Ireland Army Community Hospital

Should I have surgery to lose weight?	Tricare Benefits
What surgeries are available?	Bariatric Support Group Meetings
Do I qualify for the IRACH Surgical Weight Loss Program?	Handouts and Forms
How do I begin the process?	Additional Resources
What do I need for my first appointment with the surgeon?	Mission Statement
	Program Statement

Should I have surgery to lose weight? [BACK TO TOP]

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.

What surgeries are available? [BACK TO TOP]

The bariatric procedures currently being performed in the program are Adjustable Gastric Banding, using the Allergan's Total Care LAP-BAND System, and Open or Laparoscopic Sleeve Gastrectomy.

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.

Image of a Lap-Band Device
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.

Do I qualify for the Surgical Weight Loss Program? [BACK TO TOP]

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:

o BMI of 35 or greater with co-morbidities

o BMI of 40 or greater without co-morbidities

o We currently do not perform surgery on patients above 400 lbs. BMI restricted to females with BMI of 60 or less, and males with a BMI of 55 or less.

o Calculate your BMI: http://www.nhlbisupport.com/bmi/

· Active duty personnel cannot have weight loss surgery as
mandated by DOD

o Retired military

o Dependents of military members (Active Duty or Retired)

· You must be between the ages of 18-60 years

· 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? [BACK TO TOP]

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).

What do I need for my first appointment with the bariatric surgeon? [BACK TO TOP]

Preparing for your office visit:

Once your initial evaluation appointment has been scheduled, there are several steps you need to complete. Please follow all instructions carefully, and contact us with any questions or concerns.

Print out and complete the Medical Questionnaire, This completed form needs to be turned in at the time of your initial office visit. Failure to complete the form will result in a delay in your service.
Please review Bariatric Introductory Seminar Presentation. (Click PDF or PowerPoint) to view. Once you have reviewed the presentation you will need to print the Certificate of Completion at the end of the presentation and also turn in during your initial visit. Please note that failure to present the Certificate of Completion will result in your evaluation appointment being cancelled. Completion of the Bariatric Introductory Presentation is a mandatory program requirement.
7-10 days prior to your scheduled appointment you will need to have your labs drawn. Ireland Army Community Hospital’s Laboratory is located on the 1^st floor of the hospital. The lab work must be done in a timely manner so that the results will be available to the bariatric surgeon so that he may review them with you on your scheduled visit.
All patients being evaluated for bariatric surgery will require a Nutritional Evaluation. You may call 502.624.9834 to schedule your evaluation with the Nutrition Care Division. Also, all perspective patients will require a Swallow Study to determine any abnormalities and problems that may complicate bariatric surgery. To schedule your Swallow Study, please call the Radiology Department of Ireland Army Community Hospital at 502.624.9621
When your appointment is scheduled, the Bariatric Nurse Coordinator will provide you a list of additional diagnostics that you may need. Please follow all instructions.

We look forward to meeting with you, and providing assistance to you during this evaluation process. By following all instructions, it helps ensure that your scheduled appointment will be timely and productive for you and your bariatric surgeon.

Tricare Benefits [BACK TO TOP]

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

Support Group Information [BACK TO TOP]

Graphic image of three green apples
Bariatric Support Group Meetings
"It's a New Life, Live it Well..!"
2nd Tuesday of Every month at 1800 MEDDAC Classroom
Contact Information: (502) 624-0624

Handouts and Forms [BACK TO TOP]

Additional Resources [BACK TO TOP]

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