DebLPN

Yep,,,heard that one too,,lolol. Being told that exact thing for a lifetime, now that I've lost 65 pounds and my neck is getting flabby and my face thinner and showing those deflated wrinkles,,when I'm feeling insecure,,it makes me wonder,,,well heck! At least I used to have a pretty face!! Positive thinking,,,positive thinking,,,haha banded 1/29/07 Dr Ken Cleveland at CMMC-Jackson, MS 331/265/150

Sorryyyyyyyyyyyy I didn't mean to come across as mean! It was like a dream coming true for me as well. Everything I ever tried,,I failed. My fear of failure is my biggest character defect and I struggle with it daily. I guess I was trying to spare you the stress of agonizing over things, but I have to remember that we each have our own journey. Just be kind to yourself,,,you have lots of support here. You are not alone. banded 1/29/07 Dr Kken Cleveland Jackson, MS - CMMC

Dear GAWDDDDDDD lol You just got banded 2 days ago! Your body has to recover from surgery. The band has no Fluid in it yet. RELAX! If you start obsessing over things you're gonna drive yourself crazy. Relax,,,recoup,,,do exactly as your physician instructs you and you'll be fine. I was banded 1/29/07 and felt miserable for a few days,,bloated,,painful,,not wanting to drink anthing. I kept my manual my surgeon gave me handy,,reading all the materials,,keeping my fluids in a Tupeprware measured container. I concentrated on getting well first. My motto is : If I do what I'm supposed to be doing, I'll get the results I'm wanting. It's not easy,,but 65 pounds later,,it's easier today than it was at first. Keep your eye on the prize!! Good luck!! banded 1/29/07 Dr Ken Cleveland Jackson, MS CMMC 331/266/150

I've heard it said that when people lash out with rude, unkind, hurtful comments they're actually turning their self hatred outward. Since you said she was fat,,sounds like a fair assumption to me,,lolol. Force yourself to feel pity for a woman who doesn't recognize her own misery. :-) (I must be in a mellow mood today,,hahahaha) banded 1/29/07 Dr Ken Cleveland Jackson MS CMMC 331/266/150

Hi Gang~~ Just had my gallbladder out 2 weeks ago,,that was awful! I had a severe attack and rushed to hospital. I screamed in pain for 2 hours til they were able to get the pain under control. It took me 4 days to get my voice back,,lolol I go back to work Thursday. Cant get my ticker to work,,sighs. Banded 1/29/07 Dr Ken Cleveland CMMC-Jackson, MS 331/266/150

Hmmmmmmmmm what happened to my ticker? argh

If I ever see/taste/smell another powdered whey Protein shake I will gag. I started adding New Whey liquid Protein - Fruit Punch to my Crystal Light on the days that I knew I wanst going to make my protein quota. The "shot" has 42 grams of protein in one 3.1 Fluid ounce,176 calories, 0 fat, 0 sugar, 0 saturated fat, 31 mgs Potassium, 64 mgs Sodium, 2 Total Carbs, 0 cholesterol. I split it into 2 servings and space them apart. Works for me. Banded 1/29/07 Dr Ken Cleveland - CMMC Jackson Mississippi

Hi Ya'll~ Well,,I started a new job around the first of October and almost 2 weeks later,,,had a gallbladder attack and had to have it removed! Luckily, they are holding my job. Dr Cleveland did my surgery,,,both the lap band AND the gall bladder. Other than that,,,,I've lost 66 pounds. Had my lap band Jan 29th, 2007. Feeling good,,,nothing to complain about. :clap2:

Welllllllllllll I havent posted in ages, BUT,,I had shoulder pain,,never could figure out what it was,,my surgeon poo-poohed the idea it was gallbladder related, blah blah blah,,,,I had a horrific gallbladder attack this past Monday, went to the ER, was admitted and had my gallbladder removed the next morning. I've got an 8 x 10 color glossy of it in a basin and it looks awful! haha I had my monthly visit with my surgeon the week before the attack,,and told him my upper right back was hurting(this was months after my original complaints) and he palpated my abdomen and once again said, NO,its not your gallbladder. Pffft He already thinks I'm a smartass,,,but I really want to tell him hey,,,I've lived in this body for 53 years,,i THINK I'm pretty tuned into knowing when something is wrong. I'm a nurse,,I'm educated about anatomy and physiology and by God,,listen to me for a change and stop acting like you're the ultimate authority on MY BODY!!!!!!!!! Now,,,,,I feel better! hahahaha Ohyeah,,I had started a new job that I'm loving not quite 2 weeks before my surgery,,and once angain,,,didn't have insurance,,so its another whopper of a medical bill in my lap. ohwell,,such is life :-)

I was banded 1/29/07 and as the scales read today, I've lost 55 pounds. I had lost 62, but screwed up in July and August, ate everything and anything I could get my hands on. Also had stuff going on so I wasnt able to go to Water aerobis for a month. Went to Florida and didnt follow my food plan.Not handling stressful situations well and late night boredom are my downfalls. I've gotten back on track this month and its amazing how after maybe 3 days, I started really feeling good again. I love coming to this site and reading everyones posts BUT I really try not to compare my weight loss to anyone elses. If I do what I know I'm supposed to do, I KNOW I'll get the results that I want. (ignore my ticker numbers,,,i'm waiting to catch back up with them,,lol) banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson MS

Papain enzyme benefit by Ray Sahelian, M.D. I'd heard that Adoph's meat Tenderizer helped with that problem,,here's a site that tells how it helps other physical problems as well. Just a thought!

hi skinnydippn~ i live in jackson and was banded Jan 29th 2007 by Dr Ken Cleveland at CMMC. I was at the CMMC seminar last week and got up and spoke about my lap band experience. Hope things wotk out for you and you're able to be banded. Keep coming to this site and you'll glean some good information and support.

I had a hard time getting scrubs to fit my arms. There is a lady at the uniform place that laters tehm for me. She takes some of the material she whacks off when she shortens my scrub bottoms(i'm 5'2") and uses it to make a "V" under the arms to allow me more room. Down the road,,I hope to have it surgically removed....and I dont really care what it looks like,,scar-wise,lol. My thinking is,,,surgical scars,,no matter how many or how big,,CAN'T be as grotesque as all that fat I was lugging around! Til then, I'll do the best I can with what resources I have available. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS

Dr Ken Cleveland, Central Mississipi Medica Center, Jackson, Mississippi, USA banded 1/29/07

rivekthr6~~~ I've had 3 fills and last week had a tiny bit removed. THE FOLLOWING IS SIMPLY MY EXPERIENCE AND OPINION: My surgeon lays me on an exam table with a small pillow underneath my back, a little abuve my waist. He palpates the area slightly beneath my port incision then asks me to raise my head off the table. He inserts the needle, all the while palpating for the port. The port must offer some resistance, because when he inserts the needle in it, I can feel sort of a 'pop'. He aspirates, to be sure he's actually stuck the port. If he'd drawn back blood or any Fluid other than the clear saline, he'd know not to inject. He then injects the predetermined amount and quickly withdraws the needle. He doesn't deaden the area first,,as the stick is so minimally painful and the whole procedure so quick. I've found that deadening the area (in alot of diff procedures) hurts worse than the actual procedure itself. The whole 'fill' procedure lasts about 3 minutes. A bandaid and a handshake and I'm out of there. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS 1.8/4cc band

