SAMPLE LETTER OF SUPPORT FOR BARIATRIC SURGERY

 

 

Date:  __________

 

 

Scott Nguyen, MD

Department of Surgery

Mount Sinai Medical Center

5 E. 98th St  14th Floor   Box 1259

New York, NY  10029

(212) 241-1483    Fax (212) 241-5979

 

Re:  Patient Name:  ____________

DOB:  ____________

 

Dear Dr Nguyen:

 

This patient has been seen at this office since __________(Date),  suffering from morbid obesity for several years.  There have been several attempts at weight loss, on their own and under medical supervision. The weight has not significantly decreased as shown in the table below.

 

At the current weight of __________ lbs and height of __________, the Body Mass Index (BMI) is ___________ kg/m2.   The patient also suffers from other  major health problems due to severe obesity, such as __________(diabetes, hypertension, coronary artery disease, sleep apnea, etc) requiring ongoing medical therapy.

 

The patient has been undergoing weight management in a medically supervised manner in my office over the past several months.  This includes periodic visits with weigh-ins, education regarding diet and ongoing discussion regarding the importance of physical activity and exercise.  Additionally, a consultation with a nutritionist has been performed.  Additionally, we have counseled repeatedly on the risks of developing further co-morbid conditions due to the severe obesity. 

 

We have monitored weights in the office over several months and they are as follows:

 

    Date              Weight (lbs)              

1)

2)

3)

4)

5)

6) 

 

As you can see from the above numbers, this patient has minimal success in weight loss efforts.  Despite best efforts to comply with the program, the weight loss was not substantial enough to significantly improve health.  At this time I strongly feel that a reasonable option is bariatric surgery.  

 

Sincerely, 

 

 

 

George Washington, MD