people that choose this surgery need to be more vigilant about protein and vitamins than the average WLS patient and when people aren't as vigilant as they should be and get sick, it reflects poorly on that surgeon's record. That, or they just don't want their patients getting ill, I'd hope it was the latter, but I'm afraid that it's more often the former
Remember, though, this conclusion is my own, coming from anecdotal things I've read.

This is a non-issue in this case because the surgeon is a military member and therefore on salary .