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JANUARY 2015
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SPECIAL REPORT
T H E P H YS I O LO G Y OF HUNGER
THE
WEIGH WE ARE
Thinkstock
HUNGER HORMONES MAY BE OUTSMARTING US
T
| ARTICLE BY DEBRA GELBART | PHOTOGRAPHY BY RICK D’ELIA
he difference between true hunger — when your body tells you that you need to fuel
it so it can perform all of its functions — and appetite — when you feel the urge to eat but you don’t necessarily have the physical need to eat — can be difficult to distinguish, thanks to a hormone called ghrelin.
A hormonal gremlin
Ghrelin is produced when the stomach is empty, signaling the body that it’s time to eat. But appetite also can be stimulated by “smelling food, seeing food or even by hearing knives and forks clinking together,” said James Swain, M.D., a bariatric surgeon with Scottsdale Healthcare Bariatric Center. “I tell my patients that they can’t watch ‘Diners, Drive-ins and Dives’ on the Food Network when they’re trying to eat healthy because hormones released when you do that make it much harder to lose or maintain weight.” Ghrelin is manufactured mainly in the cells of the stomach, explained Hilario Juarez, M.D., a bariatric surgeon and medical co-director of the Bridges Center for Surgical Weight Management at St. Luke’s Medical Center in Phoenix. “In bariatric surgery, when we make the stomach smaller, ghrelin levels dive,” he said, adding that ghrelin is one of many hormones produced in the body that influence hunger and satiety, or a feeling of fullness.
Metabolizing calories
As counter-intuitive as it may sound, new research has shown that leaner people don’t use calories efficiently, but heavier people’s bodies have become adept at absorbing nearly every single calorie in their food. “That may be yet another reason that it can be so difficult to lose weight on your own,” Swain said, referring to obese individuals, “because your body has become accustomed to metabolizing every calorie that you consume, while a leaner person doesn’t necessarily process food the same way.” If you weigh more than what is considered optimal, that can mean you’re less sensitive to the release of the satiety hormones in your small intestine (two of which are called GLP-1 and PYY) as your stomach fills and the contents begin to move toward the small intestine. “People who are obese are not satisfied as soon as those with a normal body weight,” Swain said. Doctors used to think that a protein called leptin — another satiety indicator released as the stomach gets fuller — held the promise of a solution to obesity.
James Swain, M.D., a bariatric surgeon with Scottsdale Healthcare Bariatric Center, tells his patients that they can’t watch “Diners, Drive-ins and Dives” on the Food Network when they’re trying to eat healthy because hormones released when you do that make it much harder to lose or maintain weight. “But leptin has lost its luster,” Swain said, noting that doctors have determined that a higher level of leptin in the body doesn’t always tamp down appetite. Indeed, leptin levels appear to be high in obese patients, according to David Podkameni, M.D., a bariatric surgeon at Banner Gateway Weight Loss Institute in Gilbert. “We think heavier people may be resistant to its effects,” he said. “Researchers are now
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Hilario Juarez, M.D., a bariatric surgeon and medical co-director of the Bridges Center for Surgical Weight Management at St. Luke’s Medical Center in Phoenix, said that ghrelin, which is manufactured mainly in the cells of the stomach, is one of many hormones that influence hunger and satiety, or a feeling of fullness.
