LOMN

[Guest guest]

" what's the best format for a LOMN to be? "

You might have your DR follow the NIH suggestions for patient

selection as many insurance co's use this in part as thier criteria

for medical necessity:

http://odp.od.nih.gov/consensus/cons/084/084_statement.htm

Gastrointestinal Surgery for Severe Obesity

National Institutes of Health

Consensus Development Conference Statement

March 25-27, 1991

This statement was originally published as:

Gastrointestinal Surgery for Severe Obesity. NIH Consens Statement

1991 Mar 25-27;9(1):1-20.

For making bibliographic reference to the statement in the electronic

form displayed here, it is recommended that the following format be

used:

Gastrointestinal Surgery for Severe Obesity. NIH Consens Statement

Online 1991 Mar 25-27 [cited year month day];9(1):1-20.

Excerpt:

Patient Selection

These surgical procedures are major operations with short- and long-

term complications, some of which remain to be completely elucidated.

There are insufficient data on which to base recommendations for

patient selection using objective clinical features alone. However,

while data accumulate, it may be possible in certain cases to

consider surgery on the basis of limited information from the

uncontrolled or short-term followup studies available. A decision to

use surgery requires assessing the risk-benefit ratio in each case.

Those patients judged by experienced clinicians to have a low

probability of success with nonsurgical measures, as demonstrated for

example by failures in established weight control programs or

reluctance by the patient to enter such a program, may be considered

for surgery.

A gastric restrictive or bypass procedure should be considered only

for well-informed and motivated patients with acceptable operative

risks. The patient should be able to participate in treatment and

long-term followup.

Patients whose BMI exceeds 40 are potential candidates for surgery if

they strongly desire substantial weight loss, because obesity

severely impairs the quality of their lives. They must clearly and

realistically understand how their lives may change after operation.

In certain instances less severely obese patients (with BMI's between

35 and 40) also may be considered for surgery. Included in this

category are patients with high-risk comorbid conditions such as life-

threatening cardiopulmonary problems (e.g., severe sleep apnea,

Pickwickian syndrome, and obesity-related cardiomyopathy) or severe

diabetes mellitus. Other possible indications for patients with BMI's

between 35 and 40 include obesity-induced physical problems

interfering with lifestyle (e.g., joint disease treatable but for the

obesity, or body size problems precluding or severely interfering

with employment, family function, and ambulation).

Children and adolescents have not been sufficiently studied to allow

a recommendation for surgery for them even in the face of obesity

associated with BMI over 40.

hope that helps,

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo