Overview

Did You Know?
If you are overweight, you are not alone. The Centers for Disease Control and Prevention (CDC) reported that more than 60 million people in the U.S. suffer from obesity [1].

We already know that dieting, behavior modification, weight loss drugs, supplements and medications have had limited success rates for successful long term weight loss results.

It is estimated that last year more than 1,000 U.S patients traveled abroad for bariatric weight loss procedures including the Lap-Band® system, gastric bypass, gastric sleeve, and gastric balloon insertion (GBI).

Obesity can take an enormous psychological toll on individuals who deal with repeated failures with dieting, limited access to public conveniences, prejudice, and even ridicule. The rate of depression in the morbidly obese is ten times that of the non-obese population. Obese individuals often face discrimination at work. This unfair reality can affect being hired for a job or getting a promotion and it can skew perceptions about overall job performance.

But Why Travel for Bariatric Surgery?
As with many other goods and services, the global marketplace has given rise to competition in weight loss surgery. Within the healthcare universe the result as been the creation of a three dimensional reality for consumers when traveling internationally for medical services: a rise in higher quality care; an opportunity for dramatic cost-savings; and a level of superior service and patient experience.

Definition

Bariatric surgeries are surgical procedures performed to treat obesity by modifying the gastrointestinal system to restrict food consumption and/or inhibit nutrient absorption.

Obesity refers to a health condition in which a person has an abnormally high proportion of body fat. An estimated 61.3 million American adults (30.5 percent) are obese. Severe obesity is also on the rise. An estimated 9.6 million adults have a body mass index (BMI) of 35-40, while six million American adults are morbidly obese (BMI 40 or greater) [2].

Surgical Procedures

BridgeHealth’s World-Class Provider Network™ offers the following bariatric procedures. If you do not see your particular need listed here, please contact a Travel Care Coordinator to discuss further options.

Gastric Lap-Band® (Laparoscopic Adjustable Gastric Banding or LAGB)
Traditional gastric bypass surgery dramatically reduces the size of the stomach by partitioning off a small section at the top of the stomach using a series of staples. In Gastric Lap-Band® weight loss surgery, an inflatable silicon band placed around the top end of the stomach replaces the staples and restricts the amount of food the stomach can hold. Unlike traditional gastric bypass surgery, this is a reversible, minimally invasive surgical procedure.

Gastric Bypass, Roux-En-Y (RNY or RNYGB)

This procedure combines restrictive and malabsorptive surgical methods to achieve weight loss. The RNY procedure involves dividing the stomach to make a small pouch, which limits how much one can eat or drink during a given period of time. The first 100-150 centimeters of small intestine are rerouted in such a way as to “bypass” food absorption in that portion of intestine. Bile from the liver and enzymes from the pancreas don’t mix with the food to aid digestion until after the first 100-150 centimeters in intestine. An open abdominal or minimally invasive, laparoscopic, surgical approach can be used.

Gastric Sleeve/Sleeve Gastrectomy

This surgical procedure induces weight loss by restricting food intake. The surgeon removes approximately 60 percent of the stomach laparoscopically so that the stomach takes the shape of a tube or "sleeve." This procedure is usually performed on superobese or high-risk patients with the intention of performing another surgery at a later time. This is a non-reversible surgical procedure.

Vertical Banded Gastroplasty

Vertical banded gastroplasty is a restrictive surgical technique for managing obesity. The surgically formed pouch limits the amount of food a patient can eat at one time and slows passage of the food. This is a non-reversible surgical procedure.

Duodenal Switch (also known as Bilio-Pancreatic Diversion or DS)

A weight loss surgery that alters the gastrointestinal tract with two approaches: a restrictive aspect and a malabsorptive aspect. It is a non-reversible surgical procedure.

