INSURANCE COVERAGE
Many health insurance plans, including Medicare and most Medicaid plans, cover bariatric surgery for weight loss. In many cases, nutrition counseling and other noninvasive therapies are less likely to be covered by insurance, or have a limited number of sessions covered, particularly if the patient does not have an obesity-related illness, such as Type 2 diabetes, according to a study by the National Institutes of Health.
Weighing 365 pounds, Michael Strutton decided to get gastric bypass surgery. He started the process for this life-changing weight loss surgery last fall by meeting with a bariatric doctor, undergoing a psychological evaluation and obtaining one-on-one nutrition counseling.
Dr. Arvinpal Singh, medical director of the Emory Bariatric Center, stressed the importance of eating nutrient-dense foods to achieve long-term weight loss success. Something clicked. Why wait for surgery? Strutton thought to himself.
Instead of steaks and potatoes, Strutton filled up on leafy greens, mushrooms, chickpeas, fresh berries. He started walking around the parking deck at work. When he went to see Singh a month later, he got on the scale: He had lost 37 pounds. At the next month’s appointment, Strutton was nearing his surgery date, but found he was another 35 pounds lighter, so he canceled the surgery.
But he didn’t wave goodbye to the Emory Bariatric Center. Instead, he continued to go to the medical weight loss center every month for ongoing support. He wanted to stay on track, but his track would now be a nonsurgical one. Increasingly, bariatric doctors and hospitals, including Piedmont, WellStar and Northside, are offering comprehensive weight loss services. Those include not only surgical options, such as gastric bypass surgery and lap band surgery (involving the placement of an adjustable belt around the upper portion of the stomach), but also nonsurgical programming. That means nutritional and behavioral counseling, group therapy and meal replacement programs.
Andrea Addington, system clinical nutrition manager at Northside Hospital, said the demand for nutrition counseling overall has jumped 36 percent during the past six months. Registered dietitians, she said, customize counseling aimed at educating patients about food and nutrition as well as helping patients work through a variety of eating-related challenges such as emotional eating.
Major points covered in counseling include the following: the importance of a support system, of eating everything in moderation (and not depriving yourself), and to try to not be discouraged when the weight loss slows down or even halts.
These services come at a time of soaring obesity, with about 35 percent of American adults now obese, according to the Centers for Disease Control and Prevention.
Of the patients who go to the Emory Bariatric Center, Singh estimates about 80 percent want weight loss surgery. Only 40 percent of that group actually get the surgery, and for all sorts of reasons. In some cases, patients don’t qualify: They don’t follow the pre-surgery requirements, such as passing a psychological screening or following a special diet. They might move or hit a snag with insurance coverage.
But there are also those who decide they don’t want to go under the knife, or in rare instances, they are like Strutton, a 39-year-old morbidly obese man who found success on his way to surgery. Now 40, he recently dropped to 203 pounds, below his original goal, and is now shooting for 180 pounds.
The number of bariatric surgeries performed in the United States has steadily risen over the years and jumped from 158,000 in 2011 to 173,000 in 2012. But the numbers have tapered off recently with the number in 2013 up only slightly at 179,000.
Weight comes off for people who have bypass surgery, and in fact, patients generally lose two-thirds of their excess weight within two years. Research also shows weight loss surgery not only helps people lose weight but also reduces the risk of cardiovascular disease. It can help with managing, even eliminating, Type 2 diabetes.
But the surgery is not a panacea. People who undergo the procedure have difficulty absorbing vitamin B-12 and iron, so they require monitoring of food intake and nutritional supplements to prevent deficiencies.
Singh said while there are times when surgery is reasonable, such as when a person is morbidly obese, has exhausted other weight loss methods, and has life-threatening heart woes, going under the knife should always be a last resort. And ultimately, he said, the long-term success of weight loss — with or without surgery — requires a shift toward healthy eating, and the earlier a person can embrace a healthier lifestyle, the better.
“Contrary to what you have been told, you don’t have to starve yourself to lose weight, and you don’t have to count calories and you don’t have to go low-carb and you don’t have to measure food,” Singh said. “All you have to do is nourish your body the way it is supposed to be nourished, and your body can take care of the rest.”
Since last fall, Strutton has met with Singh monthly to discuss his progress. He gets his vitals checked, including his blood pressure and heart rate. His blood is tested for cholesterol. And he gets on the scale every month. Early on, Strutton read the book “Eat to Live” by Dr. Joel Fuhrman, and it revolutionized the way he nourished his body. He got a Fitbit activity tracker and set a goal of 10,000 steps every day. Then he started running. And he recently starting playing tennis again.
Along the way, Strutton opened up about his weight loss journey on Facebook as a way to hold himself accountable. He enjoyed the words of encouragement.
Strutton eats vegetable stews with chickpeas or Northern beans. He enjoys raw cashews as an occasional treat.
When he was morbidly obese, he was so sluggish, he felt like he had the flu. Now, “I have more energy than I know what to do with,” he said.
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