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Dr. Christian Birkedal MD
Dr. Christian Birkedal MD's posts

Do I need thyroid surgery?

Your thyroid gland plays a key role in maintaining hormonal balance. Some thyroid conditions call for surgical intervention. Follow this link to read about THYROID SURGERY.

Binge eating can lead to serious problems

‘Binge Eating’ is not the same as the occasional over indulgences that we all have. It is a medical condition that can lead to serious complications and it must be controlled, even in patients who are having weight-loss surgery. Discover why by reading the blog titled, “The Importance of Treating Binge Eating Before Bariatric Surgery.”

How can I take care of my spider veins

Do you know about sclerotherapy for eliminating ‘spider veins’? Follow this link to find out about spider vein removal with SCLEROTHERAPY.

Considering weight-loss surgery?

If you have been considering weight-loss surgery, but are put off by fear of the procedure, your concern is very likely misplaced. Laparoscopic techniques have made many surgical procedures safer and less invasive. See how by clicking LAPROSCOPIC WEIGHT LOSS SURGERY.

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What is the Body Mass Index?

Patients considering weight-loss surgery or a supervised diet program in a bariatric clinic have almost certainly heard the term “Body Mass Index” or “BMI”. The body mass index is a very important indicator in a patient’s overall health and should be correctly understood.
Simply put, the body mass index is a measure of how much a person weighs relative to how tall they are. It is an inexpensive, simple way to measure body fat that does not require any lab test. This index is a guideline, not a tool for diagnosing a specific disease. However, it is a statistical fact that a higher body mass index is associated with an increased risk of diseases such as diabetes and heart disease and with lowered life expectancy.
The formula for computing your BMI is
BMI = Weight (in lbs.) x 703 divided by Height (in inches) 2
This is the Imperial (English) Formula. To compute your BMI using the English system of weight in pounds and height in inches, do this – For a man, 6 ft. tall weighing 180 pounds:

Multiply his weight by 703 (180 pounds x 703 = 126,540).
Multiply his height in inches by itself (72 x 72 = 5,184).
Divide #1 by #2 (126,540/5,184 = 24.4) and his BMI is 24.4.

This formula and calculation may seem a little obscure because the original calculation was defined using the metric system. The Metric BMI Formula is:
BMI = Weight (kg) / Height (m)2
What does this index mean? Doctors use it to place patients in weight-related classifications:

A BMI below 18.5 is considered underweight.
A BMI of 18.5 to 24.9 is considered healthy.
A BMI of 25 to 29.9 is considered overweight.
A BMI of 30 or higher is considered “medically obese”.
A BMI of 40 or higher is termed “morbidly obese” and bariatric surgery should be considered.

This information, in combination with other clinical features like heart disease or diabetes, suggests a treatment plan. These treatment plans may involve measures like dietary change, exercise, stress reduction, medication and numerous other options. Bariatric surgery (weight-loss surgery) is one of those options when others have been tried and failed.
Think about the example mentioned above, the 6-foot-tall, 180-pound man. His body mass index is 24.4, which is considered within the “healthy” range, but only by a small amount. Many people, probably most adult Americans, would be very happy if they could get their BMI down to any point in that ‘healthy’ zone. According to data published by the American Heart Association, in 2013 there were 154.7 million adult Americans who had a BMI of 25 or higher and 78.4 million who had a BMI of 30 or higher. The figures for today would probably be worse; the upward trend in BMI has been going on for a long time.
So, what does this mean to a given individual, their doctor and the health care system in general? There is no doubt that the risk of many medical problems increases with a higher BMI. This is one of the biggest public health problems facing America. It is also true that a physician who insisted that everyone in their practice get to a healthy BMI would lose a great many patients. A more practical approach would be to make people aware of their BMI and its importance in their current and future health.
A lot of effort has gone into helping people learn and understand their blood pressure and cholesterol “numbers”. They know that 120 over 70 is a good blood pressure number, that LDL cholesterol of 100 or below is good and that an HDL of less than 40 is bad. It is common to find non-medical individuals who are quite aware of their own blood pressure and cholesterol levels and what they mean, but not very many people can tell you their own BMI or what it means.
To people considering bariatric surgery or those being treated medically in a bariatric clinic, the BMI has an immediate importance: insurance coverage. Health insurance companies may base approval of some treatments based in part on BMI. A patient with a BMI of 30 to 35 may be approved for weight-loss surgery if they have other medical problems such as heart disease, hypertension, sleep apnea or diabetes. A BMI of 40 or above may be an indication for weight loss surgery even if no other conditions are present.
Whatever your current medical condition, you would be wise to know your BMI and understand its importance to your health. If the formula above seems unwieldy, you can go to the National Institutes of Health website to use their convenient BMI calculator. Do not be discouraged if you find that your body mass index is above the upper limit of 25. This is a common result. The important thing is to be aware of your BMI and to get as close to the healthy range as possible, or to seek treatment if your BMI is in the obese to morbidly obese range. The link to the BMI Calculator can also be found on our homepage under ‘Weight Loss’ or by clicking NIH Body Mass Calculator.