New Advances

Intragastric Balloon and Implantable Gastric Stimulation Device
The implantable gastric stimulation device uses small electrodes attached to the stomach to create the feeling of fullness using electrical stimulation [5]. The intragastric balloon (Gastric Balloon Insertion or GBI) is a simple procedure that can be performed through an endoscope. The balloon is designed to “take up space” and thereby decrease the amount of food patients can eat [6]. Both of these procedures, while interesting in their simplicity, have not produced enough documented long-term weight loss. However, as these procedures are potentially much safer than other operations, they may have a significant role in the future.

Staged Procedures

Surgeons are devising cutting-edge procedures to decrease the complication rate in high-risk patients with extreme obesity or severe medical co-morbidities. Some surgeons are using a staged approach to bariatric surgery [7]. This approach involves two steps: first, a less invasive procedure that reduces weight to a safer level (which is not effective enough on its own) and improves overall medical condition; second, a more complex, definitive procedure is performed once the operative risks of the patient decrease significantly due to the initial weight loss. The primary, less invasive stage could include such procedures as the sleeve gastrectomy, the gastric balloon, and the adjustable band as an interim step before a gastric bypass or duodenal switch is performed [8].

Support and Aftercare

Medical Aftercare
Some follow-up care may be necessary once you return home. BridgeHealth has 33 postoperative care follow-up centers in the US for returning Lap-Band® patients and 81 US offices for postoperative care follow-up for returning gastric bypass patients. These offices are available to our clients for both pre- and postoperative care. We can help arrange a wide variety of aftercare needs including post-procedure checkups, prescription services, and even higher levels of care if necessary. Your Travel Care Coordinator will review your aftercare concerns, discuss your options with you, and arrange care if necessary. Also, your overseas surgeons will always be available for you to contact.

Emotional Support
Some bariatric surgery patients elect to join support groups. This helps them develop a social network and has been shown to improve chances of successful long-term weight loss after surgery. If you are interested in joining a support group when you return home, your Travel Care Coordinator can provide you with contact information for groups in your area.

Additional Considerations

Weight loss surgery (WLS) is not without risk. The risks of surgery must be weighed carefully against the benefits of weight loss. Any major surgery carries risks of bleeding, infection, blood clots, or pulmonary embolism – any of these can be minor, serious, or even life threatening. In addition, gastric bypass surgery carries specific risks, including but not limited to: hernia, gallbladder problems, bowel obstruction, and leak or narrowing of the anastamoses (where the bowels are hooked back together after being re-routed.) Risks of the Lap-Band® system are slippage or erosion. Women of childbearing age must avoid becoming pregnant for one to two years after surgery. Nutritional deficiencies during the rapid weight loss period after surgery could harm the developing baby.

Are You a Candidate for Weight Loss Surgery?

If your BMI is 35-39, you may qualify for surgery if you have weight-related medical conditions such as:

• Diabetes (type II)
• High blood pressure
• Sleep apnea
• Gastroesophageal reflux
• Depression because of obesity
• Degenerative arthritis

If your BMI is 40 or greater, you may qualify for surgery without having any of the medical complications listed above. First, it should be determined that you have exhausted attempts at dieting and medically supervised weight loss. Surgery is not meant to be a first line treatment for obesity, but rather a seriously considered alternative when more conservative treatment has failed.

You must be ready to make a lifelong commitment to change your habits. You must commit to significantly altered eating habits, a routine exercise regimen, and lifelong medical follow-up. If you smoke you must quit prior to surgery – it doesn’t make sense to treat the number two cause of preventable death (obesity) if you continue the number one cause of preventable death (smoking).

According to the American Society of Metabolic and Bariatric Surgery the Roux-En-Y gastric bypass, Lap-Band® system, and duodenal switch have each withstood appropriate scrutiny. Only through careful research and discussion with a qualified bariatric surgeon can a patient decide which procedure may be best for his or her condition.

Know Your Surgeon
BridgeHealth has gone to great effort to select the highest caliber surgeons across the globe. Our nursing staff attends surgeries in overseas operating rooms, observes the quality of aseptic techniques, and interviews the surgeons and their peers.

