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Gastric bypass surgery: Who is it for?

Pre-surgery requirements

If you're approved for gastric bypass surgery, your health care team will give you instructions about how to prepare in the months or weeks before the surgery. These may include restrictions on eating and drinking, undergoing lifestyle counseling to help you cope with big changes in diet and exercise, quitting smoking, and starting a supervised physical activity program.

Even after gastric bypass surgery is scheduled, it can be delayed or canceled if your health care team determines that:

  • You're not psychologically or medically ready for surgery
  • You haven't made appropriate changes in your eating or exercise habits
  • You've gained weight during the evaluation process, which makes surgery too risky

Preparing financially for gastric bypass surgery

If it's determined that gastric bypass surgery is appropriate for you, you will still have financial hurdles to negotiate. If you plan to rely on health insurance coverage for your gastric bypass surgery, you likely will need to get preapproval from your health insurance company, Medicare or your state medical assistance program — whoever you have insurance through. The preapproval process typically requires documentation from your team of doctors that justifies your medical need for gastric bypass surgery.

Different health insurers have different requirements to prove your medical need for gastric bypass surgery. Your health insurer may not cover gastric bypass surgery at all or may cover only parts of the process. In some cases, you may have to meet requirements, such as losing a specific amount of weight, before your insurance will grant approval. To avoid unpleasant financial surprises, check to see what specific services are covered. You may have to pay for some portion of the costs yourself.

Gastric bypass surgery: Is it for you?

Gastric bypass surgery isn't a miracle procedure — and it isn't for everyone. Having gastric bypass surgery doesn't guarantee that you'll lose all your excess weight or that you'll keep it off over the long term. Nor is it a way to avoid making changes in your diet and exercise habits. In fact, you can regain the weight you lose with gastric bypass surgery if you don't stick with the lifestyle changes. Still, gastric bypass surgery has helped many people lose weight and improve their health. If you think gastric bypass surgery might be right for you, talk with your doctor.

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References
  1. Collazo-Clavell ML, et al. Assessment and preparation of patients for bariatric surgery. Mayo Clinic Proceedings. 2006;81(suppl):Sll.
  2. Mun EC, et al. Surgical management of severe obesity. http://www.uptodate.com/home/index.html. Accessed Aug. 11, 2009.
  3. Ahima RS. Should eligibility for bariatric surgery be expanded? Gastroenterology. 2008;134:15.
  4. Bariatric surgery for severe obesity. National Institute of Diabetes, Digestive and Kidney Diseases. http://win.niddk.nih.gov/publications/gastric.htm. Accessed Aug. 10, 2009.
  5. Buchwald H. Consensus Conference Statement: Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third-party payers. Surgery for Obesity and Related Diseases. 2005;1:371.
  6. Flum DR, et al. Toward the rational and equitable use of bariatric surgery. Journal of the American Medical Association. 2007;298:1442.
  7. Safadi BY. Trends in insurance coverage for bariatric surgery and the impact of evidence-based reviews. Surgical Clinics of North America. 2005;85:665.
  8. Frezza EE. Six steps to fast-track insurance approval for bariatric surgery. Obesity Surgery. 2006;16:659.
  9. Collazo-Clavell ML (expert opinion). Mayo Clinic. Rochester, Minn. Aug. 24, 2009.
  10. Anderson CF (expert opinion). Mayo Clinic. Rochester, Minn. Aug. 12, 2009.

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Oct. 6, 2009

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