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Picking Experts and the Quest for Great Weight Loss Surgery

The best way to have a successful weight loss surgery is to treat it like a business project. I have definite goals, measurements, objectives, benchmarks, time frames and a vision on where I want to be within a year.
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They stack the odds, still we take to the street
For the kill with the skill to survive
It's the eye of the tiger, it's the thrill of the fight


BLIS is a fascinating specialty insurance program run by Regi Schindler in Oregon. His customers are people paying for their own weight loss surgery.

Schindler uses the analogy that BLIS is similar to a warranty on a new car. It allow patients the comfort of knowing that if something goes wrong, they won't be by additional medical expenses.

Schindler has some serious skin in the game. If a surgery goes wrong, his company is on the hook. Following the car warranty analogy, it could be the cost of some new wheel cover, but in today's expensive health care world, it might be the cost of a new Mercedes or maybe a fleet of Mercedes with a Cadillac thrown in too.

Schindler is very choosy about who he insures. His data and loss ratio calculations come to the same conclusion: it is not where you do your bariatric surgery. What makes the difference is the surgeon who does the work.

Thus, when they wheel me into the operating room on Monday, December 1 to have gastric sleeve bariatric surgery, Dr. Derek Weiss, one of only three surgeons in Kentucky that BLIS has chosen to insure, will be the one doing the surgery.

The odds are with me. The mortality rate for gastric sleeve is about the same as gallbladder surgery and if I die during surgery, I will be the first death, after thousands of bariatric surgeries, for Dr. Weiss.

I've warned him several times that killing a best-selling author and journalist would not be a good career move for either of us.

Just in case, I've purchased the BLIS insurance. I'm not a smoker or drinker and I've followed Dr. Weiss's instructions on pre-operation preparation to the highest degree. Weiss is my guru, and I am his pupil.

Derek is confident this will go well and his confidence is infectious. Confidence can replace fear in a life or death situation.

Using Business Skills to Pick an Expert

Taking care of business, every way
I've been taking care of business, it's all mine
Taking care of business. And working overtime

-Bachman-Turner Overdrive

I was a very reluctant candidate for weight loss surgery. Even when I tipped the scales at 374 pounds and was past the point of morbid obesity, I kept looking for a way to avoid an operation. From my decades as a structured settlement consultant and working with trial attorneys, my knowledge of what could go wrong in a bariatric procedure is vast and littered with real life and really dead examples.

So when I got interested in weight loss surgery, I got all in. I told Dr. Weiss that I could do all of his job expect for the actual cutting. A slight exaggeration, but I find myself explaining the gastric sleeve to physicians who are not bariatric surgeons and letting them in on my insights.

I've read over 50 books on the topic, interviewed at least that many people related to the field and came together with an epiphany that will be articulated in my upcoming book, Project 199: My Business Plan for Losing 175 Pounds.


The best way to have a successful weight loss surgery is to treat it like a business project. I have definite goals, measurements, objectives, benchmarks, time frames, and a vision on where I want to be within a year.

I want to weigh 199 pounds. That will be a 175-pound loss from where I started in August. I've lost nearly 25 pounds before the surgery just by focusing my mind and habits towards that goal.

I can visualize what life will be like when I get to my goal weight. I can visualize throwing away my blood pressure and blood sugar pills. I can visualize being able to crawl around on the floor with my grandchildren and talk long walks with my wife. I can visualize buying just one airline seat, without a seatbelt extender, and feel comfortable sitting in coach. I visualize walking into a clothing store that carries Armani or Versace suits and knowing they have one in my size. I can visualize living to an old age.

Without a plan, I was frustrated with my overall health and not sure what to do about it. Now I am excited and enthusiastic.

I been in the right place
But it must have been the wrong time

-Dr John

I went into the process of weight loss surgery backwards. My first goal was to get a hospital that would allow me to do it.

My health insurance company, Anthem, does not cover weight loss surgery and it also does not cover the complications of weight loss surgery. I thought that the Affordable Health Care Act would be my way to make it happen, but I live in one of the 23 states where ACA does not cover bariatric surgery. I recently switched to an ACA plan, still with Anthem, but the surgery barriers remain the same.

Four years ago, I went to a seminar (every bariatric program I makes you sit through a seminar like you are signing up to be a multi-level marketing program) for a hospital based in Central Kentucky, and they made me leave when they found out what kind of health insurance I had. I had to get up and walk out in front of the group.

Sometimes divine providence, combined with someone else's boorish behavior, gets you to the right spot in life. If they had kept me, I would have never heard of BLIS, not been offered the gastric sleeve and not had the opportunity to meet Dr. Derek Weiss.

I'm still a few days from launch, but I am extremely confident it will go well. At least two of the major participants in my potential funeral told me that my dying on December 1 would really mess with their schedules and I needed to live through this. I've been blessed with successful friends and will do my part to keep them on track.

Any Member Of Your Staff Will NOT Be Able To Assist Me.