investigating whether the receptor cells in obese patients can be modified to respond to leptin.” Podkameni also said researchers are looking into whether adiponectin, a protein released from adipose (fatty) tissue that seems to produce a sensation of satiety as well as potentially protecting against cancer, can be more effectively harnessed than leptin. HUNGER , continued on page 3
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HEALTHCARE INSURANCE HELP HEALTHCARE SEMINAR Jan. 21, 5–6:30 p.m. (Spanish); 6:30–8 p.m. (English) By Blue Cross Blue Shield of AZ at Residence Inn Phoenix Desert View 5665 E. Mayo Blvd., Phoenix AZBlue.com/seminars HEALTH INSURANCE MARKETPLACE HELP Jan. 22, 6–7 p.m. (Spanish); 7–8 p.m. (English) Maryvale Hospital 5102 W. Campbell Ave., Phoenix 866-893-8446 AbrazoHealth.com/PathToHealth HEALTH INSURANCE MARKETPLACE HELP Jan. 24, 6–7 p.m. West Valley Hospital 13677 W. McDowell Rd., Goodyear 866-893-8446 AbrazoHealth.com/PathToHealth HEALTH INSURANCE MARKETPLACE HELP Jan. 27, 6–7 p.m. Arizona Heart Hospital 1930 E. Thomas Rd., Phoenix 866-893-8446 AbrazoHealth.com/PathToHealth HEALTHCARE SEMINAR Jan. 28, 5–6:30 p.m. (Spanish); 6:30–8 p.m. (English) By Blue Cross Blue Shield of AZ at Chicanos Por La Causa 6850 W. Indian School Rd., Phoenix AZBlue.com/seminars UNDERSTANDING HEALTH COVERAGE Jan. 30, 11 a.m.–12:30 p.m. Maricopa Integrated Health Center South Central Family Learning Center 33 W. Tamarisk St., Phoenix 602-344-6460; mihs.org/flc
WELLNESS SKIN CANCER SCREENING Jan. 31, 8:30–11:30 a.m. By Scottsdale Healthcare at Affiliated Dermatology 20401 N. 73rd St., Scottsdale 480-882-4636; shc.org/events
CAREGIVERS CAREGIVERS SUPPORT GROUPS Various dates, times & locations By Duet; 602-274-5022; DuetAZ.org ONLINE NETWORKING (DUET) Jan. 27, 7–8 p.m. Register: DuetAZ.org (Events tab) 602-274-5022
GRIEF GRIEF SUPPORT GROUPS Various dates, times & locations By Banner Hospice Rev. Cindy Darby, cindy.darby@BannerHealth.com BannerHospice.com; 480-657-1167 GRIEF SUPPORT GROUP Various dates, times & locations By Hospice of the Valley hov.org/grief-support-groups 602-530-6970 CHILD LOSS SUPPORT Jan. 26, 6–8 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-3878; shc.org GRIEF SUPPORT Jan. 27, 3–4:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321; shc.org GRIEF SUPPORT Jan. 29 St. Joseph’s 350 W. Thomas Rd., Phoenix Call for time: 602-406-3275
JOINTS/ORTHOPEDICS TOTAL HIP REPLACEMENT Jan. 27, 6–7:30 p.m. Scottsdale Healthcare Greenbaum 3535 N. Scottsdale Rd., Scottsdale 480-882-4636 AZHipReplacement.com
PAIN IS PAIN HANDICAPPING YOUR GAME? Jan. 21, 4:30 p.m. By Mountain Vista Medical Center at Las Sendas Golf Club 7775 E. Eagle Crest Dr., Mesa Register: 877-924-WELL (9355) INTRO TO FIBROMYALGIA Jan. 21 & 28, 5:30–6:30 p.m. Fibromyalgia Wellness Center
VARIOUS DATES & TIMES
8300 N. Hayden Rd., Scottsdale 480-948-4955 HOPE FOR TODAY Jan. 27, 3:30–4:30 p.m. By Chronic Pain Anonymous at Temple Chai Shalom Center House 4635 E. Marilyn Rd., Phoenix cpa-az@cox.net ChronicPainAnonymous.org
FALL PREVENTION OUTREACH COURSES WHAT:Eight-weekprogramaimed athelpingelderspreventfallsas wellasaddresstheirfearoffalling. WHERE/WHEN:Variousdates,times andlocationsaroundtheValley. PRESENTED BY: A.T. Still University COST: Free INFO/REGISTER: 480-219-6000; ATSU.edu/FallPrevention; ebordenave@atsu.edu
HEART/STROKE STROKE SURVIVOR SUPPORT GROUP Jan. 22, 2:30–3:30 p.m. Mercy Gilbert Medical Center 3555 S. Val Vista Dr., Gilbert 480-728-5414
JAN. 22 & 29 TEEN MOMS SUPPORT GROUP WHAT: Empowering pregnant and parenting moms, ages 14 to 20, by creating positive and healthy life goals.