HCPCS Codes Description S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9-CM Diagnosis Codes Description 250.00 Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled 250.02 Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled 278.01 Morbid obesity 401.0 – 401.9 Essential hypertension Page 20 Page 20 of 28 Coverage Position Number: 0051 414.01 Coronary atherosclerosis of native coronary artery 416.0 Primary pulmonary hypertension 416.8 Other chronic pulmonary heart diseases 574.00- 574.91 Cholelithiasis 575.10 Cholecystitis, unspecified 997.4 Digestive system complication V45.3 Intestinal bypass or anastomosis status V85.35 Body Mass Index 35.0-35.9, adult V85.36 Body Mass Index 36.0-36.9, adult V85.37 Body Mass Index 37.0-37.9, adult V85.38 Body Mass Index 38.0-38.9, adult V85.39 Body Mass Index 39.0-39.9, adult V85.4 Body Mass Index 40 and over, adult Experimental/Investigational/Unproven/Not Covered: CPT* Codes Description 43845 Gastric restrictive procedure, with partial gastrectomy, pylorus-preserving duodenoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) HCPCS Codes Description No specific codes ICD-9-CM Diagnosis Codes Description All codes *Current Procedural Terminology (CPT ® ) © 2006 American Medical Association: Chicago, IL. References 1. Ali MR, Fuller WD, Choi MP, Wolfe BM. Bariatric surgical outcomes. Surg Clin North Am. 2005 Aug;85(4):835-52, vii. 2. American Gastroenterological Association. American Gastroenterological Association medical position statement on Obesity. Gastroenterology. 2002 Sep;123(3):879-81. 3. American Society for Bariatric Surgery. Guidelines for granting privileges in bariatric surgery. Established 2003 Jan. Accessed Apr 18, 2005. Available at URL address: GUIDELINES FOR GRANTING PRIVILEGES IN BARIATRIC SURGERY 4. American Society for Bariatric Surgery. Rationale for the surgical treatment of morbid obesity. Updated 2001 Nov 29. Accessed Apr 1, 2004. Available at URL address: Rationale for the Surgical Treatment of Morbid Obesity 5. Angrisani L, Di Lorenzo N, Favretti F, Furbetta F, Iuppa A, Doldi SB, et al. The Italian Group for LAP-BAND: predictive value of initial body mass index for weight loss after 5 years of follow-up. Surg Endosc. 2004 Oct;18(10):1524-7. Epub 2004 Aug. 6. Angrisani L, Furbetta F, Doldi SB, Basso M, Lucchese F, Giacomelli M, et al. Lap Band  adjustable gastric banding system. Surg Endosc. 2003;17:409-12. Page 21 Page 21 of 28 Coverage Position Number: 0051 7. Anthone GJ. The duodenal switch operation for morbid obesity. Surg Clin North Am. 2005 Aug;85(4):819-33, viii. 8. Anthone GJ, Lord RV, DeMeester TR, Crookes PF. The duodenal switch operation for the treatment of morbid obesity. Ann Surg. 2003 Oct;238(4):618-27; discussion 627-8. 9. Azagra JS, Goergen M, Ansay J, De Simone P, Vanhaverbeek M, Devuyst L, et al. Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs. open vertical banded gastroplasty. Surg Endosc. 1999 Jun;13(6):555-8. 10. Baker S, Barlow S, Cochran W, Fuchs G, Klish W, Krebs N, et al. Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005 May;40(5):533-43. 11. Balsiger BM, Murr MM, Poggio JL, Sarr MG. Bariatric surgery: surgery for weight control in patients with morbid obesity. Med Clin North Am. 2000 Mar;84(2):477-89. 12. Baltasar A, Bou R, Bengochea M, Arlandis F, Escrivá C, Miró J, et al. Duodenal switch: an effective therapy for morbid obesity-intermediate results. Obes Surg. 2001 Feb;11(1):54-8. 13. Baltasar A, Serra C, Perez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005 Sep;15(8):1124-8. 14. Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg. 2003 Nov; 138(11):1240-4. 15. Biertho L, Steffen R, Ricklin T, Horber FF, Pomp A, Inabnet WB, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003 Oct;197(4):536-44. 16. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Newer techniques in bariatric surgery. TEC Assessment Program. Vol. 18, No. 10. Chicago, IL: BCBSA; 2003 Sep. Accessed Apr 16, 2005. Available at URL address: Service Through Research 17. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Special report: the relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. TEC Assessment Program. Vol. 18, No. 9. Chicago, IL. BCBSA; 2003 Sep. Accessed Apr 16, 2005. Available at URL address: Service Through Research 18. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Laparoscopic Gastric Bypass Surgery for Morbid Obesity. TEC Assessment Program. Vol. 20, No. 15. Chicago, IL. BCBSA; 2006 Feb. Accessed Mar 31, 2006. Available at URL address: Service Through Research 19. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass. TEC Assessment Program Vol 20, No. 5. Chicago, IL. BCBSA; 2005 Aug. Accessed Apr 14, 2007. Available at URL: Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass 20. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Laparoscopic Adjustable Gastric Banding for Morbid Obesity. TEC Assessment Program. Vol. 21, No. 13. Chicago, IL. BCBSA; 2007 Feb. Accessed Apr 14, 2007. Available at URL: Laparoscopic Adjustable Gastric Banding for Morbid Obesity Page 22 Page 22 of 28 Coverage Position Number: 0051 21. Brolin RE. Bariatric surgery and long-term control of morbid obesity. JAMA. 2002 Dec 11;288(22):2793-6. 22. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. 23. Buchwald H; Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005 May-Jun;1(3):371-81. 24. Canadian Coordinating Office for Health Technology Assessment (CCOHTA). Issues in Emerging Health Technologies. Issue 79. January 2006. Intragastric Balloons: A Temporary Treatment for Obesity. Accessed Apr 11, 2007. Available at URL address: http://www.cadth.ca/media/pdf/401_balloons_cetap_e.pdf 25. Capella JF, Capella R. An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg. 2002 Feb;183(2):117-23. 26. Ceelen W, Walder J, Cardon A, Van Renterghem K, Hesse U, El Malt M, et al. Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann Surg. 2003 Jan;237(1):10-6. 27. Centers for Medicare and Medicaid Services (CMS). Coverage Decision Memorandum for Bariatric Surgery for Treatment of Co-morbidities Associated with Morbid Obesity. February 21, 2006. Accessed Mar 31, 2006. Available at URL address: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160 28. Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004 Mar;135(3):326-51. 29. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003 May 21;2560-72. 30. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 Sep;240(3):416-23. 31. Clegg A, Sidhu MK, Colquitt J, Royle P, Loveman E, Walker A. Clinical and cost effectiveness of surgery for people with morbid obesity. The National Institute for Clinical Excellence (NICE). 2001 Dec. Accessed Apr 2, 2004. Available at URL address: Clinical and cost effectiveness of surgery for people with morbid obesity 32. Colquitt J, Clegg A, Sidhu M, Royle P. Surgery for morbid obesity (Cochrane Review). In: The Cochrane Library. Most recent amendment: 25 Aug 2004. Oxford: update software. 33. Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006 Jun;20(6):859-63. Epub 2006 Apr 22. 34. DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002 May;235(5):640-5. 35. DeMaria EJ, Sugerman HJ, Meador JG, Doty JM, Kellum JM, Wolfe L, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001 Jun;233(6):809-18. Page 23 Page 23 of 28 Coverage Position Number: 0051 36. DeWald T, Khaodhiar L, Donahue MP, Blackburn G. Pharmacological and surgical treatments for obesity. Am Heart J. 2006 Mar;151(3):604-24. 37. de Wit LT, Mathus-Vliegen L, Hey C, Rademaker B, Gouma DJ, Obertop H. Open versus laparoscopic adjustable silicone gastric banding: a prospective randomized trial for treatment of morbid obesity. Ann Surg. 1999 Dec;230(6):800-7. 38. Doldi SB, Micheletto G, Di Prisco F, Zappa MA, Lattuada E, Reitano M. Intragastric balloon in obese patients. Obes Surg. 2000 Dec;10(6):578-81. 39. FDA approves implanted stomach band to treat severe obesity [FDA Talk Paper]. U.S. food and Drug Administration (FDA). Accessed Mar 21, 2003. Available at URL address: Food and Drug Administration Home Page 40. Fernandes M, Atallah AN, Soares BG, Humberto S, Guimaraes S, Matos D, et al. Intragastric balloon for obesity. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004931. 41. Fielding GA. Laparoscopic adjustable gastric banding for massive superobesity (greater than 60 body mass index kg/m2). Surg Endosc. 2003 Oct;17(10):1541-5. Epub 2003 Aug 15. 42. Fielding GA, Ren CJ. Laparoscopic adjustable gastric band. Surg Clin North Am. 2005 Feb;85(1):129-40. 43. Fielding GA, Rhodes M, Nathanson LK. Laparoscopic gastric banding for morbid obesity: surgical outcome in 335 cases. Surg Endosc. 1999 Jun;13(6):550-4. 44. Fobi MA, Lee H, Igwe D Jr, Felahy B, James E, Stanczyk M, et al. Gastric bypass in patients with BMI < 40 but > 32 without life-threatening co-morbidities: preliminary report. Obes Surg. 2002 Feb;12(1): 52-6. 45. Fobi M, Lee H, Igwe D Jr, Felahy B, James E, Stanczyk M, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg. 2002 Jun;12(3):350-3. 