Obesity and mental health

What is the relationship between obesity and mental health? The relationship is complex but conditions such as anxiety or depression can contribute to overeating and weight gain. Read about it in the blog titled, “Obesity and Mental Health.”

Insurance Coverage and Getting Approved for Weight-Loss Surgery

One of the most common questions a surgeon gets is, “Is it covered by insurance?” This is a major concern to people who are considering bariatric surgery (weight-loss surgery). Insurance companies often require that relatively high standards be met before agreeing to cover bariatric surgery cost.
A conclusive answer to this question can be found only by working with your surgeon, the office insurance staff and the policy carrier. The insurance company’s approval will depend on input from the weight-loss surgeon, other doctors and the patient. Each case is different, but there are some factors that are typical when bariatric surgery is considered. These are some of the elements that your insurance company will take into account before approving weight-loss surgery:

Your Body Mass Index (BMI). Simply put, your body mass index is a measure of body fat based on your weight in relation to your height. BMI is explained more fully in a separate blog article, but for now, let’s say this: if your BMI is 40 or over, that alone will usually make bariatric surgery ’medically necessary’ and covered by insurance policies. If your BMI is between 35 and 40, weight-loss surgery may be considered ‘medically necessary’ if you also suffer from some other conditions such as diabetes, heart disease, hypertension or sleep apnea.
Have you been in a medically supervised diet program and failed to achieve the goal. Standards for the program length vary from 3 to 7 months. This participation should be documented.
Have you had a consultation with a bariatric surgeon? Birkedal’s office staff can schedule this for you.
You should get a medical clearance letter from your primary care doctor clearing you for surgical procedures.
The insurance company may want you to have a psychiatric evaluation to obtain a mental health clearance letter and/or a nutritional evaluation from a Registered Dietitian.

Documentation for these steps should be forwarded to your insurance company for their review. This documentation should include a history of your medical problems related to obesity and the treatment attempts. Dr. Birkedal’s office staff has extensive experience in dealing with these requirements and will help with any problems you encounter.
The approval process varies with insurance carriers but a month-long process is typical and you may be asked to provide more information. If coverage for bariatric surgery is denied for any reason (such as lack of documentation, or questionable ‘medically necessary’ status), there may be an appeal process. Again the office and insurance staff will be happy to answer any questions you may have.
You can see a complete list of insurance providers accepted by Dr. Birkedal’s practice by clicking INSURANCES ACCEPTED. To schedule an appointment, please call (386) 231-3530 or use this link- CONTACT FORM.

How do hormones affect exercise and weight loss?

Different forms of exercise stimulate specific hormones. Read about the hormonal response to weight training and its effect on weight Loss by clicking HERE.

Check out our Facebook reviews

Facebook reviews of business and professional practices have become an important part of selecting a business or professional service. Click on FACEBOOK REVIEWS to read what past patients have written about Dr. Birkedal and his practice.

Is your insurance accepted?

Insurance coverage plays a part in many medical decisions and in selecting a physician. Dr. Birkedal accepts a wide variety of medical insurance plans. To see if your plan is accepted, click on INSURANCE PLANS.
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