Obesity results from having an abnormally high proportion of body fat which exceeds the body’s skeletal and physical standards.  Obesity develops into morbid obesity when an individual has a BMI (Body Mass Index) of 35 or higher with at least one associated co-morbid medical condition (like diabetes, high blood pressure, sleep apnea, to name a few). An individual is considered morbidly obese with a BMI of 40 or higher even if that individual does not have any co-morbid medical conditions.  A medical "co-morbidity" means that an individual experiences some type of significant physical ailment related to the excess weight he/she is carrying and can lead to death. Morbid obesity affects an estimated 10 million Americans, a number that has nearly doubled in the last 30 years.  With over 10 million sufferers today, morbid obesity is becoming more than just a serious disease, it’s a national epidemic. Find out your BMI by using the BMI calculator in the "Are you a candidate" tab on this website.

Let Dr. Golden help you overcome your battle with obesity!  Remember, you do have options.  We want to see you succeed on your weight loss journey.

Most insurance companies that require a pre-surgical psychological evaluation for bariatric surgery do provide coverage for the required psychological exam. Dr. Golden accepts several, but not all, insurance plans. Even if Dr. Golden is not considered "in-network" for your plan, you will be provided all necessary documentation from your visit to submit to your insurance company for any out-of-network benefits to which you may be entitled. Dr. Golden has reasonable fees and a great number of patients choose to use her services and pay for the examination out of pocket to ensure that they receive an appropriate psychological examination from a highly qualified and very experienced bariatric professional rather than take a risk on an important qualifying examination with a less experienced clinician who happens to be on their plan. Call Dr. Golden's office at 214.228.0796 to check if she is an in-network provider on your insurance plan and, if not, what your options are for proceeding with Dr. Golden.

Note that coverage for pre-surgical and post-surgical psychological therapy sessions varies widely depending on your insurance plan. Check with your insurance company regarding your mental health benefits. To protect their privacy regarding sensitive mental health issues, some patients choose to bypass their insurance company altogether when undergoing psychotherapy. Contact Dr. Golden's office to disucss your options confidentially.

Having health insurance does not guarantee you will be covered for weight loss surgery. Since the cost of this procedure can be very expensive, most patients would not even consider it an option if it were not for insurance or low interest financing.  Although weight loss surgery is still considered an elective procedure, it may be covered by your insurance carrier.  For this reason, it’s important that you fully understand what “is” and “is not” covered by your insurance provider.

Before you attempt to get authorization, here are some helpful hints to assist you with the authorization process:

• Read and understand your insurance provider’s "certificate of coverage." 
• Get a referral and copy of medical records from your primary care physician in order to substantiate your claim.
• Keep accurate, detailed records of visits to healthcare providers. Also, save receipts for any exercise equipment, fitness programs, diet centers, weight loss drugs and anything else that can assist in the authorization process.

With so many different insurance policies and types of plans among insurance providers, it’s important that you understand the authorization requirements for your individual policy.

• Current weight, height, and BMI.
• Verification from a physician that the patient is morbidly obese and that surgery is recommended.
• A detailed medical history including co-morbidities (i.e., the presence of one or more diseases in addition to a primary disease).
• Six (6) months of medical records including a patient evaluation, treatments performed to date, and specific types of lab work done.
• Six (6) months of a documented dieting and exercise routine (must include dates and results).
• A psychological/psychiatric evaluation.

Once you have submitted your claim it’s a matter of waiting for your insurance provider to respond.  At times it can be a frustrating and discouraging process, but don’t give up. If your claim is denied you have the right to appeal the decision.  Being denied coverage for surgery happens to many patients and this initial set back does not mean that you’ve reached the end of the road.  Some insurance providers may initially deny bariatric surgery claims automatically the first time they’re submitted, and can be more receptive to follow-up appeal letters.

If you have questions about the insurance process for surgery, your surgeon's office should be able to help you.  If you have questions about the insurance process for the psychological examination, contact Dr. Golden's office at 214.228.0796.

A surgical procedure of any kind will always involve a certain degree of risk, and bariatric surgery is no exception. In the past, weight loss surgery was viewed as extremely risky. However, with the development of new procedures and advancements in technology, bariatric surgery is a relatively safe solution to morbid obesity if you are having surgery with an experienced surgeon. This is not to minimize the fact that this is still a serious operation, which should only be considered after all other weight loss options have been exhausted.

Once a surgeon has determined that you are a candidate for weight loss surgery, it’s very important that as a patient you reveal all pertinent medical information to your surgical team. The bariatric surgeon will assess the risks involved with your particular surgery and take every precaution necessary to ensure your safety and to reduce the risk of complications.

Regardless of the type of weight loss surgery, it’s important that the decision to undergo surgery is carefully thought out. It’s imperative to weigh the risks of surgery with the long-term risks of remaining obese. Discuss any concerns you might have with your surgical team and your support system.

Aside from the most obvious change that takes place with respect to the drastically reduced amount of food you are able to eat following surgery, there are a number of other lifestyle changes that have to occur in order to experience success on your weight loss journey.

