Medicare Is not going to pay for the weight-loss surgery of patients with diabetes whose BMI is lower than 35.

Centers for Medicare & Medicaid Services (CMS) suggested the coverage policy for batriatic surgery for patients with type 2 diabetes was BMI 35. The other suggestion was not to cover the surgery if its purpose is to treat type 2 diabetes with a BMI below 35.

Kerry Weems from CMS finds weight-loss operation is a life-saving option for the patients who have unsuccessfully tried to lose weight in other ways. “CMS wants to be sure that these patients have access to a solution to help them achieve a healthier weight and avoid some of the most serious complications of type 2 diabetes,” he adds.
The coverage of batriatic surgery was expanded in 2006 for Medicare patients who underwent the surgery from highly qualified surgeons. In order to get the coverage, patients’ BMI needs to be at least 35 and, next to severe obesity, have serious health issues such as coronary artery disease, osteoarthritis or hypertension.

CMS covers four types of weight-loss operations: gastric bypass, open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch.

A new suggestion is not to cover surgery for those patients whose BMI is lower than 35 even if they have got diabetes. CMS is convinced it is the right decision even if batriatic surgery is very helpful for these patients.

Comments from the public confirming efficiency of the weight-loss procedure with diabetes are being searched for.

“Limiting coverage of bariatric surgery in type 2 diabetic patients whose BMI is less than 35 is part of Medicare’s ongoing commitment to ensure access to the most effective treatment alternatives with good evidence of benefit, while limiting coverage where the current evidence suggests the risks outweigh the benefits,” said Barry Straube, the CMS MD.

The public are welcome to respond to the decision on: http://www.cms.hhs.gov/center/coverage.asp.

People all over the world tend to get fatter. On the other hand however, there is a strong social need for a healthy lifestyle in order to look good.

More and more people turn to weight-loss surgery. Researches show that ten times more people go under the knife now than ten years ago.

Mike Klostreich works in a barber shop. Greeting clients and cutting hair are possible for Mike and do not hurt now. In the past, however, when he weighted 443 pounds, even very simple every day things caused many problems.

“Literally, take 200-pound sacks of potatoes, put them on your shoulders. That`s what I was carrying.” Mike says.

Mike underwent gastric bypass surgery and got his life back. He can go out, garden, even ride a bike for the first time in 15 years. Now he’s determined not to gain unnecessary weight again. After the surgery, he started exercising and changed his diet.

Mike realizes that his stomach is much smaller after the surgery and he can’t eat that much as he used to. As he says, he used to eat constantly. “You can constantly what they call graze and that`s eat all day long,” he says. “You get done eating, eat some more, about an hour later, eat some more, so you can consume the two to three thousand calories a day or three to four without thinking about it, just by constantly eating.”

A weight-loss surgeon, Michael Schmit, warns about this eating pattern. “People really need to change essentially their whole lifestyle because if you don`t what will happen, what we`ve found over and over again is that you end up gaining the weight back,” he says.

Mike Klostreich considers his present life as a second chance. He attends a monthly support group for gastric bypass patients. It helps him and the other patients to understand why food becomes emotionally important, how to keep trim and how to adapt to a new lifestyle with exercising and healthy diet.

Every week we hear yet more stories about the rationing of life-saving drugs for diseases such as cancer and Alzheimer’s.

But these are just the tip of the iceberg: there are also thousands of patients missing out on the surgery they need, thanks to the stealthy rationing of such treatment.And what makes this even more unacceptable is that Primary Care Trusts (PCTs) seem to be trying to cover it up.
My speciality is varicose veins — admittedly, these are not life-threatening, but they’re still a debilitating, chronic and often extremely painful condition.
And yet many GPs are being told not to refer patients for treatment. Even more worrying, PCTs are also telling me to ‘bounce’ back referral letters to the GP — in other words, I’m being told to refuse to see patients.
Of course I don’t bounce back these patients. But even if I do see them, only when a patient has signs of severe skin damage or a leg ulcer will a PCT sanction surgery.
The people most often affected by the condition have jobs that involve a lot of standing — policemen, schoolteachers, hairdressers and cleaners.
Their condition has a huge impact on their everyday working lives, causing them severe discomfort from the relentless aching and throbbing of their legs.
And yet I’m being told to send them home with nothing more than a packet of compression stockings —that’s because PCTs define surgery as any kind of treatment, from traditional, open surgery to lasers and injections.
No wonder I have witnessed a 70 per cent drop in patients having surgery in the past 18 months.
The fact is that compression stockings are an unsustainable short-term fix since they’re impossible for an active person to wear for any length of time.
The irony is that varicose veins are eminently treatable.Patients prepared to put up a fight for surgery can have their case considered by an exceptional treatment panel — but all 25 patient application forms I have submitted in the past 18 months have been rejected.
By arbitrarily taking operations off the menu, the NHS is simply taking another furtive step towards privatisation.
The only option for patients is to wait until their legs are bad enough to be considered for surgery (around a third will — by which time they will be in severe discomfort).
Alternatively, they can find the £2,500 or more to have the operation privately.
COSMETIC BLISS NOTE: WE CHARGE ONLY £1995 FOR THIS PROCEDURE FULLY INCLUSIVE OF FLIGHTS, HOTEL ETC

It’s not just surgery for varicose veins that’s being restricted — uncomplicated hernias are another.
What infuriates me is that the health economists responsible for this policy hide behind those at the coal face of clinical care; they expect us to break the bad news to the patient.
To ration treatment and tie a surgeon’s hands at a time when medical science can offer successful solutions is hard enough for a GP to swallow.
But forcing patients to put up with their condition is yet another hammer blow to a health service that once promised so much and now, thanks to NHS bureaucrats, can deliver so little.

