On a fairly surprising note, the FDA adjusted its criteria for LapBand surgery. The old FDA recommendations were for LapBand placement in adults with a BMI of greater than 40, or a BMI 35-40 with a serious medical condition related to obesity. The new criteria have dropped the BMI level to 30-35 with a serious medical condition. What’s a serious medical condition? This will include diabetes, obstructive sleep apnea, and heart disease. This is a big step in realizing surgical weight loss as the best tool in conjunction with a comprehensive weight loss program, to improve an individual’ health.
Even though the FDA now approves this lower BMI rating, I doubt the local insurances will rush to alter their surgical weight loss policy criteria. So, for now, if one falls within this category, they will most likely have to pursue surgery on a cash pay basis.
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If you guys have heard about a new research article in the British Medical Journal that associated an increase in heart attacks with people who take calcium supplements, you’re probably wondering what it means to you.
Basically, the paper was a meta-analysis (pooling data from a lot of different papers) showing a 30% increase in heart attacks. This paper DOES NOT apply to you! Here’s why…
1)This is the first article of its kind… We never make sweeping decisions about health care based on one study. Many times one article can be misleading, so further studies are needed to have a clearer picture.
2)The study did not account for people taking Vitamin D with their calcium. All prior research has shown this to be beneficial for a variety of functions in your body. You guys are taking your calcium with Vitamin D, so the article can not be translated to your situation.
The field of nutritional supplements is rapidly changing, and often is filled with science that is less than exact. Best advice is to tread lightly and be sceptical of new claims. I’ll do my best to keep our vitamin supplement recommendations up to date and backed by good research.
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For all the adjustable gastric band patients, I want to give you some information that hopefully will give you some piece of mind. You need to know, at some point, your band will be too tight. This isn’t necessarily based on you doing something ‘wrong’ or not following our recommendations. Think about it, you have an unforgivong foreign body wrapped around your stomach, which is a dynamic digesting muscle. There’s bound to be some issues one time or another. Following our recommendations will go a long way in preventing something getting stuck, but it isn’t a guarantee.
That being said, if your band is too tight, it doesn’t mean you have a slip. The vast majority of cases involve inflammation or swelling around the band causing persistent obstructive symptoms. This can be from eating something that didn’t pass, or stress, or even menstrual cycle. The first thing to do is call your surgeon, me. I will recommend for you to go back to clear liquid diet, possibly add an antacid, and see me the soonest available time. In the office, I will take some fluid out of your band to relieve your symptoms. Importantly, an exception to this pathway is if you have persistent pain. In which case, you have to go to the ER. After the band is adjusted, you will feel better. And after a couple weeks, we can place some fluid back into the band to get to the right level of tightness.
Having the adjustable gastric band is a learning process. It’s a great tool to help in imroving your health, but bumps along the way are to be expected.
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Have you guys heard about the buzz regarding multivitamins linked to increased death rates? This month in the Archives of Internal Medicine, researchers found a slightly increased death rate in individuals who consume multivitamins on a regular basis over a 19 year period. The study gets respect interms of the amount of patinets studied (about 40 thousand women), and the extended follow up period, but needs some serious perspective in stating its results:
-This sudy merely shows and association. It does not prove cause and effect… meaning it doesn’t show that the multivitamins increase your risk.
-It does not address nutritional needs of post surgical weight loss patients. It is clearly shown that bariatric patients need some type of nutritional supplement to prevent vitamin defficiencies.
-It fails to discuss the real issue of overall decreased nutrition of Americsns. Our generation eats greater amounts of simple sugars, modified fats, and highly processed foods with decreased nutritional content. A multivitamin can help offset this poor diet, and it’s certainly better than nothing…. but the real message should be centered on educating and supporting a society towards good nutritional food consumption.
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After submitting a formal request for HMSA to review their Vertical Sleeve Gastrectomy Criteria, once again I receive a denial. Bascially, there is growing evidence that the Sleeve procedure provides good weight loss with acceptable safety. How much evidence does an insurance company need before it adjusts their criteria? Well, we have 6 year prospective data in the US, 10 year data internationally, major insurance carriers United Healthcare and Aetna now cover the sleeve, some Blue Cross insurance companies in the US cover the sleeve, our own program has over one year data on HMSA members who have undergone the sleeve and are doing well… and yet they still will not budge!
The good news is that momentum is in our favor to accept the Sleeve as a viable option for surgical weight loss with criteria similar to the Band and Bypass. But, we are going to have to be patient and wait for HMSA to catch up. I still have a hard time rationalizing why we must argue to get our surgeries covered when we know they save lives, improve quality of life, and decrease overall medical costs.
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