WOMEN CERVICAL CANCER AWARENESS Jan. 27, noon–1 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-882-4636; shc.org/events
DIABETES MANAGING TYPE 2 DIABETES Various dates, times & locations By Dignity Health 480-728-3535 MANAGING GESTATIONAL DIABETES Jan. 21 & 28, 2 p.m. Dignity Health Center for Diabetes Management 1760 E. Pecos Rd., Gilbert 480-728-3535
ALZHEIMER’S/DEMENTIA ALZHEIMER’S CAREGIVER SUPPORT GROUPS Various dates, times & locations Alzheimer’s Association – Desert Southwest Chapter 800-272-3900; alz.org/dsw DEMENTIA PROGRESSION Jan. 22, 12:30–2:30 p.m. Banner Alzheimer’s Institute 901 E. Willetta St., Phoenix Register: 602-839-6850
BREAST CANCER BOSOM BUDDIES SUPPORT GROUPS Various dates, times & locations Ahwatukee/Chandler: 480-893-8900 East Valley: 480-969-4119 Northwest Valley: 623-236-6616 West Valley: 623-979-4279 BREAST CANCER SUPPORT Jan. 22, 6–8 p.m. Breast Health & Research Center 19646 N. 27th Ave., Phoenix 623-780-4673;JCL.com/breasthealth HOLISTIC VS WESTERN TREATMENT Jan. 27, 6–8 p.m. Breast Health & Research Center 19646 N. 27th Ave., Phoenix 623-434-2784; JCL.com/breasthealth
CANCER SUPPORT GROUPS CANCER CAREGIVERS SUPPORT GROUPS Various dates & times By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org LEUKEMIA, LYMPHOMA & MULTIPLE MYELOMA SUPPORT Jan. 21, 3–4:30 p.m. Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler 480-728-5657
JAN. 28 JUICING, FASTING & DETOXING WHAT: Learn about current detoxing trends and how they can help increase health and vitality. WHERE: Online WHEN: 5–6 p.m. PRESENTED BY: Sprouts Farmers Market COST: Free INFO/REGISTER: www3.GoToMeeting.com/ register/772619102
ABRAZO HEALTH CARE: AbrazoHealth.com; 602-674-1400 Arizona Heart Hospital, Arizona Heart Institute and Arrowhead, Maryvale, Paradise Valley, Phoenix Baptist and West Valley hospitals BANNER HEALTH: BannerHealth.com; 602-747-4000 Numerous hospitals and medical centers BANNER CARDON CHILDREN’S: BannerHealth.com; 480-412-KIDS (5437) BARROW NEUROLOGICAL INSTITUTE: TheBarrow.org; 602-406-6281 CHANDLER REGIONAL MEDICAL CENTER: DignityHealth.org/ChandlerRegional; 480-728-3000 JOHN C. LINCOLN DEER VALLEY: JCL.com; 623-879-6100 JOHNC.LINCOLNNORTHMOUNTAINHOSPITAL:JCL.com;602-943-2381 MARICOPA INTEGRATED HEALTH SYSTEM: MIHS.org; 602-344-5011 MAYO CLINIC: MayoClinic.com; 480-515-6296 MERCY GILBERT MEDICAL CENTER: DignityHealth.org/MercyGilbert; 480-728-8000 MOUNTAINVISTAMEDICALCENTER:MVMedicalCenter.com;480-358-6100 MUHAMMAD ALI PARKINSON CENTER: TheBarrow.org; 602-406-6262 PHOENIX CHILDREN’S HOSPITAL: PhoenixChildrens.org; 602-933-1000 SCOTTSDALE HEALTHCARE: SHC.org; 480-882-4000 Scottsdale Healthcare Osborn, Scottsdale Healthcare Shea, Scottsdale Healthcare Thompson Peak ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER: DignityHealth.org/StJosephs; 602-406-3000 ST. JOSEPH’S WESTGATE MEDICAL CENTER: DignityHealth.org/Westgate; 602-406-0000 ST. LUKE’S MEDICAL CENTER: StLukesMedCenter.com; 602-251-8100 TEMPE ST. LUKE’S HOSPITAL: TempeStLukesHospital.com; 480-784-5500
WOMEN WITH MULTIPLE SCLEROSIS Jan. 31, 10 a.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 480-829-6563