At home or abroad, you should feel comfortable asking your surgeon questions and discussing your procedural options, while being confident in your surgeon’s ability to assist you with your condition. A surgeon’s certifications, education, experience, and ability to communicate with you are factors you should consider in deciding if he or she is right for you.

As the premier international healthcare service provider, BridgeHealth carefully selects centers of excellence for our World-Class Provider Network™. Many facilities are accredited by bodies such as the Joint Commission International (JCI), TRENT, ISQua, etc. and are largely staffed by Western-trained, board-certified physicians.

BridgeHealth invites you to ask us about any data available for you to perform healthcare comparison-shopping and to personally evaluate provider services. We can answer any of your questions regarding your surgeon’s qualifications and experience as well.

Special Assistance
Please let your BridgeHealth nurse or Travel Care Coordinator know if you have any special needs for assistance with walking, standing or sitting, assistance with a wheelchair, toileting assistance, urinary catheter care, or help with activities of daily living such as washing or showering. BridgeHealth can help arrange any special assistance you may need.

Destinations

The following countries feature members of our World-Class Provider Network™ who perform bariatric procedures.

Brazil - This tropical South American country offers first-world medical care while being home to beautiful natural environments, including the lush Amazon Rainforest.

China - While China boasts a rich history as one of the world’s oldest continuous civilizations, the country’s medical technology is often at the cutting edge, at times besting that of its western counterparts.

Costa Rica - With its white sand beaches, generous hospitality, affordable luxuries, and medical expertise, this geographically desirable Central American nation is an ideal destination for many procedures.

India - Home to the Taj Majal, this Asian country is not only a popular tourist destination, but also features highly skilled doctors, a modern medical infrastructure, and the latest medical technology.

Mexico - Long a favored vacation getaway, Mexico offers a friendly culture, a relaxed pace, a comfortable climate, and the opportunity for many high-quality procedures.

Panama - Featuring numerous nature-oriented sightseeing opportunities, Panama’s capital of Panama City is the safest and most modern metropolitan area in Central America. Panama boasts a high percentage of US-trained doctors and is a relatively short flight from many major US airports.

Singapore - The Asian island nation of Singapore places an emphasis on technology and patient safety within its medical industry. Formerly ruled by the British Empire, English is widely spoken in this tropical country known for its rich culture and pristine cleanliness.

Taiwan - Located off the coast of mainland China and featuring a mostly mountainous terrain with lush tropical vegetation, Taiwan’s blend of Asian and Western cultures places an emphasis on high medical standards.

Thailand - The Kingdom of Thailand’s tropical setting features beautiful waterfalls as the backdrop for both traditional and modern architecture. Physicians in this predominately Buddhist country often receive specialist training in the United States and Europe.

Turkey - Situated between Europe and Asia, Turkey is home to Istanbul, one of the most significant cities in ancient and modern history. Today, Turkey’s medical industry features state-of-the-art facilities and many Western-trained physicians.

How BridgeHealth Works

As the premier provider of medical travel services, BridgeHealth International, Inc. (BridgeHealth) is dedicated to empowering you with all of the information you need to make your trip successful.

BridgeHealth understands that the prospect of traveling abroad for medical procedures can be an overwhelming experience. Because we place such a premium on the continuity of communication and care, we provide you with your own experienced Travel Care Coordinator who can help you in a way that is tailored to your exact wants and needs. Your Travel Care Coordinator is your personal contact through every step of the process and can assist you by:

• Helping you complete our Short Form Inquiry, and arranging for a BridgeHealth Nurse to talk with your international surgeon
• Planning your dates of travel including arranging for the lowest airfare possible with complimentary airport pick up, ground transport and airport drop off and ground transport to and from your consultation when you discuss the risks of surgery, your trip to the hospital for surgery and post-procedure visits with the doctor.
• Scheduling your appointments in your destination country
• Helping with passports, visas and immunizations
• Providing you with your pre- and post-procedure instructions and being available if you have questions about them.
• Answering all your questions about costs, length of stay, cultural issues abroad, what to pack, and what kinds of incidental costs you may have to plan for (ex: taxis, shopping or sightseeing tours)
• Arranging for ongoing updates on your condition with your family and friends while you are away
• Coordinating follow-up medical services for your return home

In addition to your Travel Care Coordinator, you can also speak with a BridgeHealth Registered Nurse who can answer your questions about specific medical procedures or conditions. Your nurse will also be involved in coordinating your care with your surgeon(s).

