I'm excited to share my journey towards a healthier future through gastric sleeve (Laparoscopic sleeve gastrectomy) surgery in Japan.
After a surprising discovery that this surgery could be covered by insurance in Japan, I decided to start the process. This series will chronicle my personal journey, from researching the requirements to navigating the Japanese healthcare system, as I prepare to make a life-changing decision.
Gastric sleeve is a surgery used to aid and maintain weight loss in patients. A large part of the stomach organ is removed, significantly reducing the amount a person can eat or drink at one time. It is an invasive surgery that requires anesthesia and a lengthy healing process. Upkeep after the surgery is vital; if patients don't maintain healthy habits, it's possible to stretch the stomach back to its pre-surgery size.
The Decision
I have been overweight my entire life, and have been through all the ups and downs of dieting since I was a teen. I've tried unassisted diet and exercise, hiring a nutritionist, and even Sanorex - a powerful weight loss drug in Japan. 20 years of trying to build healthy habits, but nothing stuck long term. At this point in my life (mid-30s) I'm very comfortable with how I look, discussing weight/acknowledging my weight, and the negative impact it has on my overall health. What worries me the most is how it will impact my quality of life in the future.
Gastric surgery had always been on my radar but shelved because I didn't meet the criteria to receive the surgery in Canada. Additionally, it's not covered by Canadian health insurance, so I'd need to pay out of pocket. Since it wasn't an option for me I had completely forgotten about it when I moved to Japan, and instead, I focused on other ways to improve my health. Everyone living in Japan must be enrolled in and pay for health insurance. Coming from Canada where healthcare is free (and prescriptions are partially covered), the idea of paying to see a doctor was very foreign to me. And it shifted my mindset from 'it's there if I really need it' to 'I'm paying for it, so I should get my money's worth'. I don't know what spurred my sudden interest, but while browsing the internet one day something caught my eye and gastric sleeve surgery was once again on my mind. A quick Google search for "gastric sleeve + Japan" in English brought up a Hospital in Tokyo that performs the surgery. It was on this English website that I discovered that in Japan, gastric sleeve surgery is covered by health insurance if you meet the criteria. Loop back to when I said I wanted to get my money's worth of healthcare - Earlier in the year I had undergone a full physical just to check up on my overall health and had been diagnosed with high cholesterol (something I've struggled with since my 20s) and was prescribed medication for it. My BMI, in addition to having high cholesterol, meant I potentially met the criteria to have gastric sleeve surgery in Japan, covered by health insurance. This sudden realization spurred an absolute mad dash to gather information.
Criteria for Gastric Sleeve Surgery in Japan
Gastric sleeve surgery is covered by insurance in Japan if all of the following conditions are met: BMI 35 or higher:
Having one or more of the following conditions: diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea syndrome, or non-alcoholic fatty liver disease, including non-alcoholic steatohepatitis.
6 months or more of medical treatment pre-op
BMI 32-34.9 :
Having two or more of the following conditions: diabetes (hemoglobin A1c (HbA1c) 8.0% or higher), hypertension, dyslipidemia, obstructive sleep apnea syndrome, or non-alcoholic fatty liver disease, including non-alcoholic steatohepatitis
6 months or more of medical treatment pre-op
Finding A Hospital That Performs Weight Loss Surgeries
Finding information in Japanese specifically for gastric sleeve surgery was a challenge. It took time, but eventually, I was able to find a hospital near me. Gastric Sleeve surgeries are relatively new in Japan, and not many hospitals can perform them. If you're looking for a hospital in a specific area of Japan, you will need to dig around online (in Japanese) to find what you're looking for. I decided on Hokkaido University Hospital, the biggest hospital closest to me, to start my surgery journey. The first gastric sleeve surgery performed at this hospital took place in 2016, and there is relatively little information on the website about it. Gastric sleeve surgery at Hokkaido University Hospital is handled by the Gastroenterological Surgery II department. There is no way to contact this department by email, so if you'd like to book an appointment or consultation, you will need to call the hospital.
When searching online for information, search for location+keyword, to find the most relevant results for you. If you can’t read Japanese you can download a translation app to your Chrome browser; you’ll be able to translate Google results as well as websites.