DIABETES REFRESHER CLASS Jan. 23 & 30, 9 a.m. Dignity Health Center for Diabetes Management 1760 E. Pecos Rd., Gilbert 480-728-3535 INSULIN MANAGEMENT CLASS Jan. 23 & 30, 9 a.m. Jan. 26, 2 p.m. Dignity Health Center for Diabetes Management 1760 E. Pecos Rd., Gilbert 480-728-3535 MANAGING TYPE 1 DIABETES Jan. 26, 9 a.m. Dignity Health Center for Diabetes Management 1760 E. Pecos Rd., Gilbert 480-728-3535 MANAGING PRE-DIABETES Jan. 26, 1 p.m. Dignity Health Center for Diabetes Management 1760 E. Pecos Rd., Gilbert 480-728-3535
WHERE: Chandler Regional Medical Center,1875W.FryeRd.,Chandler WHEN: 6–7 p.m. PRESENTED BY: Dignity Health COST: Free for mothers ages 14-20 and babies up to one year old. INFO/REGISTER: 480-728-5414
a-z I N F O R M AT I O N O N L I N E
CAREGIVER & FAMILY SUPPORT Jan. 21, 6:30–7:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321; shc.org LIVING WITH LYMPHEDEMA Jan. 26, 6:30–8:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321; shc.org LIVING WITH LOSS Jan. 27, 1–2:30 p.m. Cancer Support Community 360 E. Palm Lane, Phoenix 602-712-1006; rsvp@cscaz.org SURVIVING & THRIVING Jan. 27, 1–2:30 p.m. Cancer Support Community 360 E. Palm Lane, Phoenix 602-712-1006; rsvp@cscaz.org CANCER SUPPORT INFO Jan. 28, 10–11 a.m. Cancer Support Community 360 E. Palm Lane, Phoenix 602-712-1006; rsvp@cscaz.org METASTATIC CANCER SUPPORT Jan. 28, 3–4:30 p.m. Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler Register: 480-340-4013; IronwoodCRC.com IMMUNE SYSTEM & NUTRITION Jan. 29, 6–7:30 p.m. Cancer Support Community 360 E. Palm Lane, Phoenix 602-712-1006; rsvp@cscaz.org
BRAIN/NEUROLOGICAL BRAIN ANEURYSM SUPPORT Jan. 21, 6–8 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 760-333-7658 Kimberly@JoeNiekroFoundation.org
PARKINSON’S PARKINSON’S EXERCISE CLASSES & SUPPORT GROUPS Various dates, times & locations By Muhammad Ali Parkinson Center 602-406-3840
MOMS ON THE MOVE Jan. 21 & 28, 1–2:30 p.m. Scottsdale Healthcare Osborn 3624 N. Wells Fargo, Scottsdale 480-323-3878; shc.org
BRAIN TUMOR SUPPORT Jan. 27, 6–8 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 623-205-6446
POSTPARTUM DEPRESSION SUPPORT Jan. 21 & 28, 1–2:30 p.m. Chandler Regional Medical Center 1875 W. Frye Rd., Chandler 480-728-5414
RESPIRATORY BETTER BREATHERS/ COPD SUPPORT Various dates, times & locations By the American Lung Association 602-429-0005; BreatheEasyAZ.info BETTER BREATHERS CLUB Jan. 21, 2–3 p.m. Chandler Regional Medical Center 1955 W. Frye Rd., Chandler 480-728-5655; BreatheEasyAZ.info
HEARING LOSS HEARING LOSS SUPPORT Jan. 21, 1:30–3:30 p.m. By Hearing Loss Association of America at Fountain Hills Community Center 13001 N. LaMontana Dr., Fountain Hills 301-657-2248; HearingLoss.org; KFonville@fhfh.az.gov HEARING LOSS SUPPORT Jan. 22, 1:30–3:30 p.m. By Hearing Loss Association of America at Lions Foundation Campus 9451 N. 99th Ave., Peoria 301-657-2248; HearingLoss.org; melanie.orourke@gmail.com
PARENTING GRANDPARENTS RAISING GRANDCHILDREN Various dates, times & locations By Benevilla 623-207-6016; benevilla.org GRANDPARENTS RAISING GRANDCHILDREN Various dates, times & locations By Duet; 602-274-5022; DuetAZ.org CIRCLE OF MOTHERS SUPPORT Jan. 21 & 28 10 a.m.–noon Banner Estrella 9201 W. Thomas Rd., Phoenix 623-327-8200 BREASTFEEDING SUPPORT Jan. 21 & 28, 11 a.m. Chandler Regional Medical Center 1955 W. Frye Rd., Chandler 480-728-5414