To get started, please see the Get Started: Build Your Bridge Today section.

Pricing

Rest assured that BridgeHealth has negotiated the best prices available. There are no added fees for using our Travel Care Coordinators. We are here to help reduce your stress and assist you with making the best, most informed choice possible.

The cost for your procedure depends upon the particulars of the procedure itself, the destination, and your specific medical condition. The information you provide on your Short Form Inquiry can help us give you the most accurate price range for your procedure. Generally, prices for bariatric procedures range from approximately $6,200 to $13,000 USD.

Get Started: Build Your Bridge Today

Your journey into international healthcare starts by providing us with the information we need to best assist you. Please begin by filling out our Short Form Inquiry. If you are unsure about how to answer any questions on the form, a BridgeHealth Travel Care Coordinator will be happy to assist you with any questions or concerns.

After your Short Form Inquiry is complete, a Travel Care Coordinator or BridgeHealth Nurse will review your information with international surgeons and contact you within 24-48 hours. This allows us to give you the most precise pricing estimate, tailored to your exact wants and needs.

If you prefer to speak with someone immediately, or need assistance completing your Short Form Inquiry, you can reach us by phone toll free from the US and Canada at 800.680.1366 or +1.303.457.5759 from other countries. Our on call coordinators and nurses are available 24 hours a day, 7 days a week for emergencies and to assist clients abroad. All non-emergency inquiries are assigned to a coordinator immediately and calls are returned the same day received.

References

1. “The Link Between Physical Activity and Morbidity and Mortality,” Centers for Disease Control and Prevention, http://www.cdc.gov/nccdphp/sgr/mm.htm

2. US Census 2000; NHANES III data estimates

3. Med Care. 2006 Aug;44(8):706-12.Healthcare Utilization and Outcomes After Bariatric Surgery. Encinosa WE, Bernard DM, Chen CC, Steiner CA.

4. Agency for Healthcare Research and Quality: AHRQ Study Finds Weight-loss Surgeries Quadrupled in Five Years. Press Release, July 12, 2005

5. Shikora, SA. Implantable Gastric Stimulation for the Treatment of Severe Obesity. Obes Surg. 2004; 14:545-8.

6. De Luca M, Segato G , Busetto L, et al. Progress in Implantable Gastric Stimulation: Summary of Results of the European Multi-Center Study. Obes Surg. 2004; 14 Suppl 1:S33-9.

7. Regan JP, Inabnet WB, Gagner M, et al. Early Experience with Two-Stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-Super Obese Patient. Obes Surg 2003;13:861-864.

8. Nguyen NT , Longoria M, Gelfand DV, et al. Staged Laparoscopic Roux-en-Y: a Novel Two-Stage Bariatric Operation as an Alternative in the Super-Obese with Massively Enlarged Liver. Obes Surg. 2005; 15:1077-81.

9. Centers for Disease Control and Prevention: National Center for Chronic Diseases Prevention and Health Promotion. “Overweight and Obesity: Health Consequences.”

10. Institute of Medicine. Lohr KN, editor(s). Medicare: a Strategy for Quality Assurance. Vol. 1. Washington, DC: National Academy Press; 1990. p.

11. National Institutes of Health. Definition of obesity. In: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, Maryland: Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, 1998. Available from URL; http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm.

Helpful Links

ASMBS - American Society of Metabolic and Bariatric Surgery

Association for Morbid Obesity Support

WeightLoss Surgery Options (from the makers of the Lap-Band®)

National Institute of Diabetes & Digestive & Kidney Disease

Glossary

Cardiovascular disease (CVD) is any disease of the heart or blood vessels or any abnormal condition characterized by dysfunction of the heart or blood vessels.

