Weight Loss Surgery release form


The following is the release form given to the patients of Dr Terry Simpson, bariatric surgeon, Phoenix, AZ and is reprinted with his permission. It is usually attributed to the insurance provider, Kaiser Permanante and used by several doctors and surgeons across the USA. Each patient is asked to read carefully and sign before their surgery.  The patient who typed this in apparently decided against WLS after reading this. Many patients who suffer complications later admitted that they did NOT read this form - just signed it.  Going into bariatric surgery not being prepared for after surgery compliance is extremely risky.

Obesity Surgery - Considerations
Obesity is clearly an alarming health problem in the United States. Not only is the total number of obese individuals increasing, but also the age of onset of obesity is decreasing. Younger and younger Individuals have become morbidly obese and even experience adult type diabetes and heart disease at an unusually early age. Clearly the health habits of Americans are deadly. Individuals who are obese typically feel that they are going to die any minute simply because of what they weigh. They may feel they are discriminated against because of what they weigh. There is occasionally an underlying feeling that something drastic or violent needs to be done to their body in order to tame the fact that it is out of control. In their frustration they place their physician in the position of the bad guy if he or she doesn’t find them a good candidate for surgery. However, they must realize that the decision to use surgery to lose weight is not a patient decision. It is a medical decision. You may know people who have had surgery for their weight and everything has gone fine. They tell you that it was the best decision they ever made. They urge you to get the same procedure. However, It is also not their decision to make. It is a medical decision, taking into account you and your current mental and physical health. Obesity surgery is not strictly preventive. It is a medical treatment. It is a choice between two options, none of which are ideal. Patients often believe that the surgery is a preventive therapy. This is untrue Preventive therapy would have kept them from becoming obese in the first place. Obesity is a sickness and surgery is only one treatment It may not even be the best one or have the best outcome.
Read and understood ___________________________________________________


Surgeons will tell their patients that their problem is a genetic one, and that their only choice is to have this surgery. While genetics play a role, this reasoning is flawed. It happens to be true that all races within the United States have an increased risk of obesity over their genetic counterparts within other countries.

Europeans are more likely to be obese in the United States than Europe. Orientals are more likely to be obese in the United States than their country of origin. Likewise, African Americans, Hispanics Pacific Islanders, East Indians, all are likely to be heavier in this country. America is a bad place to live if you do not wish to be obese. Obesity involves complex physiology. Do not blame the lack of a cure on your doctor. Instead, blame a food industry that wants your money and will “feed” you anything to get it. We have seen patients go to other countries to live for a while and lose weight while there. We have seen patients come from these other countries and immediately begin to put on weight.
Read and understood_________________________________________________

If you believe that you want to have this surgery so that you do not have to change what you eat you are mistaken. If it works right, this surgery changes WHAT you eat, not just how much. All patients eat less. Typically those individuals who find that they can eat anything they want after they have the surgery are the same individuals who either lose little weight or eventually gain the weight back. Read and understood_________________________________________

If you believe this surgery will restore you to complete and normal health you are mistaken. You are trading one nutrition problem for another problem. Obesity alone, does not necessarily kill you. You need to understand that when researchers do studies on the obese and find that they are more likely to die, this does not necessarily mean that how much they weigh, killed them. Obesity is • symptom. It is just as likely that what they ate killed them. and also happened to make them heavy at the same time. Doctors who tell you “Just eat less” oversimplify the problem. You don’t need to eat less, you need to eat differently. This is the real reason obesity surgery works for some people. The changes they should have made without surgery are forced on them by side effects of the surgery. You will do best if fat and sugar make you sick after the procedure. Do not think you know better because you had a friend who had the surgery and did well despite eating whatever they wanted. This is an exception. Given enough time, they will probably put most of the weight back on.           
Read and understood ___________________________________________________

Keep In Mind: Slender individuals have adult diabetes. Slender individuals have heart attacks. Sender individuals develop arthritis and have joint problems. Slender individuals have strokes and develop cancer. If obese individuals have these problems more commonly than the slender, it is because the same bad health habits just don’t happen to cause obesity in some individuals “fortunate” enough to be slender no matter what they eat. They may be slender but they could very likely die just as early in life as someone who is overweight.
Read and understood ___________________________________________________

As doctors, we are nearly always told, “I am willing to take the risk of dying from this surgery because it is better than going on like this” and “I don’t want to be a model. I Just want my health back”. All but a very few of these people later cry about the fact that they did not lose all the weight they wanted to lose. They are unhappy even though their health is improved. Many of them come back and want other cosmetic tune-ups like liposuction, tummy tucks and skin removal from their arms. Kaiser Permanente does not have a cosmetic surgery benefit. Save some of the money you are not spending on food for these elective procedures.
Read and understood _________________________________________________

