She’d watched an acquaintance go through the process and was amazed as the woman’s body transformed in the months after surgery. “That inspired me to make the call,” said Daly, a Loveland mother of two young children who was more than 100 pounds overweight.
Her longstanding weight issues made it hard for her to keep up with her kids. She also suffered from sleep apnea and knew that more health problems were on the way. Daly learned that making the call is the first step in what can be a lengthy process.
Fortunately, the surgical weight-loss program at Poudre Valley Hospital — the only one in northern Colorado accredited by the Metabolic and Bariatric Surgery Quality Improvement Program — helps Daly and others like her through every milestone.
In all, the pre-surgical process at PVH’s Bariatric Center of the Rockies consists of six steps:
1. Contact Bariatric Center of the Rockies.
It all starts with a phone call or online query to Michelle Carpenter, the program’s patient navigator. “Prospective patients either call or fill out an inquiry form online,” Carpenter said. “Then I call or email them back.” As navigator, it’s Carpenter’s job to guide people through the six steps and beyond.
A registered nurse as well as a certified bariatric nurse, Carpenter begins by answering callers’ initial questions and, if they’re interested, telling them a bit more about the journey to come. “The process can seem daunting,” Carpenter said. “That’s why I’m here.”
2. Be screened for medical and insurance criteria.
To meet National Institutes of Health medical criteria for weight-loss surgery, candidates must have a body-mass index, or BMI, of 35 to 40 if they have a significant obesity-related health problem, such as diabetes, or a BMI of greater than 40 if they do not have a significant related health problem.
BMI is calculated using height and weight. According to the BMI charts used by the National Heart, Lung, and Blood Institute, a person who is 5 feet, 8 inches tall and weighs 197 pounds has a BMI of 30. If that same person weighed 262 pounds, he would have a BMI of 40. “People often think they’re not heavy or sick enough for weight-loss surgery,” Carpenter said, “but they often are.”
After medical eligibility comes insurance eligibility. Most insured people do have weight-loss surgery coverage but each insurance company’s criteria and deductibles are different, she said. Carpenter phones the insurance companies of medically qualified candidates to determine their particular coverage and guidelines. Some insurers require a medically documented duration of obesity, she said.
In those cases, Carpenter can help procure primary-care records. In addition, most insurance companies call for completion of a formal weight-loss program before surgery can be approved, which brings us to
3. Follow a medically supervised weight-loss program.
Not all insurance companies require this step, but many do, Carpenter said. And the program must be overseen by a doctor and document patients’ weight monthly. Usually, popular weightloss programs like Weight Watchers and Jenny Craig do not qualify unless they are followed intandem with regular doctor visits. The compulsory duration of the weight-loss program varies from insurer to insurer but generally ranges from three months to a year, Carpenter said.
Six months is typical. PVH runs a weight-loss program structured to meet insurance company criteria. Held once a month at PVH, the 90-minute class is led by a registered dietitian and a physical therapist. Carpenter also attends. A different diet- or exercise-related topic is covered each month, and participants weigh in at each meeting. Family members are encouraged to come, too, because the entire family will be affected by the lifestyle change.
“Most insurance companies don’t require participants to lose weight during this phase,” Carpenter said. “But the learning and behavior modification — such as walking a few more steps each day — often help candidates get healthier, which in turn makes their eventual surgery safer.”
While they work on this step, many candidates also choose to attend PVH’s monthly bariatric patient support group meeting alongside patients who’ve already had the surgery. Candidates learn firsthand what it’s really like to live with weight-loss surgery — both the good and the challenging aspects.
4. Complete the patient-education seminar.
This required one-time, 90-minute class walks candidates through the pros and cons of weight-loss surgery and the various surgical options. Gastric bypass and sleeve gastrectomy are the most common procedures at Bariatric Center of the Rockies, and both are done laparoscopically.
5. Meet with a surgeon.
After completing Steps 1 through 4, candidates may meet with one of four bariatric surgeons at Northern Colorado Surgical Associates, the physician practice affiliated with Bariatric Center of the Rockies. If during this appointment candidates decide to proceed with surgery, a surgery date is scheduled, usually about six weeks later.
6. Complete pre-op testing and consultations.
During the six weeks before surgery, patients complete a required psychological evaluation, have a one-on-one consultation with a dietitian, and meet with a pre-op nurse. “By the time they reach their surgery date, our patients are so excited,” said Lynelle Diede, a nurse and Bariatric Program Manager.
“They call it their new birthday.” Not everyone who starts down the road to weight-loss surgery ends up at the finish line, however, Carpenter said. Some people lack adequate insurance coverage. Others struggle to attend the monthly classes.
After receiving such extensive education, still others decide that weight-loss surgery is not right for them. And occasionally candidates succeed in losing weight on their own during the weight-loss education phase. “It was hard to wait,” Dalysaid. For her, it was a yearlong journey from that first call until surgery. “But it was definitely worth it.” She had gastric-bypass in 2011 and lost 130 pounds.
“I’m in my new life,” she said.