46. Fobi MA, Lee H, Igwe D Jr, Felahy B, James E, Stanczyk M, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001 Apr;11(2):190-5. 47. Fobi MA, Lee H. The surgical technique of the Fobi-Pouch operation for obesity (the transected silastic vertical gastric bypass). Obes Surg. 1998 Jun;8(3):283-8. 48. Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am. 2005;85:141-9. 49. Gastrointestinal surgery for severe obesity. NIH Consensus Statement Online. 1991 Mar 25- 27;9(1):1-20. Accessed Apr 2, 2004. Available at URL address: http://consensus.nih.gov/cons/084/084_statement.htm 50. Genco A, Bruni T, Doldi SB, Forestieri P, Marino M, Busetto L, et al. BioEnterics Intragastric Balloon: The Italian Experience with 2,515 Patients. Obes Surg. 2005 Sep;15(8):1161-4. 51. Gentileschi P, Kini S, Catarci M, Gagner M. Evidence-based medicine: open and laparoscopic bariatric surgery. Surg Endosc. 2002 May;16(5):736-44. 52. Guidance on the use of surgery to aid weight reduction for people with morbid obesity. National Institute for Clinical Excellence (NICE). Technology Appraisal Guidance No. 46. 2002 Jul. Accessed Apr 16, 2005. Available at URL address: Welcome to the National Institute for Health and Clinical Excellence Page 24 Page 24 of 28 Coverage Position Number: 0051 53. Guidelines for laparoscopic and conventional surgical treatment of morbid obesity. Surg Endosc. 2001 Oct;15(10):1251-2. 54. Gustavsson S, Westling A. Laparoscopic adjustable gastric banding: complications and side effects responsible for the poor long-term outcome. Semin Laparosc Surg. 2002 Jun;9(2):115- 24. 55. Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg. 2003 Feb;13(1):76-81. 56. Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006 Nov;16(11):1445-9. 57. Hamoui N, Chock B, Anthone GJ, Crookes PF. Revision of the duodenal switch: indications, technique, and outcomes. J Am Coll Surg. 2007 Apr;204(4):603-8. 58. HAYES Medical Technology Directory™. Biliopancreatic Diversion with Duodenal Switch for Treatment of Obesity. Lansdale, PA: HAYES, Inc.; © 2002 Winifred S. Hayes, Inc. 2002 Apr. 59. HAYES Medical Technology Directory™. Laparoscopic Bariatric Surgery. Lansdale, PA: HAYES, Inc.; © 2003 Winifred S. Hayes, Inc. 2003 Nov. 60. HAYES Medical Technology Directory. Open Bariatric Surgery. Lansdale, PA: HAYES, Inc.;  2003 Winifred S. Hayes, Inc. 2003 Dec. 61. Hell E, Miller KA, Moorehead MK, Norman S. Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obes Surg. 2000 Jun;10(3):214-9. 62. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998 Jun;8(3):267-82. 63. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005 Mar;15(3):408-16. 64. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006 Nov;16(11):1450-6. 65. Holeczy P, Novak P, Kralova A. 30% complications with adjustable gastric banding: what did we do wrong? Obes Surg. 2001 Dec;11(6):748-51. 66. Iglezias Brandao de Oliveira C, Adami Chaim E, Borges da Silva B. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003 Aug;13(4):625-8. 67. Inge TH, Krebs NF, Garcia VF, Skelton JA, Guice KS, Strauss RS, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004 Jul;114(1):217-23. 68. Institute for Clinical Systems Improvement (ISCI). Healthcare Guideline. Prevention and Management of Obesity (Mature Adolescents and Adults). November 2006. Accessed May 12, 2007. Available at URL address: ICSI - Institute for Clinical Systems Improvement d_adults__2.html Page 25 Page 25 of 28 Coverage Position Number: 0051 69. Jan JC, Hong D, Periera N, Patterson EJ. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results. J Gastrointest Surg. 2005 Jan;9(1):30-9. 70. Jones KB Jr. Revisional bariatric surgery: safe and effective. Obes Surg. 2001 Apr;11(2):183-9. 71. Karason K, Lindroos AK, Stenlof K, Sjöstrom L. Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects Study: Arch Intern Med. 2000 Jun 26;160(12):1797-802. 72. Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, et al. Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg. 2003 May-Jun;7(4):552-7. 73. Korenkov M, Sauerland S, Junginger T. Surgery for obesity. Curr Opin Gastroenterol. 2005 Nov;21(6):679-83. 74. Lee WJ, Huang MT, Yu PJ, Wang W, Chen TC. Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obes Surg. 2004 May;14(5):626-34. 75. Livingston EH. Complications of bariatric surgery. Surg Clin North Am. 2005 Aug;85(4):853-68, vii. 76. Mason EE, Renquist KE. Gallbladder management in obesity surgery. Obes Surg. 2003 Apr;12(2): 222-9. 77. Morino M, Toppino M, Bonnet G, del Genio G. Laparoscopic adjustable silicone gastric banding versus vertical banded gastroplasty in morbidly obese patients: a prospective randomized controlled clinical trial. Ann Surg. 2003 Dec;238(6):835-41. 78. National Heart, Lung, and Blood Institute (NHLBI). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report. NIH Pub. No. 98-4083. 1998 Sep. Accessed Apr 16, 2005. Available at URL address: http://nhlbi.nih.gov/guidelines/obesity/ob_home.htm 79. National Heart, Lung, and Blood Institute (NHLBI). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. 2000 Oct. Accessed Apr 16, 2007. Available at URL address: http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf 80. National Institute for Clinical Excellence (NICE). CG43 Obesity: Full guideline, section 5b - Management of obesity in clinical settings (adults): evidence statements and reviews. Dec 13, 2006. Accessed Apr 12, 2007. Available at URL address: CG43 Obesity: NICE guideline (MS Word format) 81. Neligan PJ, Williams N. Nonsurgical and surgical treatment of obesity. Anesthesiol Clin North America. 2005 Sep;23(3):501-23, vii. 82. O'Brien PE, Dixon JB. A rational approach to cholelithiasis in bariatric surgery: its application to the laparoscopically placed gastric band. Arch Surg. 2003 Aug;138(8):908-12. 83. O'Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006 Aug;16(8):1032-40. 84. O'Rourke RW, Andrus J, Diggs BS, Scholz M, McConnell DB, Deveney CW. Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006 Mar;141(3):262-8. Page 26 Page 26 of 28 Coverage Position Number: 0051 85. Parikh MS, Laker S, Weiner H, Hajiseyedjavadi O, Ren CJ. Objective comparison of complications resulting from laparoscopic bariatric procedures. Am Coll Surg. 2006 Feb;202(2):252-61. Epub 2005 Dec 19. 86. Parikh MS, Shen R, Weiner M, Siegel N, Ren CJ. Laparoscopic bariatric surgery in super- obese patients (BMI>50) is safe and effective: a review of 332 patients. Obes Surg. 2005 Jun- Jul;15(6):858-63. 87. Pasanisi F, Contaldo F, DeSimone G, Mancini M. Benefits of sustained moderate weight loss in obesity. Nutr Metab Cardiovascular Dis. 2001 Dec;11(6);401-6. 88. Pontiroli AE, Pizzocri P, Librenti MC, Vedani P, Marchi M, Cucchi E, et al. Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three-year study. J Clin Endocrinol Metab. 2002 Aug;87(8):3555-61. 89. Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass. Ann Surg. 2006 Oct;244(4):611-9. 90. Rabkin RA, Rabkin JM, Metcalf B, Lazo M, Rossi M, Lehman-Becker LB. Laparoscopic technique for performing duodenal switch with gastric reduction. Obes Surg. 2003 Apr;13(2):263-8. 91. Ren CJ, Horgan S, Ponce J. U.S experience with the LAP-BAND system. Am J Surg. 2002;184:46S-50S. 92. Ren CJ, Weiner M, Allen JW. Favorable early results of gastric banding for morbid obesity. Surg Endosc. 2004;18:543-6. 93. Rendon SE, Pories WJ. Quality assurance in bariatric surgery. Surg Clin North Am. 2005 Aug;85(4):757-71, vi-vii. 94. Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006 Oct;16(10):1323-6. 95. Rubenstein RB. Laparoscopic adjustable gastric banding at a U.S. center with up to 3-year follow-up. Obes Surg. 2002 Jun;12(3):380-4. 96. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001 Jun;11(3):276-80. 97. Safadi BY.Trends in insurance coverage for bariatric surgery and the impact of evidence-based reviews. Surg Clin North Am. 2005 Aug;85(4):665-80, v. 98. Sauerland S, Angrisani L, Belachew M, Chevallier J, Favretti F, Finer N, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005 Feb;19(2):200-21. Epub 2004 Dec 2. 99. Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad W, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003 Oct;238(4):467-85. 100. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000 Oct;232(4):515-29. 101. Schweitzer M, Lidor A, Magnuson T. Bariatric surgery. Adv Psychosom Med. 2006;27:53-60. Page 27 Page 27 of 28 Coverage Position Number: 0051 102. Shalhub S, Parsee A, Gallagher SF, Haines KL, Willkomm C, Brantley S, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004 Jan;14(1):54-9. 103. Shekelle PG, Morton SC, Maglione MA, Suttorp M, Tu W, Li Z, et al. Pharmacological and surgical treatment of obesity. Evidence Report/Technology Assessment No. 103. Pub. No. 04- E028-2. Rockville, MD: Agency for Healthcare Research and Quality; 2004 Jul. 104. Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co- morbidities in super-obese high-risk patients. Obes Surg. 2006 Sep;16(9):1138-44. 105. Sjöstrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004 Dec 23;351(26):2683-93. 106. Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Guidelines for the clinical application of laparoscopic bariatric surgery. 2003 Jul. Accessed Mar 31, 2006. Available at URL address: ttp://www.guideline.gov/summary/pdf.aspx?doc_id=4383&stat=1&string=bariatric+AND+surgery 107. Spivak H, Anwar F, Burton C, Guerrero C, Onn A. The Lap-Band system in the United States: one surgeon's experience with 271 patients. Surg Endosc. 2004;18:198-202. 108. Spivak H, Hewitt MF, Onn A, Half E. Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg. 2005 Jan;189(1):27-32. 109. Spyropoulos C, Katsakoulis E, Mead N, Vagenas K, Kalfarentzos F. Intragastric balloon for high-risk super-obese patients: a prospective analysis of efficacy. Surg Obes Relat Dis. 2007 Jan-Feb;3(1):78-83. 110. Sreenarasimhaiah J. Prevention or surgical treatment of gallstones in patients undergoing gastric bypass surgery for obesity. Curr Treat Options Gastroenterol. 2004 Apr;7(2):99-104. 111. Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. Jun 2003;237(6):751-8. 112. Suter M, Giusti V, Heraief E, Zysset F, Calmes JM. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003 Apr;17(4):603-9. 113. Thomusch O, Keck T, Dobschutz EV, Wagner C, Ruckauer KD, Hopt UT. Risk factors for the intermediate outcome of morbid obesity after laparoscopically placed adjustable gastric banding. Am J Surg. 2005 Feb;189(2):214-8. 114. Tice JA. California Technology Assessment Forum. Duodenal Switch Procedure for the Treatment of Morbid Obesity. 2004, Feb. Accessed April 3, 2006. Available at URL address: http://www.ctaf.org/ass/viewfull.ctaf?id=6071375849 115. U. S. Food and Drug Administration (FDA). Center for Devices and Radiological Health (CDRH). LAP-BAND ® Adjustable Gastric Banding (LAGB ® ) System - P000008. June 5, 2001. Accessed Mar 21, 2003. Available at URL address: http://www.fda.gov/cdrh/pdf/P000008c.pdf 116. van Gemert WG, van Wersch MM, Greve JW, Soeters PB. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg. 1998 Feb;8(1):21-8. 117. Victorzon M, Tolonen P. Bariatric Analysis and Reporting Outcome System (BAROS) following laparoscopic adjustable gastric banding in Finland. Obes Surg. 2001 Dec;11(6):740-3. Page 28 Page 28 of 28 Coverage Position Number: 0051 118. Victorzon M, Tolonen P. Intermediate results following laparoscopic adjustable gastric banding for morbid obesity. Dig Surg. 2002;19(5):354-7. 119. Villegas L, Schneider B, Provost D, Chang C, Scott D, Sims T, et al. Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg. 2004 Jan;14(1):60-6. 120. Weber M, Muller MK, Bucher T, Wildi S, Dindo D, Horber F, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004 Dec;240(6):975-82. 121. Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I. Outcome after laparoscopic adjustable gastric banding-8 years experience. Obes Surg. 2003 Jun;13(3):427- 34. 122. Weiner R, Bockhorn H, Rosenthal R, Wagner D. A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity. Surg Endosc. 2001 Jan;15(1):63-8. 123. Westling A, Bjurling K, Ohrvall M, Gustavsson S. Silicone-adjustable gastric banding: disappointing results. Obes Surg. 1998 Aug;8(4):467-74. 124. Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric banding after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg. 2002 Mar-Apr;6(2):206-11. 125. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000 Jun;10(3):233-9. 126. Zinzindohoue F, Chevallier J-M, Douard R, Elian N, Ferraz J-M, Blanche P, et al. Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg. 2003 Jan;237(1):1-9. HCPCS Codes Description S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9-CM Diagnosis Codes Description 250.00 Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled 250.02 Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled 278.01 Morbid obesity 401.0 – 401.9 Essential hypertension Page 20 Page 20 of 28 Coverage Position Number: 0051 414.01 Coronary atherosclerosis of native coronary artery 416.0 Primary pulmonary hypertension 416.8 Other chronic pulmonary heart diseases 574.00- 574.91 Cholelithiasis 575.10 Cholecystitis, unspecified 997.4 Digestive system complication V45.3 Intestinal bypass or anastomosis status V85.35 Body Mass Index 35.0-35.9, adult V85.36 Body Mass Index 36.0-36.9, adult V85.37 Body Mass Index 37.0-37.9, adult V85.38 Body Mass Index 38.0-38.9, adult V85.39 Body Mass Index 39.0-39.9, adult V85.4 Body Mass Index 40 and over, adult Experimental/Investigational/Unproven/Not Covered: CPT* Codes Description 43845 Gastric restrictive procedure, with partial gastrectomy, pylorus-preserving duodenoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) HCPCS Codes Description No specific codes ICD-9-CM Diagnosis Codes Description All codes *Current Procedural Terminology (CPT ® ) © 2006 American Medical Association: Chicago, IL. References 1. Ali MR, Fuller WD, Choi MP, Wolfe BM. Bariatric surgical outcomes. Surg Clin North Am. 2005 Aug;85(4):835-52, vii. 2. American Gastroenterological Association. American Gastroenterological Association medical position statement on Obesity. Gastroenterology. 2002 Sep;123(3):879-81. 3. American Society for Bariatric Surgery. Guidelines for granting privileges in bariatric surgery. Established 2003 Jan. Accessed Apr 18, 2005. Available at URL address: GUIDELINES FOR GRANTING PRIVILEGES IN BARIATRIC SURGERY 4. American Society for Bariatric Surgery. Rationale for the surgical treatment of morbid obesity. Updated 2001 Nov 29. Accessed Apr 1, 2004. Available at URL address: Rationale for the Surgical Treatment of Morbid Obesity 5. Angrisani L, Di Lorenzo N, Favretti F, Furbetta F, Iuppa A, Doldi SB, et al. The Italian Group for LAP-BAND: predictive value of initial body mass index for weight loss after 5 years of follow-up. Surg Endosc. 2004 Oct;18(10):1524-7. Epub 2004 Aug. 6. Angrisani L, Furbetta F, Doldi SB, Basso M, Lucchese F, Giacomelli M, et al. Lap Band  adjustable gastric banding system. Surg Endosc. 2003;17:409-12. Page 21 Page 21 of 28 Coverage Position Number: 0051 7. Anthone GJ. The duodenal switch operation for morbid obesity. Surg Clin North Am. 2005 Aug;85(4):819-33, viii. 8. Anthone GJ, Lord RV, DeMeester TR, Crookes PF. The duodenal switch operation for the treatment of morbid obesity. Ann Surg. 2003 Oct;238(4):618-27; discussion 627-8. 9. Azagra JS, Goergen M, Ansay J, De Simone P, Vanhaverbeek M, Devuyst L, et al. Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs. open vertical banded gastroplasty. Surg Endosc. 1999 Jun;13(6):555-8. 10. Baker S, Barlow S, Cochran W, Fuchs G, Klish W, Krebs N, et al. Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2005 May;40(5):533-43. 11. Balsiger BM, Murr MM, Poggio JL, Sarr MG. Bariatric surgery: surgery for weight control in patients with morbid obesity. Med Clin North Am. 2000 Mar;84(2):477-89. 12. Baltasar A, Bou R, Bengochea M, Arlandis F, Escrivá C, Miró J, et al. Duodenal switch: an effective therapy for morbid obesity-intermediate results. Obes Surg. 2001 Feb;11(1):54-8. 13. Baltasar A, Serra C, Perez N, Bou R, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005 Sep;15(8):1124-8. 14. Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg. 2003 Nov; 138(11):1240-4. 15. Biertho L, Steffen R, Ricklin T, Horber FF, Pomp A, Inabnet WB, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003 Oct;197(4):536-44. 16. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Newer techniques in bariatric surgery. TEC Assessment Program. Vol. 18, No. 10. Chicago, IL: BCBSA; 2003 Sep. Accessed Apr 16, 2005. Available at URL address: Service Through Research 17. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Special report: the relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. TEC Assessment Program. Vol. 18, No. 9. Chicago, IL. BCBSA; 2003 Sep. Accessed Apr 16, 2005. Available at URL address: Service Through Research 18. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Laparoscopic Gastric Bypass Surgery for Morbid Obesity. TEC Assessment Program. Vol. 20, No. 15. Chicago, IL. BCBSA; 2006 Feb. Accessed Mar 31, 2006. Available at URL address: Service Through Research 19. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass. TEC Assessment Program Vol 20, No. 5. Chicago, IL. BCBSA; 2005 Aug. Accessed Apr 14, 2007. Available at URL: Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass 20. BlueCross BlueShield Association (BCBSA) Technology Evaluation Center (TEC). Laparoscopic Adjustable Gastric Banding for Morbid Obesity. TEC Assessment Program. Vol. 21, No. 13. Chicago, IL. BCBSA; 2007 Feb. Accessed Apr 14, 2007. Available at URL: Laparoscopic Adjustable Gastric Banding for Morbid Obesity Page 22 Page 22 of 28 Coverage Position Number: 0051 21. Brolin RE. Bariatric surgery and long-term control of morbid obesity. JAMA. 2002 Dec 11;288(22):2793-6. 22. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37. 23. Buchwald H; Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005 May-Jun;1(3):371-81. 