The announcement is the first stage of a new drive to encourage people to lose weight and become healthier, called Change4Life.

Experts predict that if trends continue the growing obesity problem could lead to rapid rises in the rates of life-threatening diseases like diabetes and cancer.

Last year, the Government-commissioned Foresight report warned that unless urgent action was taken half of all Britons could be obese by 2050.

Earlier this year Mr Johnson warned that heavily overweight schoolchildren faced dying eleven years younger than their slimmer classmates.

Announcing the new scheme he said: “Obesity is the biggest health challenge we face - every year 9,000 people die prematurely and a third of 11 and 12-year-olds are overweight.”

The aim of the new scheme was to create a “healthy England”, he added.

A US team found levels of white blood cells were highest in men who were unfit and overweight.

White blood cells are key to fighting infection, but high levels can be a sign of inflammation, which is linked to coronary heart disease.

The study appears in the British Journal of Sports Medicine.

“There is nothing worse than a risk factor that an individual cannot modify, but here are two risk factors - obesity and fitness - which they can do something about
Professor Tim Church
Pennington Biomedical Research Center
A team from the Pennington Biomedical Research Center carried out tests on 452 healthy men who were taking part in a long-term study of fitness.

Blood tests were taken, and analysed for their content of various types of white blood cell.

After taking account of age, the researchers found that all groups of white blood cell were lowest in the men who were most physically fit.

The greater proportion of body fat a man had, the higher his white blood cell count was.

Total white cell count was highest in men who had a combination of higher body fat and lower levels of physical fitness.

Levels were also high among men with lower body weight but lower levels of fitness.

However, a high degree of physical fitness negated the effect of extra body fat.

Full article:http://news.bbc.co.uk/1/hi/health/7669966.stm

In England, a 6.4 per cent increase means the number of people diagnosed with diabetes has broken two million for the first time. In Northern Ireland and Wales, the increase was 6.8 per cent and 6 per cent respectively, with diabetes prevalence now standing at 60,822 and 138,988. Improved recording in Scotland contributed to the biggest rise (16.9 per cent) with the recorded diabetes population now standing at 200,669 compared to 171,513.

The figures also show that there are now 5 million people registered obese in the UK compared to almost 4.8 million last year.

Truly alarming figures
“These are truly alarming figures,” said Douglas Smallwood, Chief Executive of Diabetes UK.

“Part of why we have seen such a huge increase can be attributed to improved screening from healthcare services and greater awareness amongst those at high risk of Type 2 diabetes. However, there is no getting away from the fact that this large increase is linked to the obesity crisis.

“Diabetes is one of the biggest health challenges facing the UK today. It causes heart disease, stroke, amputations, kidney failure and blindness, and more deaths than breast and prostate cancer combined.

One million pounds an hour spent on diabetes
“The NHS already spends one million pounds an hour on diabetes. The soaring diabetes prevalence will continue to put a massive strain on an already struggling NHS and unless it can respond, people’s health could spiral downwards. We need to do all we can to raise awareness of the seriousness of diabetes and help people understand how a healthy lifestyle can help reduce their risk of developing Type 2 diabetes.”

Losing weight is not easy. Gaining seems to be so quick and effortless but losing requires lots of good will and… a good plan.

Especially people with diabetes have weight issues. By losing extra ponds your blood sugar will be easier controlled, also your blood pressure and cholesterol will be lower.

How to start?

The very first thing to do is to set achievable goals. Researches show that people consider themselves to be successful after losing 50 to 100 pounds. Be reasonable and set a goal of losing 10 pounds at the beginning. Moderate weight-loss is much more beneficial especially for diabetes.

The other thing is to know your Body Mass Index (BMI). Consult the BMI table. If your BMI is less than 25, your weight is normal. If it’s between 25 and 30, you’re overweight; if it’s 30 and above – you’re obese.

Losing weight on your own is not that fun. What’s more, researches show dieting with someone else is more motivating and you are more likely to lose twice as weight as someone who diets solo.
Other researches show that joining a group for losing weight, tend to lose twice as much as people who diet alone. You can join Weight Watchers but check also local community centers, hospitals and churches for weight-loss support.

The best results for losing extra pounds give matching exercising with cutting calories. If you only cut calories, the results will not be that appealing. 250 calories a day can be burnt by a long brisk walk if only you don’t replace them with food.

Don’t leave without breakfast. It’s the best thing to start day with. What’s more, a breakfast cereal with fiber makes you fuller and helps you to eat less during the day.