MOTHER-TO-MOTHER SUPPORT Jan. 23, 10–11:30 a.m. St. Joseph’s 350 W. Thomas Rd., Phoenix 877-602-4111 SUPPORT THROUGH OTHER PARENTS Feb. 3, 7–9 p.m. Larkspur Christian Church 3302 W. Larkspur Dr., Phoenix 623-846-5464 SupportThroughOtherParents.org
WEIGHT LOSS BARIATRIC SURGERY SEMINARS Various dates, times & locations By Banner Health BannerHealth.com; 480-543-2606 WEIGHT LOSS SURGERY SEMINARS Various dates & times Bridges Center for Surgical Weight Management at St. Luke’s, 555 N. 18th St., Phoenix Register: 800-248-5553 Webinar: BridgesAZ.com WEIGHT LOSS SURGERY SEMINARS Various dates, times & locations By Scottsdale Healthcare BariatricSurgeryAZ.com 480-882-4636
VALLEY FEVER INFO AZ VICTIMS OF VALLEY FEVER ArizonaVictimsOfValleyFever.org 623-584-8331; pat-valleyfever@live.com 602-242-9527; mmfcreate@aol.com VALLEY FEVER CENTER FOR EXCELLENCE 602-406-8253; vfce.arizona.edu ValleyFeverCenter@DignityHealth.org
POISON CONTROL BANNER GOOD SAMARITAN Poison & Drug Information Center Hotline: 800-222-1222
Scott A. Perkins, MD
As a nationally recognized ophthalmologist with Barnet Dulaney Perkins Eye Center, Dr. Perkins has performed over 50,000 cataract surgeries and over 10,000 vision correction procedures. As an innovator in the field of ophthalmology, he has participated in over 25 clinical trials for both pharmaceutical and ophthalmic devices. BARNET DULANEY PERKINS EYE CENTER Locations throughout Arizona www.GoodEyes.com 800-966-7000
FAMILY MEDICINE Stephen Bair, DO
A graduate of Kansas City College of Osteopathic Medicine, Dr. Stephen Bair is Board Certified and completed his internship and residency at Phoenix General Hospital. Dr. Bair serves patients of all ages and specializes in preventative medicine, chronic disease management and osteopathic treatments. Banner Health Center 155 E. Warner Road, Gilbert 480-649-6600 BannerHealth.com/HealthCenterGilbert
GERIATRICS, INTERNAL MEDICINE Kristina Balangue, MD
YOUNG ONSET WELLNESS SUPPORT GROUPS Various dates & times Muhammad Ali Parkinson Center 240 W. Thomas Rd., Phoenix 602-406-4921 SINGING FOR PEOPLE WITH PARKINSON’S Jan. 21 & 28, 10 a.m.–noon By Muhammad Ali Parkinson Center at Shepherd of the Desert Lutheran Church 11025 N. 111th Ave., Sun City 602-406-3840
BRAIN INJURY SUPPORT Jan. 22, 6–7:30 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 602-508-8024; 602-406-6688
CATARACT & REFRACTIVE SURGERY
CANCER CAREGIVERS CONFERENCE Jan. 31, 9–11:30 a.m. Cancer Support Community 360 E. Palm Lane, Phoenix 602-712-1006; rsvp@cscaz.org
A graduate of the University of the Philippines College of Medicine, Dr. Kristina Balangue completed her internship and residency in Internal Medicine at Columbia University College of Physicians and Surgeons at Harlem Hospital Center in New York. Dr. Balangue is Board Certified and specializes in complex care, care coordination and geriatrics. Banner Health Center 14416 W. Meeker Blvd., Building C, Suites 200 and 300, Sun City West 623-583-5271 BannerHealth.com/HealthCenterNWPrimaryCare
PEDIATRIC GASTROENTEROLOGY Vinay Bandla, MD
Dr. Bandla is a graduate of PSG Institute of Medical Sciences & Research in India and completed his residency at Maimonides Infant and Children’s Hospital in New York. Dr. Bandla is Board Certified and specializes in pediatric gastroenterology, including short gut and intestinal failure, eosinophilic esophagitis and celiac disease.
