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Dear Medical Directors/Review Committee:

This letter comes in response to my request for surgical solution to my lifelong struggle with obesity. Please allow me to tell you about my history and myself as well as educate you about Weight Loss Surgery.

I am a 29 year-old morbidly obese female. It is my dream to live as any normal size person and get off of this up and down dieting roller coaster that has plagued my life since birth. I am unable to walk, climb up and down steps without having hard time breathing. I have personal hygiene problems, my knee is starting to give up, and I also have polysistic Overy Disease that contributes to my obesity. I am slowly gaining more medical problems as we speak these are some of the burdens associated with my obesity. This has created so much shame in my life that only other morbidly obese people can truly understand the humiliation.

While I am not mentally ill, I do have mental burdens associated with being morbidly obese. I worry about breaking a chair when I sit down in public. I am constantly bothered with the assumptions that I am lazy and people looking and starring at me. I have been seeing psychologist since I have been in Elementary School.

Losing weight can help all of these problems. I have tried many, many diets. Jenny Craig, Diet Workshop, weight Watchers, Slim Fast, Atkins diet, phentermine to list a few. While I have lost weight before on different diets, the weight just comes back, sometime more. I am 359.5 pounds and without surgical intervention, I think that I will die soon and the medical professionals all agree. My BMI is 59.8, that makes
gastric bypass surgery a medical necessity.

I am very well educated in the area of Gastric Bypass Surgery. I have been researching this procedure and its incredible success rate for 1-� years. I belong to an on-line support group and to become more acquainted with others who also suffered ant the hands of morbid severe obesity. I have learned a tremendous amount from all these people. I know what this surgery is and what positive implications it will have in my life. That is why I want and need to have this surgery. After reviewing my family medical history, you will probably agree
with me that to not have this surgery will surely lead to more severe medical problems in the near future.

My PCP, surgeon, and my counselor all agree that this procedure is the right option for me. I also agree with them. It will save my life, and give me back what life I have left. I will not give up on getting this procedure approved. I will keep coming back. However, if this surgery request is denied. I will not be coming back alone. I have already spoken with and attorney, who will be representing me if the need be so.
I beg you, please approve this surgery. I will not go away. This surgery is as critical as a coronary bypass graft or neurosurgery. It is the ONLY documented long-term solution to chronic morbidly severe obesity. I am greater than 100 pounds over any recommended table. The metropolitan Height and Weight tables prove this.

I don�t know your medical background, but some physicians are unaware about the great amount of research that has been conducted. The American Medical Association studies that have been published in JAMA well document misconception about this surgery by those unaware of the disease of morbid
obesity is that it is a cosmetic procedure. Let me assure you that this is completely false. I have taken the liberty of going to the American Society for Bariatric Surgery (ASBS) website and the National Institute of Health�s Website to gather information for you. You will quickly see that there is nothing cosmetic about this procedure.

Clinically severe morbid obesity correlates with a Body Mass Index (BMI) of 40kg/m2 (or higher) or with being 100 pounds overweight. Being overweight is associated with real physical problems, which are now well recognized. The most obvious is an increased mortality rate directly related
to weight increase.

Obesity is dangerous to health because of the associated increased prevalence of cardiovascular risk factors such as hypertension, diabetes millitus, hypertriglyceridemia, hyperinsulinemia and low levels of high-density lipoprotein (HDL) cholesterol. Cardiovascular risk factors are reduced significantly by sustained weight reduction. Data from the Framingham study support the estimate that ten- percent reduction in body weight corresponds to a twenty- percent reduction in the risk of developing coronary heart disease.

The risk for diabetes has been reported to be about twofold in the mildly obese, fivefold in moderately obese and ten folds in severely obese persons. The risk of developing diabetes also increases with age, if a family history is present and if the obesity is central.

Surgical treatment is medically necessary because it is the only proven method of achieving long-term weight control for the severely obese Surgical treatment is not a cosmetic procedure. Surgical treatment of severe obesity does not involve the removal of adipose tissue (fat) by suction or excision. Bariatric surgery involves reducing the size for the stomach, with a degree of associated malabsorption from
bypassed intestine. Eating behavior improves dramatically.

Weight reduction surgery has been reported to improve several co-morbid conditions such as glucose intolerance and diabetes mellitus, sleep apnea and obesity-associated hypoventilation, hypertension, and serum lipid abnormalities. A recent study showed that Type II diabetics treated medically had a mortality rate three times that of a comparable group with underwent gastric bypass surgery Also preliminary data indicate improved heart function with decreased ventricular wall thickness and decreased chamber size with sustained weight loss. Other benefits observed in some patients
after surgical treatment include interpersonal effectiveness, and an enhanced quality of life. They have lessened self-consciousness. They are able to explore social and vocational activities formerly inaccessible to them. Self body image disparagement decreases. For many reasons, I am a good
candidate for this surgery and ask you to approve me for gastric bypass surgery.

Thank you for your prompt response

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