Education

Weight loss 1 month after surgery predicts long-term success!

Recently I attended a lecture by Dr. Dana Portenier, a respected bariatric surgeon from Duke University. He spoke about a study published by their practice showing that a patients success after weight loss surgery can be predicted as early as at the 1 month post-op visit.

In the graphs below, you can see that for a patient with a BMI under 50, if they have lost 6% of their excess body weight at the 1 month visit, they will be in the bottom 5th percentile at 36 months. A patient who has lost 26% of excess body weight, on the other hand, will be in the 95th percentile!

Weight Loss At First Post-operative Visit Predicts Long-Term Outcome Of Roux-en-Y Gastric Bypass Using Duke Weight Loss Surgery Chart

Surgery for Obesity and Related Diseases 8 (2012) 556-550

This is something that I’ve always suspected but have never seen presented in such an elegant fashion. You might ask, what is percent excess body weight loss? In order to know this, you must first know what your excess body weight is. This is simple: your excess body weight is your current weight minus your ideal body weight. You can look up your ideal body weight multiple ways, such as here.

So let’s say you weigh 250 lbs and your ideal body weight is 150 lbs. This makes it easy, as your excess body weight is 100 lbs! If you lose 50 lbs then you have lost half (or 50%) of your excess body weight. Surgeons will often abbreviate as 50% EWL or 50% EBWL.

Here is an excellent article that will help you figure out what your excess body weight loss is, and you can refer to the graph above to see where you fall on the curve.

One of our goals at JourneyLite Physicians is to provide the best outcomes for our patients, and given this data we have opted to change our post-op follow-up protocol to require:

monthly visits for the first year after surgery
visits every 3 months during the second year
visits every 6 months starting in the third year and beyond

We feel that more closely-spaced appointments will help patients stay on track better and give them every opportunity to succeed!

Click here to request a follow-up appointment.

Infosession

Meet Dr. Curry online!

Navigator

Interactive Online Weight Loss Navigator

eStore

Protein, Vitamins, & More!

Supervised Diet Tips

by DrCurry Leave a Comment

Reverse BMI Calculator

Insurance Tips

Supervised Diet Manual

Supervised Diet Tips

Supervised diets are frequently required by insurance companies prior to authorization for weight loss surgeries such as gastric sleeve or gastric bypass. There is no data published that shows supervised diets improve any outcomes whatsoever. However it is still very common for patients to have to go through a 3-month or 6-month program and demonstrate an overall weight loss from start to finish. Here are some tips to ensure a smooth approval process for your weight loss procedure!

How many visits are required?
- The vast majority of plans require either 3 months or 6 months. Some require none at all. Rarely, plans will require more than 6 months. Work with your insurance team or call your carrier to find out exactly how many is required for your specific plan.
Will they count your initial consult?
- Some carriers will allow you to count your initial consultation as your first supervised diet visit. Others exclude it and don’t start counting until the next visit. Find out what your policy requires so you can plan properly.
Are any specific weight loss goals are required?
- Some plans just require that you complete the specific number of supervised diet visits. Others require an overall weight loss from start to finish. It is uncommon, but not unheard of, for there to be a specific weight loss requirement. You need to know for sure so that if a goal is required, you can make sure you it.
With whom can you do your supervised diet?
- Sometimes you have to do your supervised diet with your surgeons office. Other times it’s required to do it with someone other than your surgeon. Don’t waste your time by doing your supervised diet with the wrong doctor! If you are going to do your supervised diet with your PCP, here is a helpful form to take to each visit to make sure documentation is complete.
What is your BMI minimum?
- All policies will have a certain BMI which you must be above in order to qualify for surgery. Most of the time this is:
  - A BMI of 35-40 with at least two weight-related issues (diabetes, sleep apnea, etc) OR
  - A BMI above 40, regardless of weight-related issues
- Find out what your policy requires and whether you have qualifying weight-related issues, and find out what your weight would be at that minimum BMI to make sure you don’t drop below that. If you do, it would most likely disqualify you from approval. You can use a reverse BMI calculator to help you figure this out.
Are there any other requirements?
- Does your policy require a letter of support from your PCP, thyroid labs, or drug testing? Most don’t, but some do so you need to know! As an example of what can be required, here is the Obesity Surgery Precertification Request Form for Aetna.
Make sure you have a visit each month, but not more than once per month.
- Make sure you come in for a supervised diet visit around every 4 weeks, but not twice in one month. For example, let’s say you came in for supervised diet visits on January 1st, January 31st, and March 1st. Your carrier would most likely say you skipped February, even though you were coming in around every 4 weeks. A visit January 1st, February 1st, and March 1st would solve this problem, even though there is only a 1-day difference in the middle visit!
Make sure your last one is really your last one!
- After your complete what you think is your final supervised diet visit, make 100% sure that it really is the last one needed. If there is any uncertainty whatsoever, do another one the following month. If for any reason it is determined that you needed one more, and more than a month has passed since your last one, you have to start over at the beginning!

