Necessary Hurdles
Surgeons who specialize in weight loss surgery and insurance companies that pay for it are highly selective about who qualifies for any of these dramatic operations. Approval is granted only if certain criteria are met, and the process is lengthy and arduous.
Paige spent nine months having blood tests and being evaluated psychologically to make sure she had realistic expectations and strong motivation. She met a number of times with a psychologist and filled out thick questionnaires. “The meetings and questions took four weeks total to determine that I did not have an unnatural body image or an eating disorder and that I did have the motivation to follow the instructions,” says Paige.
She consulted with a nutritionist, providing a detailed diet history of every plan she had ever tried, to make sure she understood how her eating habits would change. Although her doctors had given their okay, Paige’s fate rested in the hands of the insurance company.
Compliance is critical after bariatric surgery. Insurance companies may withhold a $30,000 weight loss surgery from a person they predict won’t stick with the program, explains Mohammad Jamal, MD, assistant professor in the division of gastrointestinal, minimally invasive and bariatric surgery at the University of Iowa Hospitals and Clinics in Iowa City. This is similar to the way organizations controlling organ recipient lists may withhold a liver from an alcoholic who would “abuse” the donated organ.
“A person who couldn’t comply with diet programs before surgery isn’t going to comply with what’s necessary after surgery,” he says.
Some surgeons have potential patients work with a nutritionist for the three to four months between the initial visit and surgery to follow a diet and exercise plan. “If they weren’t able to stick with the plan, then we must have a heart-to-heart discussion about lifestyle changes and postpone surgery,” he says.
“In my experience, only a few patients have been turned down for surgery, and some reconsider on their own,” says Dr. Jamal. Reasons include fearing the risk of potential complications, not wanting to go through the lengthy approval process or doubting their ability to adjust to the harsh realities of life after surgery.
“In a few cases, patients who go through the intense diet and exercise program during the approval process feel empowered and want to try keeping up those changes on their own before proceeding with surgery,” says Dr. Jamal.