January 2015 | Vol. 5, No. 1
A Little Fib Can Lead to a Big Problem. Free seminar with Dr. Andrew Kaplan to learn about your heart and A-Fib. February 3, 2015 5-7 p.m. Banner Heart Hospital 6644 E. Baywood Ave., Mesa 602-230-CARE to RSVP
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Wednesday, January 21, 2015 | Livingwella-z | 3
Hunger
continued from the cover
Hunger and appetite
Hunger pangs begin when the edges of the lining of an empty stomach rub together and irritate each other, Juarez said. Then, ghrelin is released in the stomach and neuropeptide Y (NPY) is released in the brain. NPY prompts a desire for more food in response to a falling blood sugar level, Juarez said. David Podkameni, M.D., a bariatric surgeon at Banner Gateway Weight Loss Institute in Gilbert, said that sweets combined with fat can challenge healthy eating more than almost anything else because our brain loves a mix of fat and sugar, a mix that can stimulate appetite. Banner Health
Appetite can be stimulated by consuming high fructose corn syrup (found in a wide range of sugary drinks and processed foods), because “the intense sweetness of high fructose corn syrup can trigger a desire to consume more sugar,” said Janis Saunders, D.O., a family medicine physician in Scottsdale with Abrazo Medical Group’s Parkway Medical office. “Reducing or eliminating corn syrup and other simple carbohydrates like white rice and white bread can help decrease cravings for sweets.” Sweets combined with fat can challenge healthy eating more than almost anything else, Podkameni said. “Our brain loves a mix of fat and sugar,” he said, “and that mix really can stimulate appetite.” A larger appetite can lead to accumulation of fat cells and a sluggish metabolism,” he said. “Once that occurs, it can be extremely difficult to reset your metabolism so that you can lose weight.”
All is not lost
But all is not lost — no pun intended. If you’re trying to lose weight, programs that include accountability and feedback generally work well because of the built-in support. “A medically supervised diet is probably best,” Podkameni said, “because then you’re getting the additional instruction and monitoring that you may need.” Perhaps the most important step toward successful weight loss is to stop berating yourself for not being able to lose weight easily. “It’s past time to drop the prejudice against heavy people,” Podkameni said,
4 top tips from the experts to help you either lose weight or avoid weight gain
1
Eliminate simple sugars. “Sugars are broken down so quickly that they trigger a release of insulin into the body which instantly brings the blood sugar level way down. That low blood sugar level then prompts more consumption of simple sugars to quickly boost glucose levels.” — James Swain, M.D.
2
Eat smaller meals.“Larger meals can stretch the stomach which can boost levels of hunger hormones.” — Hilario Juarez, M.D.
3
Include protein with each meal. “Eating at least 60 grams of protein each day while minimizing carbohydrate intake will keep blood sugars more steady throughout the day and should provide a greater and longer sense of meal satisfaction.” — James Swain, M.D.
4
Seek support. “Your weight loss will be more successful if you’re accountable to someone else.” — David Podkameni, M.D.
When bariatric surgery is the answer Requirements vary, but generally, a BMI (Body Mass Index) of 35 or above is required to be considered as a candidate for bariatric (weight loss) surgery. (To calculate your BMI, ask your healthcare provider for help or search the internet for“BMI calculator”and enter your height and weight). For full details on eligibility requirements, contact a bariatric surgery center. It’s also important to note that some insurance policies cover all or selected types of the surgery, while others specifically exclude all or some types from coverage. Check your policy for details. “beginning with yourself, and instead, understand the science of gaining and losing weight. Heavy people aren’t lazy or unmotivated; they’re fighting an uphill battle. But it’s just as important that primary care physicians address the health effects of obesity with patients, so patients can begin to think about what they might be able to change.”
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