Bariatric Surgery: Lindsey G's Story - CECity

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ut water exercises at the YMCA are thebest for my back. It may not sound likemuch, but now we park as far away fromthe store as we can just to get the extra stepsin. I do everything I can to keep my bodymoving, because there were so many thingsthat I could not do, but now I can. Nothingis going to stop me now!Lindsey explained the reactions she hasreceived from people since her weight-losssurgery:People tell me every time they see me that Ilook like I have lost weight since they sawme last. They are motivated by me andwant to lose weight too. I tell them to startinside their home, and then change outsidetheir home. You cannot eat whatever youwant and think that you can walk it offafterward—that isn’t how it works. Youhave to change how you eat first. Portionsize it so important, and also exercise. Youhave to continually push yourself.When asked to describe her currentmedical problems, she said, “The onlyproblem I still have is back pain. Myphysicians want me to have back surgery,but I am going to continue to lose myweight first. I do not want anything to getin the way of my goal. I am 294 poundsnow, but my goal weight is 150 pounds.”Lindsey stated that she has had noadverse effects from her bariatric surgery.She summarized the impact that thesurgery has had on her life as follows:I can do so much more. I am so muchhappier. I can jump rope now and shootbaskets with my son and nephew. LAGBhas done so much for me. But really, it wasjust the beginning, because you still have toexercise and eat right. For it to be a success,a combination of things has to happen.LAGB will work for anyone who does whatthey are supposed to do. I know people whogot the Lap-band and you just want tosmack them, because they were not ready totake it seriously. It isn’t what they did, it iswhat they didn’t do. They didn’t eat right,didn’t exercise, and didn’t do their part.They are heavier than they were before thesurgery. What a waste of money!“The only problem I stillhave is back pain. Myphysicians want me to haveback surgery, but I amgoing to continue to losemy weight first.—Lindsey G.Lindsey paid $2500 for her bariatricsurgery, while insurance covered theremaining $14,000. She explained thestruggle of paying for the surgery:It was a long process. I have Medicaid andMedicare, but a secondary insurance wasrequired and I had Blue Cross/BlueShield. So I thought I was completelycovered, but 2 weeks before the surgery,they [Blue Cross/Blue Shield] said Iwasn’t. They said they were sorry andthere was nothing they could do. Theywould cover gastric bypass, but not Lap-Band, but I didn’t want that [gastricbypass] surgery. At one point, I called thehospital to cancel my surgery, because Idid not have the 10% that was notcovered, but the surgeons let me do apromissory note, and now I just pay $100each month until it is paid for.Photos in this article include models who do not representactual patients.24 AOA Health Watch DOs Against DIABETES May 2012
11, 2007. Department of Health & Human Services,Surgeon General website. http://www.surgeongeneral.gov/topics/obesity/calltoaction/1_2.htmAccessed March 3, 2012.4. Miller W. How effective are traditional dietary andexercise interventions for weight loss? Med SciSports Exerc.1999;31(8):1129-1134.5. Picot J, Jones J, Colquitt JL, et al. The clinicaleffectiveness and cost-effectiveness of bariatric(weight loss) surgery for obesity: a systematicreview and economic evaluation. Health TechnolAssess. 2009;13(41):1-190,215-357,iii-iv.6. FDA expands use of banding system for weight loss[press release]. Silver Spring, MD: US Food andDrug Administration; February 16, 2011.http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm245617.htm. Accessed February25, 2012.7. Dixon JB, O’Brien PE. Health outcomes of severelyobese type 2 diabetic subjects 1 year afterlaparoscopic adjustable gastric banding. DiabetesCare. 2002;25(2):358-363.8. Andrews RA, Lim RB. Surgical management ofsevere obesity. UpToDate website.http://www.uptodate.com/contents/surgical-management-of-severe-obesity. Accessed March 2,2012. HWFinal notesIn January 2012, Lindsey weighed 294pounds, and her BMI was 44.7. She is righton track for expected weight loss. Studiesshow that after LAGB surgery, a substantialnumber of patients have lost as much as43% of their excess weight at 12-yearfollow-up. 8The decision to have bariatric surgeryshould be made only after the patient hastried other modalities for weight loss, andthe physician needs to consider eachpatient’s individual circumstances beforeThe decision to havebariatric surgery should bemade only after the patienthas tried other modalitiesfor weight loss.recommending or agreeing to such surgery,with due deliberation given to the risks.Although beyond the scope of the presentarticle, there are many contraindicationsfor, and complications of, bariatric surgery.In response to the question of whatmedications she currently takes, Lindseyproudly said, “I’m only taking prenatalvitamins.” Her primary motivation forhaving the surgery was to become healthyenough to not need medications. She hasreached her goal and has discontinuedevery medication she had been taking forher previous comorbidities of obesity.Lindsey’s life was changed dramaticallyafter having LAGB surgery. She remainsdedicated to contributing to her weight lossthrough diet and exercise. She also plans toparticipate in organized walks to raiseawareness and money for diabetes mellitusresearch. Lindsey is determined to stayhealthy, which she believes will help herbecome a better mother.References1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalenceof obesity in the United States, 2009-2010. NCHSData Brief. January 2012, No. 82. Hyattsville, MD:National Center for Health Statistics. DHHSpublication (PHS) 2012-1209. http://www.cdc.gov/nchs/data/databriefs/db82.pdf. Accessed March 3,2012.2. Obesity and overweight, fact sheet, updated March2011. World Health Organization website.http://www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed March 3, 2012.3. The Surgeon General’s call to action to prevent anddecrease overweight and obesity, revised JanuaryJaclyn E. Allred, OMS IV, will receive her DOdegree from Kansas City University of Medicineand Biosciences in May 2012, along with amaster’s degree in bioethics. In 2012, StudentDoctor Allred participated in a medical missionto Guatemala, along with Dr. Desai. InGuatemala, she served as the student leader forthe mission, which was conducted inconjunction with DOCARE International. She willbe entering a psychiatry residency program atthe University of Kansas in July 2012.Gautam J. Desai, DO, is an associate professorin the Department of Family Medicine at KansasCity University of Medicine and BiosciencesCollege of Osteopathic Medicine in Missouri.He is a Fellow of the American College ofOsteopathic Family Physicians, and serves onvarious committees for the AmericanOsteopathic Association, American College ofOsteopathic Family Physicians, NationalOsteopathic Board of Medical Examiners, andother organizations. He can be contacted atGDesai@kcumb.edu.Acknowledgments: Wethank our patient (left) andher family for participatingin the interview used inthis article.May 2012 DOs Against DIABETES AOA Health Watch 25
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