Be careful with losing too much in a short period of time. Researches show that by doing that you are more likely to gain back most or all the weight. Much more effective is changing a lifestyle in order to keep the desired weight permanently. Another thing is being very careful not to deprive your organism of essential nutrients. If you need help in this matter, a dietitian might be the person to consult. Good news is that you can still eat your favourite foods if your weight-loss plan is designed by a dietitian.

Keeping a diary will definitively help in losing weight. Note down everything you eat and drink (even a small bite of the cheesecake). Noting the time and the amount of the food will also help as well as what you felt at the time. It’s a good thing to do as many people don’t realize how much they eat and why they eat. Then the diary should be reviewed with the dietitian.

As losing weight can cause bone loss, remember to supplement your diet with 500-600 milligrams of calcium twice a day.

If, however, losing weight in a natural way is not possible, consult a weight-loss surgeon. You will be informed about possibilities of losing weight via surgery, about advantages, side effects and which procedure is the best for yourself.

Weight-loss surgery gives relatively quick effects. The body adjusts to the new system and, as patients claim, they tend to lose weight with almost no effort. Unfortunately, not everything looks that good. After the initial period after the surgery, patients’ behaviour needs changing in order to achieve a long-lasting success.

As Dr. Ajay Goyal, FACS, Director of Bariatric Surgery at Overlook Hospital said: “Weight loss surgery is not the end of the weight loss process, it’s the beginning. “Gastric Bypass, Lap Band and REALIZE Band surgery is only a tool to jump start weight loss. For long term success and weight maintenance it’s important for patients to adopt a healthy lifestyle, full of exercise and nutritious choices for life.”

The very first thing to do after the weight-loss surgery is exercise. It’s crucial to maintain not only the desired weight but also to stay healthy. Patients need to remember to start by slow and simple exercises and then change them into more demanding once their ability improves. Aerobic exercises need to be done at least 4 times a week for 30 minutes.

Another thing is being aware of the type of food provided to the body. This awareness can be risen by reading the nutritional labels, counting calories and keeping a food diary. All this will make you conscious and help to evaluate the progress.

A good way of controlling the body is weighting yourself once a week. This allows to spot on the weight gain quickly and react instantly.

Losing weight is difficult and demanding. It requires lots of good will. People need to realize, though, they will gain some weight back over lifetime. It’s natural but it cannot make patients put into a place of emotional eating for comfort. If there is an eating disorder, the patient has to admit it and find out its reasons.

After the weight-loss surgery some people are afraid of food. Food is not an enemy, though. Patients should eat healthy but not to be afraid of treating themselves from time to time. It would fend off the everyday temptations.

A rule of thumb is to follow the doctor’s guidelines after the surgery. Eating three times a day, avoiding snacks, fast food and liquid calories and eating slowly are very important to maintain healthy lifestyle.

The last, but not least, thing is to visit the doctor once a year. He/she will spot on problems and treat them quickly, and perform a nutritional evaluation to make sure the vitamins and proteins are at a good level.

Obesity could cost NHS in England £6.3bn by 2015 if no effective action is taken says the Department of Health.

Local councils in England and Wales are already shelling out tens of thousands of pounds on “fat-friendly” services, like widening crematoria furnaces.

This comes as work shows obesity levels may have been grossly underestimated. The Local Government Association, which represents over 400 councils in England and Wales, says that Britain is fast becoming the “obesity capital of the world” and even more must be done to stop the nation’s waistline continuing to expand.

Cllr David Rogers, LGA spokesperson on public health, said: “It’s a massive issue for public health but it also risks placing an unprecedented amount of pressure on council services.

“Obesity is increasingly costing the council taxpayer dear. It falls to social services to care for the house-bound obese adults, to invest money in encouraging people to be active and to replace school furniture that is just too small for larger pupils.

“Council equipment and infrastructure is having to be modified to deal with a population that is getting larger and larger.”
He said social services were increasingly having to consider taking action in cases where parents consistently placed their children at risk of morbid obesity through bad diet and lack of exercise.

He called for a national debate about the extent to which it is acceptable.

Tam Fry of the National Obesity Forum said “draconian” interventions were necessary. He warned that, as a nation, we are all getting fatter and risked early death as a result.

Chief Medical Officer Sir Liam Donaldson said: “Nothing has changed in my mind about the seriousness of this threat to the country’s future health.

“In England almost two-thirds of adults and a third of children are either overweight or obese.

“Without action this could rise to nine in 10 adults and two-thirds of children by 2050.”

A US doctor says Britain’s health calculations are wrong and that three out of four adults in this country are now overweight or obese, not two-thirds.

Dr Francisco Lopez-Jimenez of the Mayo Clinic told the National Obesity Forum in London many people with a normal body mass index or BMI - the figure typically used to determine obesity - still weigh too much because this measure does not distinguish between fat and muscle, which weighs more.

His study of more than 2,000 men and women with a normal BMI found one in five still had excess body fat, which Dr Lopez-Jimenez says is a true marker of obesity.