"Hot and cold emotion
Confusing my brain
I could not decide
Between pleasure and pain"

-Samantha Fox

I'm a big believer in experts. The fastest way to irritate me is to say (usually via a voice mail recording), "Any of our fine professionals will be able to assist you." Big corporations like that concept as it allows them to treat employees like throwaway parts. Customers don't develop a personal relationship with staff member s and the corporation is able to promote their brand more than the people who make up that brand.

A life of experience has taught me to connect with the very best experts I can find. In every form of endeavor there is always a handful of experts whose results dwarf others in the same category.

For example, I've been in the structured settlement business for 33 years and can demonstrate over and over again the difference between a good lawyer, a great lawyer, a mediocre lawyer and a bad one.

A good lawyer will get you a good settlement or jury verdict. A great one will usually get a great settlement. A mediocre one earns an okay result and a bad lawyer may get you zero. Or get you thrown in jail.

I had a stretch several years ago when I worked on nine different death cases involving trucks slamming into a car at the exact same intersection. The road was poorly designed and eventually corrected, but each of the nine people that were killed had similar demographics.

Each lived in the same neighborhood. Each was hit by a truck running a stop light. Each death was an individual driver without passengers, and each accident happened in the early morning when the sun was in the truck driver's eyes and the passenger was on their way to work. I don't remember any of the drivers drinking or taking drugs.

All of settlements were confidential, but I was there for the mediations and settlement conferences. Most of the families of the victims had mediocre lawyers and received about $400,000. One had a good lawyer who got about $600,000, and the one who had a superstar attorney received a settlement in the millions.

That family had a true expert. The rest were operating on a system of "any attorney will do" and never knew they could have had 500 percent more.

I can't imagine a more important expert than a doctor. They literally have your life in their hands and a decision they make can have an overwhelming impact on the quality of your life.

I've made it a point to really get to know any medical professional in my life, from the receptionist in my physician's office to every nurse, assistant and other person in the process. An expert can solve a problem that another cannot. Usually they attract good people around them too.

Let's not forget that most aspects of the medical profession are run by big corporations. Thus, most buy into the "any of our staff members will do" approach. It's mostly about money. If doctors become interchangeable parts, it's easier to pay them less and replace them with another without losing customers or market share.

In the bariatric surgery field, the marketing focus is on the facility and not the physician. The facility has massive advertising budgets and public relations experts, and the doctor normally does not.

The American Society for Metabolic and Bariatric Surgery has a program called the Bariatric Surgery Center of Excellence. It is an excellent idea to weed out surgeons who "dabble" in weight loss surgery from full-time professionals, but the focus is on the hospital and not on the surgeon. The federal government pays for many weight loss surgeries through Medicare, Medicaid and Centers for Medicare and Medicaid Services (CMS) and their rules revolve around facilities not surgeons. Any hospital receiving Medicare and Medicaid money has to be a Level 1 Bariatric Surgery Center or a Center of Excellence.

The mindset of the federal government is the opposite of what BLIS does when it insures surgeries. BLIS is only focused on the surgeon and not the facility.

So who is right?

Being at a Center of Excellence was definitely a consideration for me. There was no way I would be at a facility that did not have that professional standard, but it was a first step and not an only step.

Being a Center of Excellence is an incredible marketing opportunity for the hospital. Ultimately it will, and probably should, result in an outcome where no one but Centers of Excellence can make it in the bariatric business. On the other hand, hospitals can make their reputation on a great run with one set of surgeons, replace them with a lesser group and still maintain their Center of Excellence standing in the short run.

You see an analogy in the financial business. Fidelity had an incredible run with its Magellan mutual fund when Peter Lynch was managing the fund. They moved Lynch to Vice Chairman, which was a dark time in Fidelity's history as the company got into questionable practices like peddling contractual mutual funds with 50 percent commissions to soldiers fighting in the Iraq War. Congress shut down that practice, but in the meantime, Fidelity kept advertising the incredible returns on the Magellan fund long after Lynch was gone.

Fidelity is one of the most aggressive, but a lot of financial companies do it. The line "past performance is no guarantee of future results" is not just a disclaimer; it is a mantra for how many corporations market. Including hospitals.

I am happy to be having my surgery at a Center of Excellence, but even happier that Dr. Derek Weiss is the one performing the surgery.


"I can call you Betty
And Betty, when you call me
You can call me Al"

-Paul Simon

I've known a lot of doctors in my life. My mother spent 27 years as an operating room nurse and for my first years in the financial business, all of my clients were doctors. I've learned a lesson about doctors that holds true for almost any professional: the less pretentious they are, the better doctor they are.

People hide behind titles are not people I want to do business with. Usually informal people have more self-confidence and the ability to allow others to buy into their self-belief.

Titles do have a purpose and I let you know about all of mine. I put all of my professional initials behind my name as it is a shorthand way to let people know that I've been to the rodeo and know what I am doing.

On the other hand, I want you to call me Don. My three grandchildren are the only people who refer to me by a title and "grandpa" is the title I've earned.

G. Derek Weiss, MD, FACS, FASMBS is "Derek," not Dr. Weiss. He introduces himself as Derek and prefers it that way. He is friendly but oozes with self-confidence. He is an easy guy to like.

