Bariatric Surgery Program

	National Capital Area Surgical Weight Loss Program Last updated:  3/12/2012

Should I have surgery to lose weight?	Tricare Benefits
Active Duty option for weight management	Support Group Information
What surgeries are available?	Do I qualify for the NCA Surgical Weight Loss Program?
Exercise Physiology and Physical Therapy (WRNMMC) 301-295-4065	How do I begin the process?
	Handouts / Forms / PCM Materials

Should I have surgery to lose weight?

Recent research indicates many patients are unable to achieve and maintain large amounts weight loss without the assistance of weight loss surgery.

Along with the burden of obesity often times these patients are plagued with diseases associated with excess weight. These diseases are referred to as co-morbidities and include:

• hypertension
• diabetes
• sleep apnea
• GERD
• joint pain
  

Co-morbidities may be reduced or eliminated by weight loss.

The goal of the bariatric program is to provide assistance to patients who may benefit from significant weight loss and have had little success with more conservative treatment methods.

Tricare Prime retirees and dependents who meet specified criteria are eligible for the bariatric surgery program.

Active Duty option for weight management:
http://www-nmcphc.med.navy.mil/Healthy_Living/Weight_Management/shipshape_overview.aspx

What surgeries are available?

The bariatric procedures currently being performed in the program are laparoscopic gastric banding, laparoscopic sleeve gastrectomy, and open or laparoscopic gastric bypass.

All procedures are very effective but differ in surgical technique, dietary modifications, lifestyle changes, medical monitoring, and risk to the patient.

Each patient is unique and in consultation with the bariatric surgeon will determine the best surgical procedure.

Laparoscopic Gastric Banding is the least invasive but effective weight loss procedure. It is the safest procedure. In this procedure an inflatable silicone band is placed around the upper portion of the stomach.  The band is tightened around the stomach by injecting saline into the adjustable band. The tightened band creates a small pouch of the upper stomach which restricts the amount of food the stomach can hold, resulting in weight loss.

Laparoscopic Sleeve Gastrectomy is another very effective surgical weight loss procedure in which the stomach is stapled and part of the stomach is removed. The remaining portion of the stomach is called a sleeve. The sleeve remains attached to the small bowel and digestion occurs normally. The small stomach fills quickly allowing the patient a feeling of fullness, reducing the food intake resulting in weight loss.

Gastric Bypass is the most invasive and most effective weight loss surgery. In this procedure the stomach size is reduced to a pouch, and the upper portion of the small bowel is bypassed. Weight loss occurs by reducing the amount of food intake into the smaller stomach and by the GI tract's reduced ability to absorb calories and nutrients.

Following bypass surgery, the patient will require lifetime medical monitoring for nutritional deficiencies and supplemental vitamins and minerals.

http://www.uptodate.com
http://www.webmd.com/diet/weight-loss-surgery/gastric-bypass

Do I qualify for the NCA Surgical Weight Loss Program?

The eligibility criteria for a consultation with one of our bariatric surgeons are as follows:

• BMI is a method of classifying body mass into categories used to predict morbidity and mortality.  BMI is calculated as follows: weight in kilograms divided by height in meters squared.
  BMI Criteria:
• BMI of 35 or greater with co-morbidities
• BMI of 40 or greater without co-morbidities
• We currently do not perform surgery on patients with a BMI of 50+ or >400 lbs.
• Calculate your BMI: http://www.nhlbisupport.com/bmi/
• Active duty personnel cannot have weight loss surgery as
  mandated by DOD
  
  • Retired military
  • Dependents of military members (Active Duty or Retired)
• You must be between the ages of 18-64 years
• We only accept patients with Tricare Prime
• You must not be pregnant or lactating
• Without multiple serious medical complications related or unrelated to weight

Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. For more information, view the Health Affairs Policy 07-006.

How do I begin the process?

The road to weight loss surgery begins with an appointment with your Primary Care Manager (PCM). Your PCM is going to play a vital role should you and he/she decide weight loss surgery is the best choice for you. You must keep in close contact with him/her. Your health maintenance needs to be up-to-date with optimization of current medical problems needs. If you had a diagnosis of H. pylori in the past you must have documentation that it was treated.

If you meet the criteria listed in the previous section and have been unsuccessful with other methods of weight management, have your PCM enter a consult to the General Surgery Clinic entering “bariatric surgery” as the reason for consult. On that referral, your doctor will need to include the following: your actual weight at the time of the visit, highest weight, height, BMI, and co-morbidities (other conditions caused by obesity).

