I just came back from the surgeon’s office. I was told “no surgery” (I need a spinal fusion) until I lose 50 pounds and stop smoking. But if I could have the surgery and stop having so much pain, then I could get more active and lose weight. I feel like I’ve been gut-punched with my hands tied. Is there any way I could convince this doctor to let me take the risk and just have the surgery then get the weight off?

Patients in need of major surgeries like spinal procedures are faced with some unique dilemmas. Back (and sometimes buttock or leg pain) keep you from being active. Physical inactivity can lead to weight gain. Obesity is a risk factor for many potential post-operative complications from infection and blood clots to heart attacks, stroke, and even possible death.

Surgeons are trained to assess and evaluate each patient individually. Studies have provided clear information about predictive risk factors. This refers to patient characteristics that can predict a positive (or negative) outcome. Surgeons must select patients for success — your success, not theirs. They want you to have the best results possible with the fewest adverse events.

Weight loss and smoking cessation are two important keys to good or better health. These are not unreasonable requests or requirements before surgery. Together your actions to improve your health will insure a better outcome following surgery.

There are many helps available in most communities that focus on these two lifestyle changes. TOPS (taking off pounds sensibly), Weight-Watchers, support groups, and smoking cessation clinics have proven success in helping people change the direction they are going (or as in your case, prepare for surgery).

Talk with your doctor (or the clinic nurse) about options that might work for you. Try to see this as an investment in your health, your future. It may take some time to accomplish but the results are well-worth it. Some patients have even reported no longer needing surgery when they were able to stop smoking, lose a little weight, and get more active.

You may want to explore other possibilities as well. For example a fitness coach can assist you in setting up a reasonable, do-able exercise program. A life coach can help you identify your life goals and pursue them successfully. Other tools to aid in changing difficult behaviors such as hypnosis, acupuncture, meditation, yoga, tai chi, qi gong and so on are also possibilities.