Below are some of the most frequently asked questions patients have about bariatric surgery.  If you have any other questions, or would like to schedule an appointment, we would love to hear from you.

Click on a question below to see the answer.


View all answers
A:

One definition of morbid obesity is being 100 pounds or more over the ideal bodyweight.  A better definition is having a BMI (Body Mass Index) of 40 or higher.  To calculate your BMI, go to the BMI Calculator link.
A: At a Body Mass Index (BMI) of 40 or above, there is a higher likelihood of having so-called co-morbidities.  Co-morbidities are medical conditions that are caused by, or made worse by, obesity.  Some may actually shorten the life expectancy.  Examples include diabetes type 2, hypertension, heart disease, sleep apnea, liver disease, and certain types of cancer.
A:

With over 6 million Americans suffering from morbid obesity, the need for weight loss surgery has become more apparent.  Morbid obesity brings with it a plethora of health issues that, if left untreated, will substantially shorten life expectancy. 

The following are the criteria for being a candidate for weight loss (bariatric) surgery:

  • Weight criteria:  One of the following:
    • 100 pounds or more over the ideal body weight.
    • BMI (Body Mass Index) of over 40.
    • A BMI of 35-40 accompanied by significant co-morbidities.
  • Inability to maintain a healthy body weight for a sustained period of time after numerous attempts to achieve weight loss using non-surgical means.
  • Overweight for at least 5 years with many failed attempts at losing the excess weight.

Weight loss surgery is often the best option for an obese individual to improve associated health problems.  It is important that you discuss all of your concerns with our bariatric team. 

 
A:

Patients who have the metabolic syndrome or joint pains from osteoarthritis, in general, benefit tremendously from the effective and durable weight loss that can be achieved from weight loss (bariatric) surgery.  The following are the most impressive results: 

Diabetes Type 2: Resolved 76.8%      Resolved or improved 86%
Hyperlipidemia: improved in 70%
Sleep apnea: Resolved 85.7%
Hypertension: Resolved 61.7%  Resolved or improved 78.5%

(Reference: Buchwald H, et al; Bariatric surgery: a systematic review and meta-analysis.
JAMA. 2004 Oct 13;292(14):1724-37.)

Symptoms that show remarkable improvement include: acid reflux (GERD), breathing difficulties, level of activity, knee pain (including pain from osteoarthrosis/osteoarthritis), and lower back pain (including pain from disc space disease and osteoarthritis).  Notice that, while losing weight may improve those joint symptoms, it does not cure the underlying joint or disc space disease.  A small number of patients reported worsening low back pain after gastric bypass, probably related to a change in the joint dynamics and center of gravity.

Other medical problems that improve or resolve after bariatric surgery, to the extent that they may be caused by the obesity, include: infertility, stress urinary incontinence, fatty infiltration of the liver (hepatic steatosis), self-esteem issues, depression, and mobility.
A:

A surgical procedure of any kind will always involve a certain degree of risk, and bariatric surgery is no exception.  In the past, weight loss surgery was viewed as extremely risky.  However, with the development of new procedures, more experience, and advancements in technology, bariatric surgery is a relatively safe solution to morbid obesity.  Today, the overall risk of weight loss surgery is fairly low with most patients experiencing few, if any, complications.  This is not to minimize the fact that this is still a serious operation.

Once a surgeon has determined that you are a candidate for weight loss surgery, it is very important that as a patient you reveal all pertinent medical information to your surgical team.  The bariatric surgeon will assess the risks involved with your particular surgery and take every precaution necessary to ensure your safety and to reduce the risk of complications.

Regardless of the type of weight loss surgery, it is important that the decision to undergo surgery is carefully thought out.  It is imperative to weigh the risks of surgery with the long-term risks of remaining obese.  Discuss any concerns you might have with your surgical team and your outside support system (family, friends).