24. Canadian Coordinating Office for Health Technology Assessment (CCOHTA). Issues in Emerging Health Technologies. Issue 79. January 2006. Intragastric Balloons: A Temporary Treatment for Obesity. Accessed Apr 11, 2007. Available at URL address: http://www.cadth.ca/media/pdf/401_balloons_cetap_e.pdf 25. Capella JF, Capella R. An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg. 2002 Feb;183(2):117-23. 26. Ceelen W, Walder J, Cardon A, Van Renterghem K, Hesse U, El Malt M, et al. Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann Surg. 2003 Jan;237(1):10-6. 27. Centers for Medicare and Medicaid Services (CMS). Coverage Decision Memorandum for Bariatric Surgery for Treatment of Co-morbidities Associated with Morbid Obesity. February 21, 2006. Accessed Mar 31, 2006. Available at URL address: http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160 28. Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004 Mar;135(3):326-51. 29. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003 May 21;2560-72. 30. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 Sep;240(3):416-23. 31. Clegg A, Sidhu MK, Colquitt J, Royle P, Loveman E, Walker A. Clinical and cost effectiveness of surgery for people with morbid obesity. The National Institute for Clinical Excellence (NICE). 2001 Dec. Accessed Apr 2, 2004. Available at URL address: Clinical and cost effectiveness of surgery for people with morbid obesity 32. Colquitt J, Clegg A, Sidhu M, Royle P. Surgery for morbid obesity (Cochrane Review). In: The Cochrane Library. Most recent amendment: 25 Aug 2004. Oxford: update software. 33. Cottam D, Qureshi FG, Mattar SG, Sharma S, Holover S, Bonanomi G, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006 Jun;20(6):859-63. Epub 2006 Apr 22. 34. DeMaria EJ, Sugerman HJ, Kellum JM, Meador JG, Wolfe LG. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002 May;235(5):640-5. 35. DeMaria EJ, Sugerman HJ, Meador JG, Doty JM, Kellum JM, Wolfe L, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001 Jun;233(6):809-18. Page 23 Page 23 of 28 Coverage Position Number: 0051 36. DeWald T, Khaodhiar L, Donahue MP, Blackburn G. Pharmacological and surgical treatments for obesity. Am Heart J. 2006 Mar;151(3):604-24. 37. de Wit LT, Mathus-Vliegen L, Hey C, Rademaker B, Gouma DJ, Obertop H. Open versus laparoscopic adjustable silicone gastric banding: a prospective randomized trial for treatment of morbid obesity. Ann Surg. 1999 Dec;230(6):800-7. 38. Doldi SB, Micheletto G, Di Prisco F, Zappa MA, Lattuada E, Reitano M. Intragastric balloon in obese patients. Obes Surg. 2000 Dec;10(6):578-81. 39. FDA approves implanted stomach band to treat severe obesity [FDA Talk Paper]. U.S. Food and Drug Administration (FDA). Accessed Mar 21, 2003. Available at URL address: Food and Drug Administration Home Page 40. Fernandes M, Atallah AN, Soares BG, Humberto S, Guimaraes S, Matos D, et al. Intragastric balloon for obesity. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004931. 41. Fielding GA. Laparoscopic adjustable gastric banding for massive superobesity (greater than 60 body mass index kg/m2). Surg Endosc. 2003 Oct;17(10):1541-5. Epub 2003 Aug 15. 42. Fielding GA, Ren CJ. Laparoscopic adjustable gastric band. Surg Clin North Am. 2005 Feb;85(1):129-40. 43. Fielding GA, Rhodes M, Nathanson LK. Laparoscopic gastric banding for morbid obesity: surgical outcome in 335 cases. Surg Endosc. 1999 Jun;13(6):550-4. 44. Fobi MA, Lee H, Igwe D Jr, Felahy B, James E, Stanczyk M, et al. Gastric bypass in patients with BMI < 40 but > 32 without life-threatening co-morbidities: preliminary report. Obes Surg. 2002 Feb;12(1): 52-6. 45. Fobi M, Lee H, Igwe D Jr, Felahy B, James E, Stanczyk M, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg. 2002 Jun;12(3):350-3. 46. Fobi MA, Lee H, Igwe D Jr, Felahy B, James E, Stanczyk M, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001 Apr;11(2):190-5. 47. Fobi MA, Lee H. The surgical technique of the Fobi-Pouch operation for obesity (the transected silastic vertical gastric bypass). Obes Surg. 1998 Jun;8(3):283-8. 48. Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am. 2005;85:141-9. 49. Gastrointestinal surgery for severe obesity. NIH Consensus Statement Online. 1991 Mar 25- 27;9(1):1-20. Accessed Apr 2, 2004. Available at URL address: http://consensus.nih.gov/cons/084/084_statement.htm 50. Genco A, Bruni T, Doldi SB, Forestieri P, Marino M, Busetto L, et al. BioEnterics Intragastric Balloon: The Italian Experience with 2,515 Patients. Obes Surg. 2005 Sep;15(8):1161-4. 51. Gentileschi P, Kini S, Catarci M, Gagner M. Evidence-based medicine: open and laparoscopic bariatric surgery. Surg Endosc. 2002 May;16(5):736-44. 52. Guidance on the use of surgery to aid weight reduction for people with morbid obesity. National Institute for Clinical Excellence (NICE). Technology Appraisal Guidance No. 46. 2002 Jul. Accessed Apr 16, 2005. Available at URL address: Welcome to the National Institute for Health and Clinical Excellence Page 24 Page 24 of 28 Coverage Position Number: 0051 53. Guidelines for laparoscopic and conventional surgical treatment of morbid obesity. Surg Endosc. 2001 Oct;15(10):1251-2. 54. Gustavsson S, Westling A. Laparoscopic adjustable gastric banding: complications and side effects responsible for the poor long-term outcome. Semin Laparosc Surg. 2002 Jun;9(2):115- 24. 55. Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg. 2003 Feb;13(1):76-81. 56. Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006 Nov;16(11):1445-9. 57. Hamoui N, Chock B, Anthone GJ, Crookes PF. Revision of the duodenal switch: indications, technique, and outcomes. J Am Coll Surg. 2007 Apr;204(4):603-8. 58. HAYES Medical Technology Directory™. Biliopancreatic Diversion with Duodenal Switch for Treatment of Obesity. Lansdale, PA: HAYES, Inc.; © 2002 Winifred S. Hayes, Inc. 2002 Apr. 59. HAYES Medical Technology Directory™. Laparoscopic Bariatric Surgery. Lansdale, PA: HAYES, Inc.; © 2003 Winifred S. Hayes, Inc. 2003 Nov. 60. HAYES Medical Technology Directory. Open Bariatric Surgery. Lansdale, PA: HAYES, Inc.;  2003 Winifred S. Hayes, Inc. 2003 Dec. 61. Hell E, Miller KA, Moorehead MK, Norman S. Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obes Surg. 2000 Jun;10(3):214-9. 62. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998 Jun;8(3):267-82. 63. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005 Mar;15(3):408-16. 64. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006 Nov;16(11):1450-6. 65. Holeczy P, Novak P, Kralova A. 30% complications with adjustable gastric banding: what did we do wrong? Obes Surg. 2001 Dec;11(6):748-51. 66. Iglezias Brandao de Oliveira C, Adami Chaim E, Borges da Silva B. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003 Aug;13(4):625-8. 67. Inge TH, Krebs NF, Garcia VF, Skelton JA, Guice KS, Strauss RS, et al. Bariatric surgery for severely overweight adolescents: concerns and recommendations. Pediatrics. 2004 Jul;114(1):217-23. 68. Institute for Clinical Systems Improvement (ISCI). Healthcare Guideline. Prevention and Management of Obesity (Mature Adolescents and Adults). November 2006. Accessed May 12, 2007. Available at URL address: ICSI - Institute for Clinical Systems Improvement d_adults__2.html Page 25 Page 25 of 28 Coverage Position Number: 0051 69. Jan JC, Hong D, Periera N, Patterson EJ. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results. J Gastrointest Surg. 2005 Jan;9(1):30-9. 70. Jones KB Jr. Revisional bariatric surgery: safe and effective. Obes Surg. 2001 Apr;11(2):183-9. 71. Karason K, Lindroos AK, Stenlof K, Sjöstrom L. Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects Study: Arch Intern Med. 2000 Jun 26;160(12):1797-802. 72. Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, et al. Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg. 2003 May-Jun;7(4):552-7. 73. Korenkov M, Sauerland S, Junginger T. Surgery for obesity. Curr Opin Gastroenterol. 2005 Nov;21(6):679-83. 74. Lee WJ, Huang MT, Yu PJ, Wang W, Chen TC. Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obes Surg. 2004 May;14(5):626-34. 75. Livingston EH. Complications of bariatric surgery. Surg Clin North Am. 2005 Aug;85(4):853-68, vii. 76. Mason EE, Renquist KE. Gallbladder management in obesity surgery. Obes Surg. 2003 Apr;12(2): 222-9. 77. Morino M, Toppino M, Bonnet G, del Genio G. Laparoscopic adjustable silicone gastric banding versus vertical banded gastroplasty in morbidly obese patients: a prospective randomized controlled clinical trial. Ann Surg. 2003 Dec;238(6):835-41. 78. National Heart, Lung, and Blood Institute (NHLBI). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report. NIH Pub. No. 98-4083. 1998 Sep. Accessed Apr 16, 2005. Available at URL address: http://nhlbi.nih.gov/guidelines/obesity/ob_home.htm 79. National Heart, Lung, and Blood Institute (NHLBI). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. 