Few medical professionals like to interviewed by the media and having a patient is writing a book about their performance can be nerve-racking. The facility where I am having the procedure DOES NOT (let me repeat DOES NOT) want to be mentioned in my writing and since I am a guest in their hospital, I am doing my best to accommodate them.

Derek is the opposite. He's done three interviews with me and spent three hours on a Sunday afternoon answering a plethora of questions, from hardballs to softballs. His answers were 100% dead on and honest.

When you are a journalist or work with trial attorneys, you can get skeptical and cynical. I do both. You see people's worst sides. It's extremely hard to win me over, but Derek has. I buy into his confidence that things will go smoothly and I will be well on my way to better health. I'm three days from the surgery but anticipating it like a child waiting for Santa Claus. I can't wait to it rolling and get my second chance at life started.

Derek is a man of strong opinions and not afraid to clash with those who disagree with his thoughts and beliefs. I've interviewed several of his former patients who adore him and read hundreds of messages on message boards about him. The overwhelming majority like him, and the ones that don't focus more on his strong personality than his surgical skills.

I like Derek as a person, but my most important concern is that he be a great surgeon. I need him to be on top of his game on December 1, but he really doesn't need me to write about him. He doesn't chase publicity. He has patients lined up all day and night. He does not spend any personal money on advertising and doesn't need to. After thousands of procedures, he pushes forward to continuously improve his craft with an intense enthusiasm.

He has been terrific on helping me keep costs down. He is also extremely affordable and highly aware that I am paying for every dime of the medical procedure without the help of my insurance company. The hospital has been helpful on the cost front as well. Picking up my own tab has made me an extremely cost conscious medical consumer and I am thrilled that my cost are dramatically less than others I am seeing on online message boards like In fact, they are in the range of people who are going to other countries like Mexico to get the surgery done more cheaply.

The main thing you get from Derek is his zest for living. Derek Weiss loves being Derek Weiss, and it shows in his infectious zeal for his work. He is a great surgeon and I have done incredible and extensive research to make that statement. Even if I had not done the spadework, I would have guessed on our first meeting that Derek is a master of his craft.

Weiss talks about bariatric surgery the way that some people talk about sex, money or their grandchildren. It is his passion. He bubbles with enthusiasm and recognizes that his profession gives people a second chance at life.

Weiss was born into the surgical business. His father was a surgeon at the military base at Fort Knox and his mother was an operating room nurse. He grew up in Louisville, was Magna Cum Laude in Biochemistry at Dartmouth, was in the top 10 percent of his class at the University of Louisville Medical School and did his surgical training (residency) at Emory University where he worked under Dr. John Hunter, an internationally known leader in laparoscopy.

Derek brought his laparoscopy skills back to Louisville and spent eight years as a successful general surgeon when Dr. Tom Lavin, one of the nation's most successful bariatric surgeons, asked Derek to move just outside New Orleans to join his booming weight loss practice.

Weiss has incredible respect and admiration for Dr. Lavin, who he has praised lavishly in every conversation that I have had with Derek. My wife is President of the Ursuline Academy, the oldest all-girls school in the United States, based in New Orleans, and I suspect the Kentucky to New Orleans connection plays into our multiple conversations about Dr. Lavin.

Weiss would have been happy spending his career in New Orleans, but a big opportunity came up for him to come home to Kentucky and partner with another surgeon in the bariatric field. They were together for several years and dominated bariatric surgery in Kentucky. His former partner now practices in Louisville, while Derek focuses on Lexington and Central Kentucky.

Derek fits all my criteria for an expert. He is well-educated, passionate about his craft, continuously learning, connected to other top experts and sees his work as his calling, not an occupation.

I want a surgeon who can't wait to get up and get into the operating room. Since I am scheduled to be his first patient on Monday, I definitely want him to be enthusiastic about mine. He will be, but he also maintains that enthusiasm for everyone else he operates on. I recognize that I will probably get VIP treatment but he assures me that every patient gets that same level of care. I've talked to enough of his former patients to recognize that is true.

I went from a horrible fear and dread of the gastric sleeve surgery to anticipation. Not about the actual surgery, but the idea that I will recover quickly and be on a life journey that will allow me to give back and make a difference.

Like Dr. Derek Weiss is doing.

(You can track me on twitter @donmcnay and see how thing are going. I'll post as soon as I get out of recovery on Monday December 1. ) Please offer your prayers and wish me luck.

Don McNay CLU, CHFC, MSFS, CSSC is a best-selling author and has been an award-winning syndicated business columnist. He is the founder of McNay Consulting and McNay Settlement Group. He lives in Lexington, Kentucky and also in New Orleans. He is a member of the Eastern Kentucky University Hall of Distinguished Alumni and current a Director on their Foundation Board. He has Masters Degrees from Vanderbilt University and the American College

For More Information:

American Society of Metabolic and Bariatric Surgery

Dr John Hunter and history of Emory Department of Surgery

Ursuline Academy of New Orleans

Affordable Health Care Act