Gastric surgery for weight loss causes nutritional deficiency in nearly 100% of individuals who have it done. The most common deficiencies are Vitamin B12, Iron, Calcium, Magnesium, Carotene (beta-carotene and other carotene vitamins) and potassium. In the beginning patients will faithfully get their vitamin B12 shots and take their vitamins. After a while they flatter themselves that they are healthy and just like anyone else. They discontinue getting checkups. This is risky. A recent follow-up study done on gastric bypass patients showed that even 10 years later there were severe nutritional deficiencies. You are NEVER normal. NEVER.
Read and understood __________________________________________________

If you have mental health issues like depression, anorexia, or bulimia you must not hide these problems. If you have any mental health history of any kind you must report this to the doctor who may refer you for this surgery. Initialing here, signifies that you have reported any of these problems. Kaiser cannot be responsible for what you have not disclosed to us.
Read and understood __________________________________________________

If you have a hidden or unreported problem with alcohol or drug abuse you must report these prior, to the surgery. The surgery could very likely kill you if this is true. Read and understood___________________________________________________

If you have pre-existing nutritional deficiencies or vitamin deficiencies because of poor eating habits you must report these and they must be corrected before surgery is even considered. It is not always possible to correct deficiencies once the surgery is performed. An example would be iron deficiency anemia.           
Read and understood______________________________________________

If you are a candidate for surgery you must take either a high quality liquid vitamin or chewable vitamin with a complete listing of vitamins and minerals for the rest of your life. Flintstones chewable vitamins are one example. There are 3 or more versions of these vitamins and you need to carefully check for the one with the longer list of nutrients. Unless your vomiting is severe, take these daily even if you occasionally regurgitate or vomit food. If you are regurgitating and/or vomiting but are able to swallow any water or sip anything at all, you should be able to safely chew and swallow a small vitamin. Often patients complain that they do not like the flavor of these vitamins. Sorry, take them anyway.          
Read and understood __________________________________________________

A complete inability to eat, or an ongoing problem with vomiting Is a dangerous situation. Fasting for more than 3-4 days is dangerous. Do not let a problem like this go on more than a day before seeking medical attention. Carefully document what you are able to eat and report it to the health care provider who sees you. Up to 30% of individuals develop ulcers where your intestine will join your stomach. This can cause vomiting and abdominal pain. Other more serious internal problems like bowel strangulation, perforation, infection of the inner abdomen and gallstones can cause the same thing. Seek medical help and make it clear to the provider that you have had gastric surgery. If possible, it is best to go back to the surgeon, if the surgery was recently performed. Remember, this is the surgery YOU asked for. If you wait days or weeks to seek medical help, we cannot be responsible for the complications or nutritional problems that occur.
Read and understood _________________________________________________

You should be aware that as nutritional science advances, we are discovering that there is more to food and health than vitamins, minerals, fiber, protein, carbohydrate and fat. Deficiencies in these nutrients resulted in rapid health effects that made them easy to identify. Nutrition science is now moving into new areas involving other more obscure chemicals in plants that have health effects that are more subtle and long term. This makes them harder to find, and their benefits difficult to document Most health studies are not done long enough to discover all outcomes. As these new substances are located and understood it will probably emerge that our stomachs have to be a given size just to take them all in. Because of this surgery, you will not be able to do so. Biologically, we have the G.I. tract we have for a reason. Changing it is purely experimental.
Read and understood __________________________________________________

Fruits, grains, vegetables, beans, nuts and wild animals (that were tough and hard to catch), existed on this planet long before farm machinery, stockyards, commercial animal processing plants and refineries. While what you do is your business, as far as your body is concerned, you do not have the right to eat abnormally. Your body chemistry will not adapt to junk just because you wish it This surgery does not make junk food good for you. Abuse your body and you lose. Chips, sugar, sodas, cookies, cakes, pudding, fast food, snacks, fried foods and excessive fat intake did not exist for human consumption before the last 75-100 years. What we consider food in this country is so different from what humans used to eat, we are almost certain to get sick on it as well as gain weight. Gastric bypass does NOT enable you to eat these foods and be healthy anyway. Normal weight is NOT all that is necessary to be healthy. When your stomach is the size of a teacup, and your small intestine arranged to cause malabsorption, you cannot eat poor quality food. You need every opportunity you can to even begin to get the nutrition you need. Gastric bypass creates malabsorption. You will not absorb all you eat because of what has been done to you. Gastric bypass makes poor eating habits no longer an option. We can’t come check your cupboards. This is your responsibility.                                
Read and understood___________________________________________________

Complications include, but are not limited to, infection, rupture, strangulation of the bowel, ulcers, non-healing of the wound, hernia at the Incision, excessive skin, abdominal pain, vomiting, nutritional deficiencies, depression, arthritis, gas, diarrhea, hair loss, gallstones, bone demineralization,  menstrual changes, headaches, weight regain, body odor, bad breath, reflux, heartburn, pulmonary embolisms, heart attack or stroke, or other blood clots as well as death from the surgery Itself. Remember that those who had the surgery and say it was the best thing that ever happened to them, are the ones who are alive to tell you their side of the story. You're getting only part of the picture no matter what you learned from a friend, a TV news magazine, or on the internet.                     
Read and understood___________________________________________________

I have been given a copy of this.




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