2000 Oct. Accessed Apr 16, 2007. Available at URL address: http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf 80. National Institute for Clinical Excellence (NICE). CG43 Obesity: Full guideline, section 5b - Management of obesity in clinical settings (adults): evidence statements and reviews. Dec 13, 2006. Accessed Apr 12, 2007. Available at URL address: CG43 Obesity: NICE guideline (MS Word format) 81. Neligan PJ, Williams N. Nonsurgical and surgical treatment of obesity. Anesthesiol Clin North America. 2005 Sep;23(3):501-23, vii. 82. O'Brien PE, Dixon JB. A rational approach to cholelithiasis in bariatric surgery: its application to the laparoscopically placed gastric band. Arch Surg. 2003 Aug;138(8):908-12. 83. O'Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006 Aug;16(8):1032-40. 84. O'Rourke RW, Andrus J, Diggs BS, Scholz M, McConnell DB, Deveney CW. Perioperative morbidity associated with bariatric surgery: an academic center experience. Arch Surg. 2006 Mar;141(3):262-8. Page 26 Page 26 of 28 Coverage Position Number: 0051 85. Parikh MS, Laker S, Weiner H, Hajiseyedjavadi O, Ren CJ. Objective comparison of complications resulting from laparoscopic bariatric procedures. Am Coll Surg. 2006 Feb;202(2):252-61. Epub 2005 Dec 19. 86. Parikh MS, Shen R, Weiner M, Siegel N, Ren CJ. Laparoscopic bariatric surgery in super- obese patients (BMI>50) is safe and effective: a review of 332 patients. Obes Surg. 2005 Jun- Jul;15(6):858-63. 87. Pasanisi F, Contaldo F, DeSimone G, Mancini M. Benefits of sustained moderate weight loss in obesity. Nutr Metab Cardiovascular Dis. 2001 Dec;11(6);401-6. 88. Pontiroli AE, Pizzocri P, Librenti MC, Vedani P, Marchi M, Cucchi E, et al. Laparoscopic adjustable gastric banding for the treatment of morbid (grade 3) obesity and its metabolic complications: a three-year study. J Clin Endocrinol Metab. 2002 Aug;87(8):3555-61. 89. Prachand VN, Davee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass. Ann Surg. 2006 Oct;244(4):611-9. 90. Rabkin RA, Rabkin JM, Metcalf B, Lazo M, Rossi M, Lehman-Becker LB. Laparoscopic technique for performing duodenal switch with gastric reduction. Obes Surg. 2003 Apr;13(2):263-8. 91. Ren CJ, Horgan S, Ponce J. U.S experience with the LAP-BAND system. Am J Surg. 2002;184:46S-50S. 92. Ren CJ, Weiner M, Allen JW. Favorable early results of gastric banding for morbid obesity. Surg Endosc. 2004;18:543-6. 93. Rendon SE, Pories WJ. Quality assurance in bariatric surgery. Surg Clin North Am. 2005 Aug;85(4):757-71, vi-vii. 94. Roa PE, Kaidar-Person O, Pinto D, Cho M, Szomstein S, Rosenthal RJ. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006 Oct;16(10):1323-6. 95. Rubenstein RB. Laparoscopic adjustable gastric banding at a U.S. center with up to 3-year follow-up. Obes Surg. 2002 Jun;12(3):380-4. 96. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001 Jun;11(3):276-80. 97. Safadi BY.Trends in insurance coverage for bariatric surgery and the impact of evidence-based reviews. Surg Clin North Am. 2005 Aug;85(4):665-80, v. 98. Sauerland S, Angrisani L, Belachew M, Chevallier J, Favretti F, Finer N, et al. Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc. 2005 Feb;19(2):200-21. Epub 2004 Dec 2. 99. Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad W, et al. Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003 Oct;238(4):467-85. 100. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000 Oct;232(4):515-29. 101. Schweitzer M, Lidor A, Magnuson T. Bariatric surgery. Adv Psychosom Med. 2006;27:53-60. Page 27 Page 27 of 28 Coverage Position Number: 0051 102. Shalhub S, Parsee A, Gallagher SF, Haines KL, Willkomm C, Brantley S, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004 Jan;14(1):54-9. 103. Shekelle PG, Morton SC, Maglione MA, Suttorp M, Tu W, Li Z, et al. Pharmacological and surgical treatment of obesity. Evidence Report/Technology Assessment No. 103. Pub. No. 04- E028-2. Rockville, MD: Agency for Healthcare Research and Quality; 2004 Jul. 104. Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co- morbidities in super-obese high-risk patients. Obes Surg. 2006 Sep;16(9):1138-44. 105. Sjöstrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004 Dec 23;351(26):2683-93. 106. Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Guidelines for the clinical application of laparoscopic bariatric surgery. 2003 Jul. Accessed Mar 31, 2006. Available at URL address: ttp://www.guideline.gov/summary/pdf.aspx?doc_id=4383&stat=1&string=bariatric+AND+surgery 107. Spivak H, Anwar F, Burton C, Guerrero C, Onn A. The Lap-Band system in the United States: one surgeon's experience with 271 patients. Surg Endosc. 2004;18:198-202. 108. Spivak H, Hewitt MF, Onn A, Half E. Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg. 2005 Jan;189(1):27-32. 109. Spyropoulos C, Katsakoulis E, Mead N, Vagenas K, Kalfarentzos F. Intragastric balloon for high-risk super-obese patients: a prospective analysis of efficacy. Surg Obes Relat Dis. 2007 Jan-Feb;3(1):78-83. 110. Sreenarasimhaiah J. Prevention or surgical treatment of gallstones in patients undergoing gastric bypass surgery for obesity. Curr Treat Options Gastroenterol. 2004 Apr;7(2):99-104. 111. Sugerman HJ, Wolfe LG, Sica DA, Clore JN. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. Jun 2003;237(6):751-8. 112. Suter M, Giusti V, Heraief E, Zysset F, Calmes JM. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003 Apr;17(4):603-9. 113. Thomusch O, Keck T, Dobschutz EV, Wagner C, Ruckauer KD, Hopt UT. Risk factors for the intermediate outcome of morbid obesity after laparoscopically placed adjustable gastric banding. Am J Surg. 2005 Feb;189(2):214-8. 114. Tice JA. California Technology Assessment Forum. Duodenal Switch Procedure for the Treatment of Morbid Obesity. 2004, Feb. Accessed April 3, 2006. Available at URL address: http://www.ctaf.org/ass/viewfull.ctaf?id=6071375849 115. U. S. Food and Drug Administration (FDA). Center for Devices and Radiological Health (CDRH). LAP-BAND ® Adjustable Gastric Banding (LAGB ® ) System - P000008. June 5, 2001. Accessed Mar 21, 2003. Available at URL address: http://www.fda.gov/cdrh/pdf/P000008c.pdf 116. van Gemert WG, van Wersch MM, Greve JW, Soeters PB. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg. 1998 Feb;8(1):21-8. 117. Victorzon M, Tolonen P. Bariatric Analysis and Reporting Outcome System (BAROS) following laparoscopic adjustable gastric banding in Finland. Obes Surg. 2001 Dec;11(6):740-3. Page 28 Page 28 of 28 Coverage Position Number: 0051 118. Victorzon M, Tolonen P. Intermediate results following laparoscopic adjustable gastric banding for morbid obesity. Dig Surg. 2002;19(5):354-7. 119. Villegas L, Schneider B, Provost D, Chang C, Scott D, Sims T, et al. Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg. 2004 Jan;14(1):60-6. 120. Weber M, Muller MK, Bucher T, Wildi S, Dindo D, Horber F, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004 Dec;240(6):975-82. 121. Weiner R, Blanco-Engert R, Weiner S, Matkowitz R, Schaefer L, Pomhoff I. Outcome after laparoscopic adjustable gastric banding-8 years experience. Obes Surg. 2003 Jun;13(3):427- 34. 122. Weiner R, Bockhorn H, Rosenthal R, Wagner D. A prospective randomized trial of different laparoscopic gastric banding techniques for morbid obesity. Surg Endosc. 2001 Jan;15(1):63-8. 123. Westling A, Bjurling K, Ohrvall M, Gustavsson S. Silicone-adjustable gastric banding: disappointing results. Obes Surg. 1998 Aug;8(4):467-74. 124. Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric banding after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg. 2002 Mar-Apr;6(2):206-11. 125. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y-500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000 Jun;10(3):233-9. 126. Zinzindohoue F, Chevallier J-M, Douard R, Elian N, Ferraz J-M, Blanche P, et al. Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg. 2003 Jan;237(1):1-9. HCPCS Codes Description S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline CIGNA's medical coverage position on pneumatic compression devices for the treatment of vascular diseases of the lower extremi Go to page 19,,close to the bottom. The degree of gastric restriction can be adjusted by accessing the reservoir through the skin and adding or removing saline (CPT 90772 or HCPCS S2083). https://www.oxhp.com/secure/policy/gastric_surgery.html Sorry about the delay,,I've been gone. For teh life of me,,I cant remember the exact site I found it the first time,,but here is a site that says the same thing. My surgeon's office is connected to teh hospital and they don't seem to want to give me a call back. I'll try them again. If I were you tho,,I would contact the part B Medicare carrier in YOUR state and ask them what the correct code is and tell them they obviously need to send a rep out to educate your physician's office insurance coder,,hahahaha. I used to coordinate workshops between our member physicians and Medicare to educate them on changes and new codes. lyndalafe,,,,,i worked in health insurance for a gazillion years,,we only gave info to the patient who was our subscriber or the physician's office performing the procedure,and then it had to be in writing, stating exactly what they7 wnated to know. Anytime it was a question

Denise~~ Saw my surgeon about that left arm pain. Mine too was not in my chest or so much the shoulder, but in my bicep and down my arm. He said sometimes teh phrenic nerve in the diaphram can be aggravated by the surgery, but it causes shoulder pain,,not radiating down the arm and numbness,,like I'm having. He said mine sounded more like something cervical related. I AM going to Water aerobics 3 times a week and never had any pain beefore that,,hmmm,,maybe I pinched something. Anyway,,now I have NO pain, but stil some numbness. As long as it doesnt bother my hand or fingers,,I can live with it. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS

Hi ya'll~ Last week I got my 3rd fill and I think its a tad too tight! I was able to swallow water right afterwards, so I left his office feeling good. Thought perhaps this fill would hit my sweet spot. Before teh fill I had 1.7ccs, I think, in my 4cc band. He pushed me up to 2.0. WELLLLLLLL I got home later and fixed supper and almost died trying to swallow anything. I've never hurt that bad or had that kinda of hurt before. I read some posts,,seeing what others had to say about similar experiences. Lots of folks said after THEY got a fill, it was tight and took a few days to a week or two before it settled down. So,,,I just tried to eat soft things,,no go. Anything with the consistence thicker thatn water sticks in my throat(?) and kills me. It goes down,,,but it hurts like hell. Still,,I was giving it time to 'settle down'. Its now one week after that fill and it hurts as bad today as it did the first bite. I've got an appt in the morning,,wish me luck! hahahaha I was a self-pay, so my fills/office visits for a year are included in my one time fee. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS

