Bariatric surgery is a major decision. Understandably, you will have a lot of questions as you consider your options. This list will be a good start toward understanding the different bariatric surgery techniques, like lap-band (gastric band) and gastric bypass. Plus, it will help you get an overview of what’s involved pre-op and post-op. We encourage you to consider your options carefully.
Above all, we want you to know that morbid obesity is a disease, and as with any disease that threatens your health, it’s smart to get information and find expert medical help with treating it.
If you have questions that are not here, please feel welcome to call us!
Am I a candidate for bariatric surgery?
If your BMI is 35 or above, you could be a candidate for bariatric surgery. Please use our BMI calculator to figure out your BMI.
Where do I start the process?
Most patients have a lot of questions about the type of procedures as well as the risks and complications. The first step is to attend a seminar by one of our surgeons. Seminars are free, last about 90 minutes, and give you the opportunity to hear the information first hand and have your questions answered directly.
Who should attend the seminar with me?
We recommend that you bring someone who will be your support person throughout your weight loss journey.
What can I do before the appointment to speed up the process of getting ready for bariatric surgery?
Attend a seminar.
Make a list of all the diets you have tried and bring it with you to your doctor.
Bring any pertinent medical data to your appointment with the surgeon. This would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summaries if you have been in the hospital.
Bring a list of your medications with dose and schedule.
Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.
What impact do my medical problems have on the decision for bariatric surgery, and how do the medical problems affect risk?
Medical problems, such as serious heart or lung problems, can increase the risk of any bariatric surgery. On the other hand, if they are problems that are related to your weight, they also increase the need for bariatric surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass bariatric surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.
What are the routine tests before bariatric surgery?
Certain basic tests are done prior to bariatric surgery: A Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a read out of about 20 blood chemistry values. Often a Glucose Tolerance Test is done to evaluate for diabetes, which is very common in overweight persons. All patients but the very young get a chest X-ray and an electrocardiogram. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or psychiatric evaluation, may be requested when indicated.
When might the insurance deny coverage of weight loss surgery?
Payment may be denied because there may be a specific exclusion in your policy for obesity bariatric surgery or "treatment of obesity." Insurance payment may also be denied for lack of medical necessity. A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments—such as dieting, exercise, behavior modification, and some medications—are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as one to five years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
What can I do to help the process?
Gather all the information (diet records, medical records, medical tests) your insurance company may require before your consultation. This can help reduce the time it takes to navigate through your insurance plan's process.
Why does it take so long to get insurance approval?
After all pre-operative tests have been ordered and results have been received, your surgeon’s office must mail or fax your information to your insurance carrier. Insurance carriers’ time frames vary from one to four weeks to respond to your surgeon’s request for the bariatric surgery.
How long do I have to stay in the hospital?
Although it can vary, the hospital stay (including the day of bariatric surgery) can be one to two days, but is usually 24 hours.
Will I have a lot of pain?
Every attempt is made to control pain after bariatric surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.
How soon can I drive?
For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 7-14 days after bariatric surgery.
How soon will I be able to walk?
Almost immediately after bariatric surgery doctors will ask you to get up and move about. Patients are asked to walk or stand at the bedside on the night of bariatric surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting, and with transportation.
The Hospital Stay
What should I bring with me to the hospital?
Personal toiletries (comb, toothbrush, etc.) and an outfit to change into before going home. A hospital gown will be provided by the hospital during your stay, but some people prefer to bring their own. Choose clothes for your stay that are easy to put on and take off. Because of your incision, your clothes may become stained by blood or other body fluids. Other ideas:
Reading and writing materials
Crosswords and other puzzles
Life After Bariatric Surgery
If I continue to smoke, what happens?
Smoking increases the risk of lung problems after bariatric surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues.
Will I lose hair after bariatric surgery? How can I prevent it?
Many patients experience some hair loss or thinning after bariatric surgery. This usually occurs between the fourth and the eighth month after bariatric surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc supplement and a good daily volume of fluid intake.
Does hair growth recover?
Most patients experience natural hair growth recovery after the initial period of loss.
How can I know that I won't just keep losing weight until I waste away to nothing?
Patients may begin to wonder about this early after the bariatric surgery when they are losing 20-40 pounds per month, or maybe when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss bariatric surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. In the absence of complications, patients are very unlikely to lose weight to the point of malnutrition.
Will I have to change my medications?
You will need to keep in close contact with your primary care doctor regarding any long term medications you are currently on. Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss bariatric surgery. For medications that need to be continued, the vast majority can be swallowed, absorbed, and work the same as before weight loss bariatric surgery. Change in dosage may be required with weight loss but will need to be discussed with your primary care doctor. Two classes of medications that should be discussed during your consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss bariatric surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
Will I be miserably hungry after weight loss bariatric surgery since I'm not eating much?
Most patients say no. In fact, for the first four to six weeks, patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger.
What can I do to prevent lots of excess hanging skin?
Many people heavy enough to meet the surgical criteria for weight loss bariatric surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic bariatric surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of bariatric surgery (often seen as elective bariatric surgery). However, some do pay for certain types of bariatric surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.