• Avoid alcoholic beverages.
• Avoid carbonated beverages. 
• Avoid high fat foods.
• Chew slowly during meals.
• Don’t drink with meals. Wait 30 minutes before and after eating to drink.
• Keep snacking between meals to a minimum.
• Omit sugar.
• Eat protein first.

Home/Work Life

Your post surgery physical activity level will likely be determined by the type of procedure you have undergone.  Most patients can return to work within 1-3 weeks following laparoscopic surgery, while open surgical procedures may be slightly longer. Your surgeon will advise when you can begin exercise and what type, although most encourage walking as soon as possible following surgery.

Follow-up Care

Follow-up care is very important after weight loss surgery. Your follow up care schedule will vary depending on the type of procedure you had. Be sure to follow your surgeon's instructions carefully and attend all follow up appointments, even if things seem to be going fine. There typcailly is testing to determine:

• Nutritional levels (vitamin B-12, iron, and folate levels, etc.).
• Is the patient anemic (i.e., low red blood cell count).

Follow-up with a bariatric psychologist and with a dietician is a very helpful part of staying on track after surgery to achieve the results you desire.

Support

Having the support of family and friends is important; however, it is also helpfu for a weight loss surgery patient to have access to and support from other weight loss surgery patients who have experienced what you are going through. Choose a surgeon who offers support groups as a standard part of follow up care. Weight loss surgery is not a quick fix to repair the years of emotional pain caused by being morbidly obese.  The support groups are merely a way for patients to share their challenges and/or successes with others who have been through similar challenges.  In fact, there is typically a big difference between the patients who are involved in a support group on a regular basis and those who attempt their weight loss journey alone.  Many patients also turn to support from a mental health professional following surgery.

Pregnancy 

Most surgones advise to take every precaution not to become pregnant for the first 12-18 months after weight loss surgery. Pregnancy is taxing on the body and the potential for fetal damage may increase given your reduced capacity to receive proper nutrition. During this waiting period, it’s important to give the body time to heal and recuperate. Should you become pregnant in the 12 months following weight loss surgery, contact your surgeon's office and OBGYN immediately.

With over 10 million Americans suffering from morbid obesity, the need for weight loss surgery has become more apparent.  Morbid obesity brings with it number of health issues that if left untreated will substantially shorten life expectancy.  In fact, morbidly obese adults (those individuals whose weight is twice the ideal amount) are twice as likely to have an early death as compared to a non-obese adult.

Would you like to know if you are a candidate for weight loss surgery?  To determine if you are a candidate for surgery, it’s important to know what medically classifies an individual as “morbidly obese.”  The following criteria are characteristic of a morbidly obese individual and could qualify you for weight loss surgery:

• 100 pounds or more over their ideal body weight.
• BMI (Body Mass Index) over 40.
• A BMI of 35-40 accompanied by significant life threatening medical conditions such as Type II diabetes, high blood pressure, heart disease, and severe sleep apnea, among others.
• Inability to maintain a healthy body weight for a sustained period of time after numerous attempts to achieve weight loss with diet, exercise, medication, hypnosis, therapy, or a combination of methods.
• Overweight for at least 5 years with many failed attempts at losing the excess weight.

Weight loss surgery is often the only option for an obese individual to improve their health.  In fact, for many patients, the risk of death from not having weight loss surgery is much greater than the potential risks associated with the procedure itself.  It’s important that you discuss all of your concerns with your bariatric team.

Please Note: It’s important to realize that weight loss surgery is not the answer for everyone who suffers from obesity. The operation is an elective procedure so it’s imperative that you are well informed about the potential risks and benefits involved.  Also, the surgery is not a guarantee to long term weight loss. It is only the beginning of a lifelong commitment to healthy living that is required if you are to succeed.  Following the operation and, preferably, even before the operation, you will begin the process of making important lifestyle and behavior changes in order to increase your chances of experiencing lasting weight loss and continued good health.

A clinical psychologist is a professional who has completed a doctoral degree in the scientific study of behavior, feelings, motives, and thinking. Psychologists also study the biological and physiological bases of behavior because of the interdependence of mind and body. The job of the clinical psychologist is to apply this knowledge to help people solve personal problems, treat mental disorders, and maximize  human potential. To become a licensed clinical psychologist in the state of Texas, clinical psychologists graduate from college, attend four to five years of graduate school in psychology, complete a comprehensive research study (dissertation) in their field (psychologists who earn a Psy.D. degree instead of a Ph.D. do not complete a dissertation), complete an internship (approximately 2,000 hours) one year of postdoctroal superised training (an additional 2,000 hours) and must pass state and national examinations to be licensed as a psychologist. Psychologists are highly skilled in the assessment and treatment of emotional and behavioral problems.

The licensing requirements for psychologists are at a higher threshold than those for Licensed Professional Counselors (LPCs) or licensed social workers (LCSW or LMSW-AP).

Psychologists are different from psychiatrists, who complete medical school (rather than graduate school in psychology) and then complete a psychiatric residency and have national and state board examinations for medical doctors. Psychiatrists are skilled in prescribing psychotropic medications. In the state of Texas, licensed psychologists do not prescribe medication.