My opinionated responses common WLS questions

I have spent a good bit of time over the past six years in the bariatric surgery support network. There is a recognizable pattern in the WLS support networks. The typical person engages in the conversation for a year or so as a post-op. Life moves on, the pounds have been shed, and support is seen as not a necessity.

Several questions pop up frequently in this community. It has been a while since I have weighed in on them. Here are my opinionated answers to the big three pre-op and post-op questions. My answers at six years post-op are heavily based on my life experiences and my life in the WLS community. They have definitely evolved over time.

Big 3 Pre-op WLS Questions

  1. Why won’t insurance pay for my WLS? This is a complicated question. Two factors largely influence your personal coverage. Your employer contracts with a health insurer on an annual or multi-year basis. They opt into coverage based on risk and cost. Actuaries have calculated the risk of serious illness based on obesity risk factors and priced the coverage accordingly. Your employer determines whether they are willing to add this cost to their insurance cost. Secondly, many employers see WLS as a temporary fix and not a permanent solution. They fail to carry this coverage based on this WLS and obesity prejudice.
  2. How much weight will I lose? WLS clinics promise a large weight loss in their advertisements. The slim person sells the dream that WLS will make the prospective patient look the same. The reality is that some people will lose a lot. Others will lose less. The average WLS patient loses 50-70% of their excess body weight. Keep in mind that is an average. Pre-ops need to focus more on how they will define success after WLS other than by the pounds on the scale.
  3. What surgery is the best? Bariatric surgery is evolving. WLS medical research over the decades is helping surgeons understand what works in sustaining weight loss. There is no one answer. This is something the pre-op need to discuss with their doctor and bariatric surgeon. Everyone’s bodies and lives are different. It is through the patient’s research and honest discussions with bariatric professionals that the person and surgeon together arrive at their best option. Keep in mind that the surgery is the tool to enable greater changes under the patient’s control.

Big 3 Post-op WLS Questions

  1. How do I stop weight regain? As I mentioned above, surgery is the tool that enables weight loss. It is the patient who needs to sustain weight loss. Make no mistake. The answers to this question are difficult. The standard bariatric diet needs to be followed. The patient needs to follow bariatric post-op guidelines. An active life helps keep the pounds down. All of these factors rely heavily on the patient breaking bad habits learned through life. It involves the patient making a commitment to change their life. The post-op needs to fully invest their energies and mindset into being a new person.
  2. Why is my life not what I expected after WLS? Each of us has dreams on what life will be after WLS. Many of our dreams are driven by images in the media. Those images of are slim people who are always happy. Losing weight does not always equate to happiness. Post-ops can struggle with poor body image. Years of being seen as somewhat of a social outcast remains in the back of their minds. Forging a new life after WLS takes work. It may take some professional counseling. Again, this is not an easy answer. It is one that the post-op needs to look deeply into the root causes and take the appropriate action.
  3. My WLS failed. Will my insurance pay for a revision? My response to the first pre-op question, “Why won’t insurance pay for my WLS?” applies to this question. However, there is a twist to that response. It is true that the risk and cost associated with the risk is a determining factor. WLS prejudice is also rampant in this question. Revision surgery is seen by many as failing in WLS. Employers typically will not pay for a “second chance” at losing weight. Insurers and employers will pay for revision surgery when it is medically necessary. If the WLS failure puts the person at risk, it must be reversed for the person’s health and well-being. If your health related problems with your WLS are well documented and your health is genuinely at risk, you stand a better chance of having your revision surgery paid.

Tom Bilcze

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