PCP Against WLS

I'd been getting SO excited about the possibility of the sleeve surgery - I'm 51, have many health problems (some of which are weight related), and have struggled with weight since age 7.  I went to my primary doctor this morning and asked him about WLS - years ago I'd asked him about it so I knew he's not really "for it" - but I'd hoped that with my medical conditions and extreme obesity (BMI 55) he would reconsider. But he didn't

He gave me a long talk about how WLS is NOT the answer and if it really "worked" everybody would be doing it. He feels it is just a temporary fix like dieting is and I asked what about all these people on these forums that it seems to have worked for and he said these forums are made up of people who are "for" these surgeries so of course they will seem positive. huh?? Anyway - I asked him well what IS the answer then? And he started talking about a counselling center in town that specializes in getting to the roots of eating disorders and that this would be his suggestion - to fix "the real problem" which is overeating. He also said he has 3 morbidly obese patients who HAD gastric bypass surgery and are now morbidly obese again - he feels they are no better off.

Needless to say, I felt pretty bummed about his attitude. I even shared how I've joined 2 online forums and read 3 books to learn all about this and that at this point in my life I feel it may be the "lesser of two evils" since I have diabetes, sleep apnea, etc. I don't know. I really love him and have seen him for about 15 years now so I wouldn't really want to switch... BUT - ?? I don't know. Just a bummer

I went threw the same thing, and the only advice I can give you is DO NOT WAIT to change your pcp.. I waited and I regrett it with my whole heart. I had been with this dr for almost 25 years and hated to give up that relationship but 1 1/2 years ago I did it, and there was no looking back! It took me a year to get all my ducks in a row because the insurance had me jumping threw hoops, then changed criteria..one thing that screwed me up was that you had to see a dr for weight loss every month, I thought as long as I got in on that month I was good, but nooooo, they wanted if I seen dr on the 10 I had to see dr every month before the 10th..anyway thats a whole nother story.. I say if you want this surgery find another pcp, I did and Im glad that I did, just dont wait years like I did.. Good luck. I know its  hard thing to do but you have to do it for you!

 I have had a couple of PCPs in the past few years (one left for another job) and they, plus my GI doc are HUGE proponents of WLS, primarily RNY.  I see docs that are part of a large medical center practice.  And, if the surgeons don't think WLS is right for you, they won't do it.

Here, the various WLS practices offer free seminars to explain the procedure.  Check to see if those types of seminars are offered in your area, then go to all of them and check out the docs. There's also a section on this site that has reviews of docs.

Talk to the surgeons about your options, then go from there!

Good luck in your journey! 

I would change PCP's, tenured or not. It is your life, it is your choice. WLS is not a quick fix and I hate knowing that a Dr is so ignorant to something so serious. This is a lifetime committment to becoming and sustaining health so that you can prolong your life...you would think a Dr would be on board with that. 

 I would find another PCP ASAP. There are many physicians out there who would recommend WLS.. It wasn't even on my radar, until my PCP suggested it to me. I am eternally grateful for him for recommending WLS to me, and I am so glad that I had an open mind to do the research. I am so much healthier, active, and happier. I feel and look like a different person. My severe sleep apnea is gone, no longer pre-diabetic, no joint issues, BP is within normal range, labs are great.

I wish you success in finding a more receptive PCP.



Gail

His experience is limited. He is NOT a specialist in the field of bariatrics.

Love or hate him, he is not supporting your life to better health. Would you pay the guy at the Toyota service shop to do an oil change on your Ford just because you love him? NOPE, you are paying this doctor for a service and for him to support you in your efforts to gain health, lose weight.

You can do both, seek counseling for your eating issues and have surgery.

NOT every flipping fat person is a food addict. I'm not, and I have zero compulsive tendencies when it comes to food or eating, I do not eat to soothe, comfort or numb me. Therefore, my issues were portion control and learning to eat the right foods and getting my head screwed on straight meant being diligent with a structured food/meal plan.

I would be looking for a new PCP but I do understand you don't want to to that.