Navigating a supervised diet requirement is not difficult once you get all the facts, so make sure you have gathered all the proper requirements for your plan. If you have any questions or unsure about any of your requirements, please email our insurance team at insurance@curryweightloss.com.

Band-To-Sleeve Conversion with Medtronic’s New Signia Smart Stapler

by DrCurry Leave a Comment

Band-To-Sleeve Conversion

Band-to-sleeve conversion is becoming a more popular procedure amongst weight loss surgeons. The gastric band, once the most popular weight loss surgery in the world, has worked well for many patients over the years. However, some patients either had issues requiring removal of their band, or perhaps didn’t achieve their weight loss goals due to the limited power of gastric banding in higher BMI patients. At JourneyLite, we have done over a thousand successful band-to-sleeve conversions and we typically find fantastic success in most patients who undergo this procedure. While it is a little more complicated than a routine gastric sleeve, in experienced hands it can be done safely and most of the time in a single operation. Take a look at this video, recorded by Dr. Trace Curry at JourneyLite Surgery Center in Cincinnati, to learn more about band-to-sleeve conversion surgery!

40% Reduction in Risk of Death and Cardiac Complications After Weight Loss Surgery

by DrCurry Leave a Comment

Recently the Cleveland Clinic published a paper in JAMA looking at 2300 patients who underwent weight loss surgery (gastric sleeve, gastric bypass, gastric band, or duodenal switch) compared to 11,500 matched patients with similar medical issues who did not have surgery.

The endpoint of the study was the occurrence of one of the following: death, coronary artery events, cerebrovascular events, heart failure, atrial fibrillation, or kidney disease. They looked at these patients over an 8 year period and their findings were striking: patients who had one of the above weight loss surgeries were 40% less likely to experience on of these major complications.

This study adds to a growing body of evidence that shows some amazing reductions in mortality (and various other serious medical issues) cause by obesity.

JourneyLite Physicians offers all of the procedures featured in this study, some of which can be done on an outpatient basis with minimal down time or missed work. So schedule a consultation to meet with one of our experienced weight loss surgeons in Ohio and start on a pathway to a healthier life now!

JourneyLite and Medtronic’s New Signia Smart Stapler

by DrCurry Leave a Comment

JourneyLite has adopted the use of Medtronic’s new Signia smart stapling system for our linear staple lines. This high-tech new stapler uses Adaptive Firing™ technology, which gives the surgeon real-time feedback, measuring tissue thickness and adjusting firing speed based on the tissue’s thickness and variability. This technology results in outstanding performance in variable tissue, leading to the formation of more perfect staple lines.

Watch Dr. Trace Curry, medical director at JourneyLite, perform a gastric sleeve using this new, state-of-the-art, stapling device!

Gastric Sleeve, Dr. Trace Curry-Cincinnati Ohio

Saxenda: A New Injectable Weight Loss Medication

by DrCurry Leave a Comment

Saxenda: A New Injectable Weight Loss Drug

Other Weight Loss Medications

Saxenda (generic: liraglutide) is derived from the diabetes medication Victoza. Researchers found that patients who were on Victoza frequently lost a small amount of weight. Eventually, studies were done utilizing Victoza at double the regular dose and its effect on weight loss, and results revealed that patients who were taking Saxenda lost more weight than those on a placebo, and the results were statistically significant. This led to FDA approval of a 3mg dose of Victoza for weight loss, but under the name Saxenda.

Saxenda is injected from a pre-filled pen with a dial to adjust the dosage, similar to many diabetes medications. The dosage is increased gradually over several days until 3mg is reached. Generally the medication is well-tolerated, with the most common side effects being nausea and diarrhea. Patients on Saxenda will be required to have monthly office visits to meet with a medical provider and a registered dietitian.

Saxenda works by interacting with GLP-1 receptors in your body. GLP-1 (glucagon-like peptide) is an appetite hormone that is naturally produced in humans that helps to regulate hunger. Saxenda works like GLP-1 by regulating your appetite, which leads to decrease calorie consumption and therefore weight loss.

Saxenda, being a new medication, can cost upwards of $1000/month for patients without insurance coverage, so it is important to explore your options. Patients are advised to call the Saxenda coverage hotline at 888-809-3942 to find out about coverage prior to requesting an appointment.

It is always exciting to see new treatment options for weight loss coming to fruition, and JourneyLite Physicians is proud to be on the forefront of fighting the disease of obesity!