ktkt,,, I don't count calories. My surgeon nor dietician ever mentioned calories to me. I'm comfortable that IF I eat the foods I'm supposed to, in the amounts I'm supposed to, exercise, get all my water,,things will fall into place. So far,,it's worked for me. But then,,that's just what I'm doing. I had a fill last week and it's so tight I can't eat anything without having terrible pain. SOoooooo in hte morning I'm going to see my surgeon and see if I'm just a tad too full in my band. Hopefully,,I can find that sweet spot. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS

How great to hear from someone with so much time banded! Glad you shared your anniversary!! I've wondered if there were any different issues with those banded for a long time, but haven't noticed anyone with 10 years behind them before. Thanks for blazing the way!! banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS

Bullwinkle,,,I apologize that the tone of my post offended you. I would never intentionally try to shame or finger-wag anyone. Thank you for calling me on the carpet. I will be more careful in how I say things from now on.

We should be getting 60-80 grams of Protein a day. Looking at what you listed for supper, I hope you made up the other grams at earlier meals. vegetables- 1/4 cup has 1 g of protein low fat yogurt- 1 cup has 7 g of protein 1 ounce of low/no fat cheese has 7 grams of protein gingersnaps-i'd venture to say has zero If I ate for supper what you listed, I'd only have gotten 23g of protein. Where did the other 37 minimum grams come from? 57 if you go to the maximum grams? Hard Proteins will stay with you longer giving you a better sense of fullness. Yogurt is tasty to me,,but as far as staying wth me and making me feel full,,nada. Gingersnaps,,,,nada,,useless carbs. I'd worry more about the protein count than I would about the fat count. That's why my surgeon and dietician stress: Proteins FIRST,,veggies SECOND, carbs,,,only if I have room for them. For ME,,when I was eating the wrong things,,I never felt full. If I eat in the order and amounts I'm supposed to ,,I'm full. That's just my take on it. banded 1/29/07 Dr Ken Cleveland-CMMC-Jackson, MS 2cc/4cc band

well,,,today is Sunday and tonight i was able to eat solids for the first time without the pain from my fill Thursday. I guess it just needed time. Heck,,I dunno,,whatever it was,,passed.

Welllllllllllll I AM post-menopausal and 53. I was banded 1/29/07 and my pre-surg weight was 331 and I'm 5'2". As of last Thursday I've lost 66 pounds. I knew I had to do something or I was going to be miserable the rest of my life or dead. Choosing to have the band is the best thing I've ever done for myself.