These are some keywords to use when researching weight loss surgery in Japan:
Laparoscopic sleeve gastrectomy
LSG
腹腔鏡下スリーブ状胃切除術
スリーブ状胃切除術
First Appointment, June 18 2024 - Consultation
Because my Japanese isn't well enough to navigate vital medical information, I opted to contact a local translation service that specifically helps non-Japanese speakers make appointments over the phone, and translate in person during appointments. Translators are paid via the hospital, but the service is completely free to patients. The initial consultation was brief; they took my height and weight, and medical history and explained what the surgery was. There were no tests done at this time; I verbally confirmed that I have high cholesterol and am taking medication for it. Based on that information and my BMI, the doctor agreed to start the pre-op process. To have the surgery covered by Japanese health insurance, the patient must be monitored for 6 months or more. During that time, many other appointments and tests will take place. Cost: ~¥800
Second Appointment, July 25 2024 - Tests
At this appointment, I had various tests. My blood was drawn, my thyroid was tested, and the Insulin in Blood Test (to check for issues such as diabetes).
Cost: ~¥2000
Third Appointment, August 28 2024 - Test Results & Dietician
This was a very long day because I booked 2 appointments on the same day. In the morning, I visited the gastroenterology department to discuss the results of my previous tests. Thankfully, there were no surprises and the tests confirmed that I did have high cholesterol.
In the afternoon I visited with the hospital dietician. It's mandatory during the pre-op period for patients to meet with the dietician every 1-2 months. During this appointment I had my body fat and muscles measured for the first time. I was a bit surprised to see that ~50% of my body weight is fat. I wasn't upset by it, instead, it gave me a clear goal to work on.
After talking about my daily schedule and normal eating habits, she gave me a new eating schedule, recommended that I eat 80g of protein a day, and gave me a daily goal of 1800 calories. I walked into this appointment expecting a similar experience to previous dieticians and nutritionists I worked with. But after giving me my daily goals, that was it. You are not provided with a meal plan or much nutritional guidance. When I asked for some protein suggestions she handed me a picture of a nutrition wheel, and that was that. I was told I'd be on my own for making healthy choices. I was informed that for the "liquid" stage of my pre-op and post-op diet, I will be required to drink meal replacements. And not just any meal replacements, it must be a specific brand sold through the hospital. It's expensive, about ~¥25000 out of pocket to cover the whole period. (1-3 weeks, depending). She gave me a sample in the flavor "Caramel Latte" to try.
Cost: ~¥2000
Fourth Appointment, September 17 2024 - Endoscopy
Patients must get an endoscopy before bariatric surgery so that doctors can see if they have any issues in their throat or stomach. They do this by slowly feeding a long tube camera down your throat. I made the mistake of opting not to be sedated for this. If you’re given the option, get sedated. If I had to do this again, I would 100% be sedated.
First, they gave me some numbing gel which I had to hold at the back of my throat for 3 minutes without swallowing. That made the back of my throat and tongue numb. Next, I laid down on my left side on the hospital bed, and a mouth-opening plastic piece was put in my mouth. The doctor slowly fed the scope down my throat. It initially was fine because I couldn't feel it, but as it started going down my body began to naturally gag and retch, trying to clear my airway. It very much felt like I was choking, so my body was auto-piloting self-preservation. There were a few instances where I couldn't catch my breath and just stopped breathing - until the nurse and doctor reminded me to breathe. I had to concentrate on staying calm and breathing. Everything in me wanted to pull the scope out, and instinctively I raised my hand a few times towards the hose. The doctor or nurse gently would push my hand down each time.
It only took 10 minutes and went fine. It wasn’t painful at all, and I had no issues that would prevent surgery. But now I understand why a lot of hospitals in other countries don't even give patients the option to be awake for this procedure.
Cost: ~¥4300
Up Next
I have another meeting with the dietician on October 2nd. We will remeasure my body, and go over further changes that need to be made to my diet. After that, I'm not sure what other tests will need to be done. Given the usual 6 month pre-op period, from the first or second appointment, I should receive a surgery date by December or January.
The Cost Of Gastric Sleeve Surgery in Japan
My hospital can't give me a price estimate until the doctor sets a surgery date, and the doctor can't set a surgery date until I clear the 6-month pre-op period. So as of now, my total cost is unknown.
Generally, with insurance, the cost for gastric surgery in Japan is between ¥90000 (~$700USD) and ¥150000 ($1100USD). There are also additional costs, for example, mandatory inpatient care where you must stay at the hospital. During the hospital stay you are charged for the room, meals and supplies.
Every hospital is different and has different rules about how long you must be hospitalized.
At Hokkaido University Hospital, patients getting the gastric sleeve are hospitalized 2 weeks pre-op and 1 week (or more) post-op. Overall, I will need to put my life on hold for about 1 month to get this surgery.
Once I have all the pricing information I will post an update.
Join Me on the Journey
I'm incredibly happy and nervous about going down this path. Going forward I will be posting regular updates, detailing all parts of the gastric sleeve surgery process in Japan. If you're interested in pursuing this option yourself, please join me on this exciting journey to change my life.
Stats: 35, female, caucasian
HW: 220 lbs
CW: 206LBS
GW:130 lbs
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