Cholecystitis is inflammation of the gallbladder

Cholelithiasis is the presence or formation of gallstones in the gallbladder or bile ducts.

Cholesterol is a soft, waxy substance manufactured by the body and used in the production of hormones, bile, and vitamin D. It is present in all parts of the body, including the nervous system, muscle, skin, liver, intestines, and heart. Cholesterol regulates membrane fluidity and functions as a precursor molecule in various metabolic pathways. However, too much “bad cholesterol” (low-density lipoproteins) may cause arteriosclerosis, the buildup of plaque on the artery walls.

Congestive heart failure (CHF) is a condition marked by weakness, edema (fluid retention), and shortness of breath that is caused by the inability of the heart to maintain adequate blood circulation in the peripheral tissues and the lungs.

Type II Diabetes. More than 80 percent of type II diabetics have complete resolution of their diabetes, and many others have greatly improved control.  This usually occurs within a few weeks of surgery for gastric bypass patients, and slightly longer for Lap-Band® patients.  Patients are usually able to come off their medications including insulin injections and return to normal blood glucose and Hemoglobin A1C levels.

Cost savings are reductions in all or any portion of the costs of providing goods or services.

Diabetes. Any of several metabolic disorders marked by increased blood glucose, excessive discharge of urine, and persistent thirst.

Diabetes mellitus. Elevations of blood sugar due to deficient insulin production or action.

Inflatable silicone band. Approved by the FDA in June 2001, the Lap-Band® is the newest and only adjustable and completely reversible surgical treatment for morbid obesity in the United States. It induces weight loss by reducing the capacity for food and drink in the stomach. Since its clinical introduction in 1993, more than 200,000 Lap-Band® weight loss surgeries have been performed around the world. Like a wristwatch, the band is fastened around the stomach to create a smaller pouch that limits and controls the amount of food the patient eats. It also creates a small outlet that slows the emptying process in the lower half of the stomach and intestines. As a result, patients experience an earlier sensation of "fullness" and are satisfied with smaller amounts of food.

Hypertension/High Blood Pressure. After bariatric surgery, over 70 percent of patients are able to come off all of their anti-hypertensive medications.  Many other patients are able to significantly reduce the number or dosages of their medications. 

High cholesterol. Over 80 to 90 percent of patients will develop normal cholesterol levels within two to three months after gastric bypass, with significant improvement seen for Lap-Band® patients as well.

Gout is a disturbance of uric acid metabolism occurring chiefly in males. Gout is characterized by painful inflammation of the joints, especially in the feet and hands, and arthritic attacks resulting from elevated levels of uric acid in the blood and the deposit of urate crystals around the joints. The condition can become chronic and result in deformity.

Infertility is defined as absent or diminished fertility; the persistent inability to conceive a child.

Insulin is a polypeptide hormone secreted by the pancreas. Insulin regulates the metabolism of carbohydrates and fats, especially the conversion of glucose to glycogen, which lowers the blood glucose level. Insulin can be synthetically created for use in the medical treatment and management of diabetes.

Lipids are organic (carbon-containing) substances that do not dissolve in water. Lipids, together with proteins and carbohydrates, constitute the principal structural components of living cells. Lipids include fats, waxes, phospholipids, cerebrosides, and related and derived compounds.

Sleep apnea syndrome / Hypoventilation. The large majority of patients have improved breathing at night and overall decreased shortness of breath following weight loss.  Sleep apnea is resolved in over 85 percent of patients.  Patients feel refreshed and usually no longer require accessory breathing apparatuses after weight loss.

Stress urinary incontinence is an involuntary loss of urine occurring simultaneously with increased internal abdominal pressure, such as when laughing, sneezing, coughing, or performing physical activity.

Osteoarthritis (Degenerative Joint Disease) occurs mainly in older persons and is characterized by chronic degeneration of the cartilage of the joints. This condition is also called degenerative joint disease. Patients with this disease have significant joint pain that limits their activities. After weight loss surgery, these patients can usually participate in many activities and social events, even sports. 