Bariatric studies to be ordered by PCM after the patient is accepted into National Capital Area Surgical Weight Loss Program and attends the Bariatric Seminar

PCM to coordinate:		Time Frame Test Valid
Contraception		Contraception should not be taken within 4 weeks prior to surgery
CBC		Labs Baseline Nutritional Status Valid within 1 yr
Complete Metabolic Panel		Valid within 1 yr; if no active problems
Lipid Panel		Valid within 1 yr
Vit D(calcidiol/25-hydroxy Vit D		Valid within 1 yr
HB A1c if diabetic ; must be < 8.5		Valid within 1 yr; if no active problems
Vit B12/Folate		Valid within 1 yr
Serum Thiamine		Valid within 1 yr
Iron studies		Valid within 1 yr; if no active problems
Serum ferritin		Valid within 1 yr
TSH		Valid within 1 yr; if no active problems
PTH		Valid within 1 yr
Colonoscopy beginning at age 50		Valid within 2 yrs; current with recommended screenings
Mammogram-females beginning at age 40		Annual; current with recommended screenings
Cervical Pap beginning at age 18		Valid within 2 yrs; current with recommended screenings
PSA- Prostate Specific  Antigen-beginning at age 50		Annual
Ultrasound of Right Upper Quadrant of Abdomen if gallbladder present		Valid within 1 yr.
H Pylori		Valid within 2 yrs; if + must be treated
EKG-males beginning at age 40: females beginning at age 50		Valid within 6 mo. of surgery date
Cardiac Risk Stratification e.g.  echo?		Valid within 6 mo. documentation of surgical clearance required
Sleep Study		Valid with  2 yrs
CPAP/Bi PAP		If indicated in report
Dietician NCA approved Only		3 pre-op bariatric visits and explicit recommendation for surgery
Exercise Therapist		Within 1 yr.
Support Group-NCA only while actively in program		2 support pre-op and life long participation
Studies coordinated by Bariatric Surgery
GI-endoscopy and PH/Mannometry		Within in 2 yrs
Psychiatry		Within 1 yr

Tricare Benefits

TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions:

• Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints
• Is 200 percent or more over ideal weight for height and bone structure
• Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown)

TRICARE does not cover:

• Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction
• Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity

For more information concerning Tricare Benefits please refer to the website below:
http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Gastric+
Bypass&topic=Men

Exercise Physiology and Physical Therapy (WRNMMC) 301-295-4065

Required Consults:
Exercise Physiology and Physical Therapy

Our Exercise Physiologist and Physical Therapist are members of the multidisciplinary team caring for you in the NCA Bariatric Surgical Weight Loss Program.
Through research in their field, their expertise lies in evaluation muscle response to activity and maximizing its positive effect on the body. This information enables them to formulate exercise programs for professional athletes as well as with patients suffering from cardiac conditions, asthma, chronic obstructive pulmonary disease, or bariatric patients with various limitations in their ability to exercise in the normal sense. In collaboration with your surgeon and other team members, they develop a customized exercise program for you. Their program will assist you in developing techniques and movements to improve your mobility and body strength.
Exercise, as a requirement of the weight loss program, is a key element in achieving and maintaining long term success in managing a healthy weight. This program will assist you in incorporating exercise into your lifestyle. Services are available at WRAMC. Please call 301-295-4065 for an appointment or more information. .
WRNMMC Authorized Work Hour Fitness Time for Civilians

Support Group Information

WRAMC Bariatric Support Group

Every Wednesday
Time: 6:00-7:00pm
Location: Bldg 10, Room #7037
POC: Adam Hunzeker email:adamhunzeker@yahoo.com
Carla Schnitzen

Every 2nd and 4th Friday of each month
Time:  11:00am-12:00pm
Location: General Surgery Conference Room
             Bldg 9, 1st Floor Room 1211
POC: Elizabeth Lynch 301-400-256

DeWitt Army Hospital
1st Tuesday of each month
Time:     4:30pm-5:30pm
Location: Main Conference Room
To sign up for Support Group please call 571-231-3369

Family Health Center of Woodbridge
3rd Tuesday of each month
Time:       4:30pm-5:30pm
Location:  Education Classroom, Military ID holders only
To sign up for Support Group please call @ 703-491-7668

PREGNANCY IS SAFER AFTER BARIATRIC SURGERY

Handouts

Nutrition and Exercise Log Websites (PDF)
Pre-op eating behaviors (PDF)
Nutrition for Bariatric Surgery Presentation ( PDF)
Bariatric Infomation Session Presentation (PDF)
Weight loss Surgery Nutrition Guidelines booklet (PDF)
Nutrition Appointment Numbers (PDF)

Forms

Pre-surgical nutrition questionnaire (PDF)
Bariatric Surgery Preop Checklist (v20120105) (PDF)

PCM Materials

An overview of our process (v100318) (PDF)

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