At a Glance
- Many people are suffering with weight-related health issues that might be resolved with surgery or through other means.
- Only around 2% of eligible patients seek out weight loss surgery.
- By staying up to speed on eligibility requirements, insurance coverage and the risks of weight loss surgery, providers can help patients make an informed decision.
There’s no denying that obesity continues to be a major health concern in the U.S. According to a survey by the Centers for Disease Control and Prevention (CDC), more than 39 percent of American men and women over age 40 are now classified as obese. That’s almost a six percent increase compared to 2007.
The impact of these excess pounds: more heart disease, diabetes and other serious health problems. "The New York Times reported recently on research that links over 7 percent of cancers to excess bodyweight as well,” says UVA surgeon Peter Hallowell, MD.
Unfortunately, weight loss is a sensitive subject. Patients are hesitant to discuss their weight with their doctors. And some doctors avoid the topic for fear of offending their patients. But avoidance hinders progress, leaving many people suffering with weight issues that might be resolved with surgery or through other means.
“I know there may be some fear of turning patients off a particular provider, but these are major medical problems we’re dealing with. If we don’t manage obesity appropriately, then it’s going to continue to drive those problems,” says Hallowell.
Referral Tips and Talking Points
Only around one to two percent of people eligible for weight loss surgery actually pursue it. Lack of awareness is one of the key reasons why. To get more patients to consider this option, Hallowell provides some helpful talking points and referral suggestions below.
Eligibility
- If a patient has a body mass index (BMI) of 35 or above and a major medical condition, such as diabetes, obstructive sleep apnea or uncontrolled hypertension, they may be eligible and should be referred for a weight loss surgery consultation.
- If a patient has a BMI of 40 or above, then no other medical condition is necessary to qualify. The minimum age for weight loss surgery is 18; the maximum age varies depending on the health status of the patient, but generally, the age cutoff is 65.
- The most successful candidates are those who are committed to making a change in lifestyle and truly want to get healthy.
- Patients who are ineligible include those who are over 500 pounds, non-ambulatory or who have serious comorbidities, including some cancers. “Referring providers should reach out to us if they’re uncertain about a particular patient’s eligibility,” says Hallowell. “We see a wide range of patients at UVA who have a much higher degree of illness than typically treated by other programs.”
Insurance coverage
- Most major insurance companies will cover common weight loss surgeries such as gastric bypass, but it’s best to advise the patient to speak to their insurance provider to determine their approval process. The timeframe varies from one carrier to the next, but can take anywhere between a few months to one year for a patient to get final approval. “A referral for weight loss surgery is not like any other procedure,” says Hallowell. “There are a lot of barriers to getting the patients approved for this service, but we’re trying to break down the barriers as best we can.”
- Many insurance companies still require patients to attempt a supervised diet and a psychological evaluation prior to approving the procedure. “We now have a nurse practitioner who can help guide patients through the dieting phase,” says Hallowell. “This has been a barrier in the past because often patients had nowhere to turn for this support. We’ve seen an uptick in the number of patients taking advantage of this service and a high level of satisfaction because of it.”
Risk
- Weight loss surgery is not as high risk as some assume, especially now that the transition has been made from open surgery to minimally invasive laparoscopic surgery in a majority of cases. Overall, the risks are fewer and the outcomes are better with laparoscopic surgery.
- The mortality rate is similar to gallbladder removal. “That’s a striking statistic considering everyone we operate on has a significant medical problem and is severely obese,” says Hallowell.
Effectiveness
- Patients who have weight loss surgery typically lose more weight than they’ve lost with previous nonsurgical approaches.
- Most patients will lose approximately two-thirds to three-fourths of excess pounds by year two.
- For a majority of patients, this weight loss will improve or resolve those medical conditions related to weight, including diabetes, sleep apnea, joint pain and more.
- There’s evidence that shedding excess weight effectively lowers the risk for cancer and prolongs life expectancy.
Putting Patients at Ease
There are many misconceptions about weight loss surgery that make broaching the subject a challenge. Some feel surgery is an easy way out and that anyone unable to lose weight by traditional means (diet and exercise) just isn’t trying hard enough. But several studies have proven that’s false.
“It’s important to reassure patients that the vast majority of obese people are heavy not from lack of trying, but because they need tools to overcome the metabolic changes that occur in the body over time, which make it more difficult to shed the pounds,” says Hallowell.
If it’s the idea of surgery that makes a patient wary, there are alternatives. “We now have medical options available that can make having a discussion about weight loss a little easier with patients who may not be interested in surgery,” says Hallowell.
Ready to refer? Rest assured that patients are in good hands when they choose UVA for their weight loss needs. The metabolic and bariatric team is one of the most experienced in the state. They offer the full range of treatments available to help overcome weight problems, from surgical options like gastric bypass and the more common sleeve gastrectomy to non-surgical interventions, such as the gastric balloon and medical therapy.
Each patient will have an individual consultation to evaluate their individual medical problems and weight loss goals. Then they can determine which type of weight loss procedure is best and safest for them.
To refer a patient for a weight loss surgery consultation, call UVA Physician Direct at 800.552.3723.