Denied Bariatric Surgery Due to Previous Hospitalizations?

Question Below Submitted By:  

Heather M. (a patient from White River Junction, VT, USA)

I began researching weight loss surgery in March 2011 and went to my first informational meeting April 1, 2011. I decided that I wanted to go forward and have Roux-en-Y gastric bypass and went through my local hospital to meet all their prerequisites for surgery.

I have Vermont Medicaid, and they have a requirement which was 6 months with a dietician before surgery. I met with a nutritionist, did my classes, and was set for the final steps of “Attend evaluation meetings with a nurse practitioner, dietitian, representative from Patient Financial Services, and the bariatric surgeon.”

However, at this point, in October 2011, I was told that because of my history of hospitalizations for depression, the team was removing me from the program and refusing surgery. They said if I could remain hospital-free for a minimum of 2 years, they would reconsider me for the program. I was extremely discouraged.

Last year, I called a different hospital and was told that nobody would do surgery on me until I made that requirement. According to them, any hospital would say the same thing.

I can’t seem to stay out of the hospital for longer than a year. I have been hovering between 275 and 292 pounds for the past couple of years. I can lose some, with my low being 275, but then I gain it back. I am 5’7″ and 39 years old. Am I doomed to be morbidly obese for the rest of my life?

I also have a hard time with some of what is “good for me” as I had to have all my teeth surgically removed due to them crumbling and breaking from medication side effects. I believe psychiatric medications contributed to my gaining initially….I gained 100 pounds within about 6 months in 2003. I have gained more since then, bringing me to my current weight, but it has been a much slower 30 pounds since 2003.

Can anybody help me? Is there a way to get surgery?


Bariatric Surgery Source

Expert Responses to the Question Above

Surgeon Response to "Denied Bariatric Surgery Due to Previous Hospitalizations?"

by: John Rabkin, M.D., Pacific Laparoscopy


Weight loss surgery (WLS) is a very serious permanent medical intervention that alters your body and physiology.

An assessment of a prospective WLS patient's ability to conform to the mandatory changes in both behaviour as well as medical care required for a successful outcome following WLS is a large part of the evaluation of prospective WLS patients.

If there is an inability of a patient to comply with the post WLS regimen, serious adverse health consequences may result. If there is a significant perceived risk that a patient may not be able to comply with the post WLS follow-up, that patient should not proceed with WLS until that risk is mitigated.

Consequently, in order to avoid harming their patients, WLS programs have psychologic health requirements which must be met prior to proceeding with the surgery to ensure that their patients will be capable of following through with their post WLS care.

These requirements may differ from WLS program to WLS program, although, in general, most follow similar guidelines.

In order to reach your goal of obtaining WLS, I recommend that you continue to try to meet your WLS program's outlined requirement of a minimum of a year without psychaitric hospitalization.

It is possible that an alternative WLS program may consider you a candidate without achieving that specific requirement, although it would appear to be in your best interest to avoid WLS until your psychiatric illness can be satisfactorily controlled as your WLS program has mandated.

John Rabkin, M.D.

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.


Patient Responses to the Question Above


by: Yvonne McCarthy

Heather I'm not properly qualified to give you better answers and even if I were I couldn't possibly know your entire story.

I can tell you that those rules were put in place for your safety.

You spoke about hormones and there is so much information about what happens to our hormones after surgery.

It can be a very tough time and adding people into the fray who are already having a tough time is very dangerous.

The rules are there to protect you even if it doesn't feel like it. I'm sorry there isn't someone who could better explain it to you.

I have seen so many outcomes after surgery and read about even more.

There are some studies about WLS and suicide so they have to be very careful who they approve for surgery.

I wish you the very best.

I hope you'll be able to get what you want and I hope you understand they have these rules in place for a reason.

Best of luck.

my answer...

by: Heather M.

I go to a psychiatrist once a month for med management. Most of the time, that, and therapy once a week, is fine...occasionally, my hormones get out of whack or something and I start considering suicide. I usually end up in the hospital for 4 or 5 days....they sometimes tinker with my meds while I'm there, sometimes not...usually it's extra support and I get my head on straight again and am fine.

I don't think, if people who know me much better think I can handle this, that I should be prevented from doing it. It's kind of a possible death sentence in itself. "Gee, sorry your health is bad, and we know everyone else supports you in this, but we have to look out for our statistics and you could be a failure and make us look bad."

Here's my suggestion

by: Yvonne McCarthy

Can you possibly just go to your therapist to adjust meds so they can keep you out of the hospital or do those two things mean the same thing? If so...I don't know how you could fight it but it seems that if the ONLY way you can get your meds adjusted means you have to go to the hospital, it doesn't seem fair.

Let me know if that's the case.

I'm very familiar with ECT because of my brother.

I sincerely hope you can get this done.

It will make you healthier but like you say you have to get around the rules. Thanks, Y

further clarification

by: Heather M.

I have been in therapy for most of the last 32 years. I have been on many different medications, and even done ECT (Electro-Convulsive Therapy) more than once. I do not expect WLS to make me happy, just healthier. I have mild sleep apnea, mild stress urinary incontinence, Poly-Cystic Ovarian Syndrome, fatty liver disease, and high cholesterol.

I have resigned myself to the fact that I may have to go into the hospital once a year or so to get my meds adjusted and get stabilized. My therapist and psychiatrist of the last 5 years support me getting weight loss surgery. They think I can handle it. The hospitals don't care. They seem to only be concerned with statistics, not with who I really am.

Depression and WLS

by: Yvonne McCarthy

Heather I can certainly relate.

I am 5'7" and had my WLS 12 years ago when I was 47.

Medicaid rules are very strict. I know it doesn't seem possible but weight loss surgery will not make you happy. I have lost half my weight and have worked super hard and not regained.

It is a struggle every single day.

I have been volunteering in the community since the beginning and while it is true that most obese people are depressed to some degree, many are still depressed after weight loss.

I still fight depression but if I work very hard to have an attitude of gratitude it seems to go a bit easier.

Weight loss surgery is not an easy way out but for me it was easier than all the diets I did for 30 years that didn't work.

I lost 100 pounds 100 times.

I know 2 people who lost 200 pounds on their own only to gain it all back plus more.

If someone had told me before surgery that losing the weight wouldn't make me happy I would have not believed them.

After the first year when you quit losing you have to work very hard on not regaining. I have talked with so many people who were more miserable over a 30-40 plus pound regain than when they were at their heaviest even though they had still kept off over 100 pounds.

You haven't said exactly why you were admitted to the hospital but I'm wondering if you have access to a therapist? you have to go to the hospital in order to get meds adjusted or be seen by someone? I want to say I'm not a doctor...I have been involved in the community full time for a long time and there is a lot of concern about people with severe depression having surgery.

It's primarily due to a less than desirable outcome in those cases.

Maybe you can do some extra work and do what it takes to stay out of the hospital for the required amount of time. You will need to be in the best shape possible before you tackle surgery.

Take it slow, do it right, you've still got time.

Like I said I was 47 when I had surgery and I am better for that.

I hope you will find a way in your own time.

I have known many people who tried to get surgery for over ten years before they got it so you are not alone.

About denial

by: Lucy

Could it be because you have such a long history of hospitalizations?? More than just a few

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