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From fat to free

Insurance will cover gastric bypass surgery and other treatments for obesity

Insurance will cover gastric bypass surgery and other treatments for obesity

August 02, 2004|by ANDREA ROWLAND

andrear@herald-mail.com

HALFWAY - Sam Clingan weighed 505 pounds the day of his gastric bypass surgery. His blood pressure was spiking, his legs seeping fluid, and his joints were straining under the body weight that Clingan called the result of an increasingly sedentary lifestyle.

"I used to be a be strong, muscular guy," said Clingan, 54, of Halfway. But a full-time desk job, taste for breads and fried foods, and distaste for exercise, caught up with him over the course of two decades. The 6-foot-1-inch Clingan topped out at 520 pounds a few months before his March 2002 surgery.

The snickers his obesity sometimes elicited made him want to hide himself away, he said. Despite his ailing body and self-esteem, Clingan continually failed to lose significant weight. He said he tried all the diets on the market, got hypnotized twice and worked with nutritionists at the University of Maryland Medical Center for almost five years. He got to the point where he didn't feel capable of exercising - he couldn't even climb the seven steps to his apartment without stopping for breath, he said.

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"Before my operation, I was almost ready to get a wheelchair," said Clingan, who qualified for federal disability payments because his ballooning weight squeezed out job opportunities.

Though nervous about going under the knife to have his small intestine rerouted to cut down on food absorption and his stomach reduced to the size of an egg, Clingan felt he had nothing to lose but the pounds that were killing him.

"I took the risk that I might not come out of this thing," he said. "Every surgery is dangerous, but I wasn't going to survive if I didn't have it done. I don't think I would have made it another year or two."

A worthwhile price


Though gastric bypass surgery, stomach stapling and other anti-obesity treatments generally fell outside the realm of Medicare coverage, Medicare paid the bulk of Clingan's estimated $20,000 surgery, he said. His out-of-pocket costs tallied about $3,000. Clingan said Dr. William E. Roll Jr., a Fairfax, Va.-based obesity specialist, performed the gastric bypass at less than half the cost University of Maryland Medical Center was charging for the surgery.

U.S. Health and Human Services Secretary Tommy Thompson recently announced that obesity now is considered an illness so some treatments for it can be covered by Medicare, the federal health insurance program for the elderly and disabled. Medicare announced July 15 that it will cover scientifically proven obesity treatments. Weight-loss drugs will not be covered. Health policy experts have said the change will likely put pressure on private insurance carriers to provide similar coverage.

The U.S. Centers for Disease Control and Prevention estimates that more than 60 percent of Americans are overweight or obese. Obesity is defined as a Body Mass Index, which describes body weight in relation to height, of 30 and above. Morbid obesity refers to individuals who are at least 100 pounds above their ideal body weight or have a BMI value of 39 or greater. Obesity has been linked to such serious health problems as diabetes, high blood pressure and stroke.

Though difficult at more than 500 pounds and recovering from major surgery, Clingan was walking down the hospital's hallway eight hours after the start of his surgery, he said. He left the hospital three days later. He stuck to a daily walking regimen and pureed-food diet, eating only unappetizing ice-cube-sized portions of mushy bean soup and other entrees for the first six weeks of his recovery.

"I didn't have the urge to eat," Clingan said.

Over time, he incorporated solid foods back into his diet - though he still can't eat an entire sandwich at one sitting - and the pounds continued to melt away. Clingan lost more than 250 pounds the first year after his gastric bypass. His weight has hovered around 185 pounds for the past seven months.

Sometimes Clingan feels disappointed that he can't enjoy former favorite foods like spaghetti and mashed potatoes - which these days make him nauseous - but his experience with obesity keeps his cravings in check.

"I could stretch my stomach back to the way it was, it's possible, but when I'm full, I stop eating," he said. "You've got to have willpower."

Clingan's blood pressure is now normal; his arthritis symptoms are gone; and the skin that started sagging as he lost hundreds of pounds is beginning to firm up again, he said. He now holds a full-time job at a liquor store near the home he shares with his wife of nearly 35 years.

She thinks he's getting too thin, he said. But Clingan feels great.

"I feel like a whole new person," he said. "I would do it again in a heartbeat. It's the best thing that ever happened to me. I got my life back."

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