Your questions answered: Q&A with a bariatric surgeon

We sat down with Bariatric Surgeon Kelly Blair, MD, FACS, and South Puget Sound Region Program Manager Jennene Wheeler, RN, CBN, from the MultiCare Center for Weight Loss & Wellness to help answer some of the most common questions about bariatric surgery.

Q: Wanting to lose weight is just me being vain. I shouldn’t have surgery just to look better, should I?

Dr. Blair: Obesity negatively impacts people’s health and can reduce life expectancy by eight to 20 years. Some of the conditions caused or made worse by being overweight include gastroesophageal reflux (GERD), heart disease, high blood pressure and sleep apnea. Being overweight or obese is often not just about your appearance. It is a real medical issue that deserves to be treated with the same level of attention as any other chronic illness.

Q:  Surgery seems like the easy way out. Shouldn’t I just work to lose the weight myself?

Dr. Blair: Whether or not you have bariatric surgery, you are still going to have to use the basic building blocks of weight loss and weight control — portion control, exercise and healthy food choices — to lose and maintain your weight. Using those tools, most of us can lose some weight on our own. How much depends on a number of factors, but generally speaking, the more you need to lose to get to a healthy weight, the more difficult it can be to do that on your own.

Most patients who qualify for bariatric surgery need to lose a significant amount of weight, creating a real barrier to success. So bariatric surgery can be a critical component in helping patients with a BMI of 35 or more to lose weight and reclaim their lives. Medical, surgical, behavioral health and nutritional specialists at our multidisciplinary weight-loss program work hand-in-hand to help people learn and use the appropriate tools to achieve the necessary weight loss.

Q. I’m not overweight enough, so I can’t have weight-loss surgery. Don’t I need to be at least 100 pounds overweight to be a candidate?

Dr. Blair: An outdated rule, which is no longer used, required patients to be 100 pounds over their ideal body weight. Today, we use body mass index (BMI), which takes into account a patient’s height and weight, as well as other weight-related conditions a patient might have, such as diabetes or high blood pressure, to assist in the determination for weight loss surgical referral. Currently, patients with a BMI of 35 or more who also have one or more comorbidities — conditions related to being overweight — or patients with a BMI of 40 or more, with or without comorbidities, usually qualify for bariatric surgery. I tell patients and providers to attend one of our free seminars, look online or contact our office to help determine eligibility.

Q: A friend had a bad experience with the surgery years ago. What’s different now?

Dr. Blair: I get it. Surgery is a big deal and the idea of having a bad experience can be concerning. A lot has changed in the world of bariatric medicine and surgery. In the past, complications were common because patients had limited surgical options. Having bariatric surgery required them to undergo a long operation with a large incision and stay in the hospital for a long time.

Today we have minimally invasive laparoscopic and robotic-assisted surgery techniques with many surgical procedures available tailored to the patients’ individual needs. Operative times are shorter, hospital stays are shorter, stapling devices have improved and standardized techniques and patient care pathways have helped to produce the best outcomes in the history of our profession. We track our outcomes and constantly fine-tune our techniques and processes to achieve the safest and most cost-effective care for our patients.

Q: My friend’s neighbor went to Mexico and had this surgery done for way less money than it costs in the United States. Is that a good option?

Dr. Blair: There are people who have had success with having surgery in Mexico. I respect the hard-working medical and surgical teams in Mexico. The issue is not just the operation. The issue is the before and after care. There are both short- and long-term complications that may occur from traveling abroad to have surgery. And now you have to find a doctor at home who is willing to take care of complications from surgery done elsewhere because of the medical and legal liability.

Wheeler: Not only is it dangerous, but none of the follow-up care you might need due to complications will be covered by your insurance and the expense can be devastating. You also don’t get the education about what to eat and what vitamins to take or what medicines to avoid.

Q: Speaking of money, I just don’t know how I’m going to afford this surgery. There’s no point in me pursuing it unless I have the cash for it, right? 

Wheeler: We have dedicated staff who work with insurance companies and employers to maximize any coverage you might have, whether for the surgery or before and after care. In addition to BMI, there are more than 100 comorbidities — other chronic conditions associated with being overweight or obese — that can qualify you for coverage. But if you do have to pay the entire bill yourself, you probably need financing. There are a number of resources out there, such as medical loan companies, that people can access for financing.

I had to pay for the surgery myself. I had a friend who did it before me and said, “I can buy a new car or I can buy a new life. I don’t need a new car, but I really need a new life.”  That outlook really helped me see the value of being there for my kids and grandkids.

Dr. Blair: Our medical and surgical multidisciplinary teams in the Inland Northwest, South Puget Sound and Thurston County stand ready to help patients who want to get to a healthy weight and reclaim their lives. We are here to help.

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