If you need his referral for surgery, I would go back to him with
Age 51, BMI of 55, comorbidities---I know I have allot to lose; I've lost weight xxx times before but have gained it back; I understand that WLS surgery isn't the fix but a tool to help lose and more importantly maintain; I do need to work on head issues. Can you give me the referral for WLS and to the counseling center. 

If he doesn't respond positively or you don't need his referral, I would just move forward with finding a surgeon and working with the counseling center.

Good luck.

 That's sad. My pcp totally supported me and said I would do great.   My bmi was 35. 

And just for reference EVERYONE might not be doing it, BUT here's some stats for the increase in number of bariatric surgeries just in the U.S.

This DOES NOT account for all the self pay patients who leave the country for surgery:

http://www.news-medical.net/news/20091209/More-number-of-obese-adults-are-turning-to-bariatric-surgery-as-a-last-resort-says-WHO.aspx

The number of bariatric surgeries has increased at an average rate of 20% annually over the past 15 years. Procedure volumes have ballooned from a minimal number in 1993, to an estimated 350,000 in 2009. This translates into sales of $517 million for surgical devices used in bariatric surgery, or a 21.6% increase over 2008 sales. Although growth has slowed somewhat since 2007, it is still increasing at double-digit rates today and Kalorama forecasts 13.4% growth through 2013. Women, especially in their late 30s to early 40s, account for the lion's share of bariatric procedures.

"The sheer number of people battling the bulge, with no end in sight to the health crisis, predicates continued strong growth in the volume of bariatric surgeries," notes Kalorama Information analyst Melissa Elder. "This in turn will create opportunity for makers of devices used in these surgeries."

http://www.facs.org/news/jacs/bariatric0811.html

Number of Laparoscopic Bariatric Procedures Continued to Rise Between 2003-2008

Journal of the American College of Surgeons Study Shows Number of Laparoscopic Procedures Significantly Increased, Inhospital Mortality Rate Dropped

CHICAGO (August 8, 2011) – According to a study published in the August issue of the Journal of the American College of Surgeons, there was an increase in the number of laparoscopic bariatric procedures, an increase in the number of bariatric surgeons and a decrease of inhospital mortality rates between 2003 and 2008. During the past decade, the field of bariatric surgery has changed dramatically and the authors concluded that these trends are due, in part, to an increase in the use of laparoscopic techniques and a greater acceptance of bariatric surgery by patients.

“We’ve identified a national trend in the use of bariatric surgery that is tied to the rapid expansion of the laparoscopic approach to bariatric surgery and the laparoscopic adjustable gastric banding operation," said Ninh T. Nguyen, MD, FACS, chief surgeon for the Division of Gastrointestinal Surgery with University of California, Irvine Healthcare and the study’s lead author. “Many reports we looked at documented the long-term survival and metabolic benefits of bariatric surgery and these benefits are having an impact on patients' willingness to accept bariatric surgery as an option for the treatment of morbid obesity."

Using data from the Nationwide Inpatient Sample (NIS) from 2003 through 2008, the study authors found that the number of bariatric operations peaked in 2004 at 135,985 cases (63.9 procedures per 100,000 adults) and reached a plateau at 124,838 cases (54.2 procedures per 100,000 adults) in 2008. The proportion of laparoscopic bariatric operations increased from just over 20 percent in 2003 to more than 90 percent in 2008 and the inhospital mortality rate for these procedures decreased from 0.21 percent to 0.10 percent.

The researchers also identified a considerable swell in the number of bariatric surgeons during the six-year study period. Bariatric surgeons with membership in the American Society for Metabolic and Bariatric Surgery (ASMBS) increased from 931 to 1,819 representing a 95 percent increase.

With regard to the procedure****ting a plateau in 2004, Dr. Nguyen concluded it was likely due to a decrease in patient demand or increased difficulty for patients to access bariatric surgery, possibly tied to lack of insurance coverage.

The median age of patients studied who underwent bariatric surgery ranged from 42 to 45 years, with 79.2 percent to 82.6 percent female and the proportion of Caucasians ranged from 71.3 percent to 78.2 percent. The study sample represents approximately 20 percent of U.S. community hospitals and includes public hospitals and academic medical centers.

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

 

In you're in Florida, look into Dr Thomas Bass...