Lower back pain and disc disease can be relieved with as little as 25-30 pounds of weight loss. 

Acid reflux occurs when stomach acid leaks into the esophagus. Bariatric surgery is an excellent method of treating acid reflux disease.  Relief is usually noticed within a few days of the surgery. 

Polycystic Ovarian Syndrome (PCOS) is the most common syndrome in reproductive-age women and is often associated with obesity. PCOS is an accumulation of incompletely developed follicles in the ovaries and is characterized by irregular menstrual cycles, multiple ovarian cysts, and hirsutism (excessive hair growth) and often results in infertility.

Poor Outcomes. A system known as the Bariatric Analysis and Reporting Outcome System (BAROS) analyzes post-surgical outcomes including weight loss, quality of life, and improvements in obesity-related co-morbidities. Scores of three or less indicate fair outcomes or worse.

Major surgery is defined as extensive, relatively complex surgical procedures involving vital organs and/or posing a mortality risk. Major surgery, such as gastric weight loss surgery, that is performed using a minimally invasive laparoscopic surgical technique is still major surgery.

Sleep apnea is a temporary suspension of breathing occurring repeatedly during sleep that often affects overweight people, people with an obstruction in the breathing tract, an abnormally small throat opening, or a neurological disorder.

Successful long-term weight loss. For bariatric surgery to be considered successful, a patient must lose 50 percent of their excess body weight and keep it off in the long term. Therefore, in the case of a patient who is 200 pounds overweight, the gastric bypass or Lap-Band® operation is considered successful if the patient loses at least 100 pounds and keeps it off long term (more than six to 10 years).

Sibutramine is a drug used for the management of obesity that helps reduce food intake. It is indicated for weight loss and maintenance of weight loss when used in conjunction with a reduced-calorie diet.

Stroke is sudden loss of brain function caused by a blockage or rupture of a blood vessel to the brain.

Triglycerides are a type of fat found in your blood and the foods you eat. They are the most common type of fat in your body and are a major source of energy. Triglycerides commonly circulate in the blood in the form of lipoproteins (also referred to as neutral fat).

Waist circumference is the distance around your waist. Abdominal fat is a predictor of your risk for developing heart disease and other diseases. This risk increases with a waist measurement of over 40 inches in men and over 35 inches in women.

Thyroid is a gland in the neck that produces hormones designed to regulate the body's metabolism and organ function.

High-density lipoprotein (HDL) is a lipoprotein of blood plasma that is composed of a high proportion of protein with little triglyceride and cholesterol. HDL carries plaque away from artery walls, decreasing the probability of developing atherosclerosis. Therefore, HDL is commonly known as “good cholesterol.”

Weight loss drugs. There have been many pharmacological weight loss regimens offered to manage obesity.  Some of the early trials used amphetamine-like drugs or administration of thyroid hormone.  These were subsequently abandoned for a variety of causes including abuse, side effects, and weight regain upon withdrawal of the medication.  In the 1990’s the combination of phentermine and fenfluramine (“phen/fen”) was heralded as a pharmacological breakthrough.  This was later found to contribute to cardiac valvular disease and primary pulmonary hypertension and was subsequently withdrawn from the market.  There are some current medications that are used in various weight loss programs.  Medications like phentermine, sibutramine, or orlistat are examples and are generally reserved for individuals with a BMI over 30.  Unfortunately, the weight loss with these medications is limited and all drug trials have been disappointing.

 

Disclaimer

The information provided here is presented for your education and is not intended to replace a consultation with a licensed physician. It is not to be construed as medical advice nor is it to be used for any emergency health need you may be experiencing. Surgery always carries with it risks of infection and bleeding and anesthesia always carries numerous risks including death. Any country, including the United States, can have an outbreak of illness at anytime. These illnesses are listed at the Centers for Disease Control (CDC) website www.CDC.gov. © BridgeHealth International, Inc. 2008 For more details, see Terms of Use.