I know most of you reading these Health Tips are health oriented, possibly a little overweight, some post-pregnancy and others due to Covid inactivity, nothing too serious.
But if you happen to know someone who’s seriously obese, this Health Tip could change their lives. Consider finding a way to get this information to them.
Doctors classify people as seriously obese by using the Body Mass Index (BMI), calculated from your weight and height. It’s not perfect (if you’re mostly muscle you’ll already know that muscle weighs more than fat and hence the BMI results don’t apply to you), but it’s a reasonably good way to determine your health risks based on how fat you are.
You can use this calculator to easily determine your BMI. Just add your height (in feet and inches) and your weight in pounds. Hit the Compute BMI button and you’ll get a number you can compare to the categories at right.
An obese person has a BMI of around 30 and a morbidly obese person (80 to 100 pounds overweight) runs a BMI of around 40.
If you find yourself in the overweight group, you can get your avoirdupois under control if you set your mind to it by trying a ketogenic diet, intermittent fasting, and exercising. You’ll lose 5 to 10% of your weight over the first few months, but, as so many people know, the pounds often return.
The wisest choice is not to “go on a diet,” but rather to re-educate yourself on healthier eating, meal timing, and exercise. A good nutritionist can help. I can recommend both Olivia Wagner and Becca Zachwieja.
Don’t give up hope
People who are obese often have given up hope. Many have been fat since childhood or adolescence, have been scolded by everyone from parents and peers to physicians, have tried every conceivable diet, and sometimes just say, “This is it. This is my life.”
Perhaps they’re diabetic, have chronic back or knee pain, or have to use a CPAP machine for sleep apnea, all complications of obesity.
These are also the people who (sometimes privately, sometime publicly) have considered surgical intervention. They wonder what it be like to be thin, or at least a more healthy size.
I support surgical weight loss
Right up front, let me say I’m a major fan of surgery for weight loss, mainly because I’ve seen the results in my own patients and, just as important, know some of the statistics about disease reduction, patient satisfaction, and longevity.
The two most popular procedures are the sleeve gastrectomy, which removes 80% of your stomach, and the mini Roux-n-Y gastric bypass, which shrinks your stomach and reduces the amount of calories and fat your small intestine absorbs.
After the surgery, you will definitely lose weight. A woman I spoke to recently went from 350 pounds to 165 and she was, as you can imagine, quite pleased. The patient satisfaction rate after bariatric surgery is 85%, which is very high. Why it’s not 100% reminds us that we’re all psychologically more complex than resolving one single issue.
Interestingly, the satisfaction rate for weight-loss surgery drops to 77% after seven years, except among patients who exercise regularly. For them it remains firmly at 85%.
Making healthy choices after surgery is as an essential part of the process.
Insurance companies don’t get it
It’s well known that bariatric surgery dramatically reduces the risks for all the diseases linked to obesity: diabetes, heart disease, high blood pressure, sleep apnea, osteoarthritis, and fatty liver. Knowing this, and knowing how expensive these conditions are over the years of treatment required, common sense would tell you that insurance companies would cover bariatric surgery in a heartbeat.
Unfortunately, quite the opposite is the case.
I looked at a variety of websites hosted by Chicago medical centers that perform bariatric surgery and it really is difficult to get a clear sense of pricing. Using your health insurance is a long and drawn-out process, often requiring appeals letters written by different physicians saying you’ve tried and failed to lose weight or that the surgery is “medically or psychologically necessary.”
Some insurers offer partial coverage, which means your insurance company chooses what to cover and the sky’s the limit for hospital add-on costs. Insurance company denial rates seem high. Additional appeals include peer-to-peer review (in which your doctor talks to the insurance company doctor). One site even suggests hiring an attorney to contest denials.
An attorney? Wow. Bet my insurance doesn’t cover that.
Although the price of the procedure itself seems to be around $20,000, that’s for the procedure alone and nothing else. You still have all the pre-op costs, lab work, anesthesiology, etc.
One patient who had been denied coverage simply asked the hospital what the total cost would be–cash price, period–and was told to expect to pay around $45,000 to $50,000.
Toronto is a 90-minute flight from Chicago
Now that to me is excessive, and so here is my Health Tip in short: go to Canada for the surgery.
Patients from around the world have sought out private surgical specialty hospitals in Canada for years. The physicians are well-trained and highly experienced, the hospitals pristine, and the costs a fraction of US prices.
Take a look at Smart Shape Weigh Loss Center as one example, though there are others. When I last looked (pre-pandemic), the total cost with no add-ons, was around $15,000 Canadian. You might consider getting a health loan from your bank or borrowing against your 401K.
Remember, any prices you’re quoted will be in Canadian dollars. Conversion to US dollars will reduce costs 20%. There’s more here.
David Edelberg, MD