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McCall's WLS Article
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After Weight Loss Surgery

My Appeal Letter

February 15, 1999

Dear Review Committee:

This letter comes in response to my recent denial for surgery. I am writing this letter to appeal your
decision. I will use this forum to tell you about myself and my history as well as educate you in the
arena of Weight Loss Surgery.

I am a 36 year old morbidly obese wife and mother of three children. It is my dream to be able to go on bike rides, hikes, walks, even amusement park rides with my kids. Things the "normal" person takes for granted. When I walk from my car to my office, my heart is pounding and racing. I am so out of breath
people stare. My lower back is so painful, I can not walk for long periods, I have to stop and rest for a bit.

I suffer from severe acid reflux disease, incontinence, severe chronic lower back pain, and depression. It has been documented that all of these problems can be helped, if not cured, by losing weight. I have tried many, many diets. (I have included my diet history with this letter.) The most weight I was able to lose was 30 pounds. My BMI is 44, that makes gastric bypass surgery a medical necessity.

I am very well educated in the area of Gastric Bypass Surgery. I have been researching for months. I have been going to support group meetings where the participants are mostly post operative gastric bypass surgery patients. I also belong to a support group mailing list of over 600 members, both post-op and pre-op. I have learned a tremendous amount from all these people. I know what this surgery is and what it will do for me and my life. That is why I want and need to have this surgery. And after reviewing my family medical history, you will probably agree with me that to not have this surgery will surely lead to more severe medical problems in the future.

Here is my family medical history:

Grandmother on my mother's side died of a massive heart attack at age of 42. One of my mother's brothers died of a massive heart attack while waterskiing at age 32. Another of my mother's brother's had a triple bypass at age 37.  My mother has coronary vascular disease.  My Grandmother on my father's side had diabetes, and died of heart failure at age 67.  Obesity runs on both sides of my family.

My PCP, my surgeon, and my Psychologist all agree that this procedure is the right option for me. I also agree with them. I want this surgery. It will save my life, and give me back what life I have left. I will not give up on getting this procedure approved. I will keep coming back. However, if this surgery request is denied a second time, I will not be coming back alone. I have already spoken with an attorney, who will be representing me if the need be. So, I beg you, please approve this surgery... I will not go away.

There has been a lot of misconception about this surgery, so I have take the liberty of going to the American Society for Bariatric Surgery (ASBS) website and gathered this information for you.
Clinically severe (Morbid) obesity correlates with a Body Mass Index (BMI) of 40 kg/m2 (or higher) or with being 100 pounds overweight. Being overweight is associated with real physical problems which  are now well recognized. The most obvious is an increased mortality rate directly related to weight increase.

Obesity is dangerous to health because of the associated increased prevalence of cardiovascular risk factors such as hypertension, diabetes mellitus, hypertriglyceridemia, hyperinsulinemia and low levels of high density lipoprotein (HDL)cholesterol. Cardiovascular risk factors are reduced significantly by sustained weight reduction. Data from the Framingham study support the estimate that a ten percent reduction in body weight corresponds to a twenty percent reduction in the risk of developing coronary heart disease.

The risk for diabetes has been reported to be about twofold in the mildly obese, fivefold in moderately obese and tenfold in severely obese persons. The risk of developing diabetes also increases with age, if a family history is present and if the obesity is central.

Surgical treatment is medically necessary because it is the only proven method of achieving long term weight control for the severely obese. Surgical treatment is not a cosmetic procedure. Surgical treatment of severe obesity does not involve the removal of adipose tissue (fat) by suction or excision. Bariatric surgery involves reducing the size of the gastric reservoir, with or without a degree of associated malabsorption. Eating behavior improves dramatically. This reduces caloric intake and ensures that the
patient practices behavior modification by eating small amounts slowly, and chews each mouthful well. Success of surgical treatment must begin with realistic goals and progress through the best possible use of well designed and tested operations. These have been worked out over the last thirty years, and are now standardized, clearly defined procedures, with well recognized and documented outcome results.

Prevention of secondary complications of severe obesity is an important goal of management. Therefore, the option of surgical treatment is a rational one supported by the time honored principle that diseases that harm call for therapeutic intervention that is less harmful than the disease being treated.

The option of surgical treatment should be offered to patients who are severely obese, well informed, motivated, and acceptable operative risks. The patient should be able to participate in treatment and long term follow-up. A decision to elect surgical treatment requires an assessment of the risk and benefit in each case. Increased abdominal fat or "central obesity" (apple shaped as opposed to pear shaped) is an important risk factor associated with the major complications of obesity.

Patients whose BMI exceeds 40 are potential candidates for surgery if they strongly desire substantial weight loss, because obesity severely impairs the quality of their lives. They must clearly and realistically understand how their lives may change after operation.

Weight reduction surgery has been reported to improve several comorbid conditions such as glucose intolerance and frank diabetes mellitus, sleep apnea and obesity associated hypoventilation, hypertension, and serum lipid abnormalities. A recent study showed that Type II diabetics treated medically had a
mortality rate three times that of a comparable group who underwent gastric bypass surgery. Also preliminary data indicate improved heart function with decreased ventricular wall thickness and decreased chamber size with sustained weight loss. Other benefits observed in some patients after surgical treatment include improved mobility and stamina. Many patients note a better mood, self esteem, interpersonal effectiveness, and an enhanced quality of life. They have lessened self consciousness. They are able to explore social and vocational activities formerly inaccessible to them. Self body image disparagement decreases. Marital satisfaction increases, but only if a measure of satisfaction existed
before surgery. If marital discord exists preoperatively, the improved self image may lead to divorce postoperatively.

I appreciate your attention to this appeal. If you have any questions or need any further documentation, please call me.

Sincerely,

Debbie - Pre-Op
This was taken in August 1998

Debbie - 7 wks Post Op
Down 40 pounds 6/7/99

Debbie - 10 wks Post Op
(with my husband, Tom) Down 50 pounds 6/27/99

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