Mortality (risk of dying) from weight loss surgery is 0.5%.  The most common cause is the development of blood clots (deep vein thrombosis and pulmonary embolism).  This is why precautions (leg pumps, early ambulation and walking, and heparin injections) are all implemented in our program as standard precautions.  The risk of complications in general is 5-10%.  The benefits can be found above in the FAQ question: "Does weight loss surgery improve or resolve other health problems?"
A: Well, many of our patients have any combination of diabetes type 2, high blood pressure, sleep apnea, high cholesterol, and a variety of other health problems.  Many of our patients had previous abdominal surgeries.  In fact, it is very rare to have an obese patient who does not have other health problems.  If you have any of those disease conditions, you are just like one of our average patients.
A:

You will eat small portions, more frequently. You will make better choices with regards to the quality of food.  You will most likely be able to, and have to, increase your daily activity level.  There will be some healthy restrictions related to drinking and eating, that will be explained in detail when you meet with the dietitian.  You are re-engineering your life to a much healthier one.

Home/Work Life
Your early post surgery physical activity level will likely be determined by the type of procedure you have undergone.  Most patients can return to work within 1-3 weeks following surgery, depending on which procedure was chosen.

Follow-up Care
Long term follow-up is an important element of our prgram.  After gastric bypass, you will be seen 2 weeks, 3 months, 6 months and one year after surgery, then annually.  After Lap Band, you will be seen one week, 6-8 weeks then every 4-6 weeks as needed, to give you the best adjustment.  Sometimes we will ask to see you more frequently as needed.  We also have an open door policy in that we encourage you and your primary care physician to contact us any time if there are any concerns.

Support
Having the support of family and friends is important.  Equally important is for a person to surround themselves with other weight loss surgery patients who understand the intricacies of weight loss surgery.  Weight loss surgery is not a quick fix to repair the years of emotional pain caused by being morbidly obese.  The support groups are merely a way for patients to share their challenges and/or success’ with others who have been through similar challenges.  In fact, there is typically a big difference between the patients who are involved in a support group on a regular basis and those who attempt their weight loss journey alone. 

Pregnancy
For the first 18-24 months after weight loss surgery it is important to avoid being pregnant.  This is a commitment that has to be made before accepting to have bariatric surgery, particularly gastric bypass and sleeve gastrectomy.  The safety of rapid weight loss on the fetus and the pregnant cannot be guaranteed.  After that period, pregnancy has been consistently eported to be safe, and results in healthy babies.
A: Central to the process of weight loss is changing eating habits to healthier ones.  That is the whole idea.  You will have to commit to eat smaller meals each time, to make healthy choices as to the quality of the food, and to take over the counter supplements.  Our program will help you learn those skills and implement them.  Remember, the "only" mechanism that makes your tool, the surgery, work, is the changes that will follow.  You will eat solid food after an initial period of liquid diet, and avance slowly.  Patients may like food items they did not like before.  They may dislike some items they used to like.  They may find certain types of food not well tolerated.  It is always interesting to listen when patients exchange their experiences, and even recipes, during the support group meetings.  And yes, you can eat in a restaurant, but your portions will be much smaller, and you will mkake choices that are smart and healthy.
A: Yes.   Remember that "Revision Surgery"  is more difficult, and is not taken lightly.  Revision surgery has higher risk of complications than a first operation.  Before deciding if needed, we have to identify the reason(s) of regaining the weight.  If the reasons can be handled without an operation, that will be the advice.  If surgery is the best option, then it will be planned.
A: I do not think that one surgery is best for all because, well, how to define "better"?  No surgery is ideal.  Having no surgery, in the absence of an effective alternative, is not ideal, either, and could be dangerous.  Among the available surgical options, I perform routinely the gastric bypass (both the laparoscopic, and the open via a relatively small incision) and the adjustable gastric banding (Lap Band).  Each procedure has its advantages and disadvantages.  When you attend one of our free no-obligation seminars, you will find us particularly addressing this question in some detail, to help you decide for yourself.  You have to be totally comfortable with your decision, based on a balanced discussion. I have no particular interest in promoting one procedure over the other, except for what will fit you more.  Some patients may be better served with another addition to the surgical options, that is "Sleeve Gastrectomy."  When you come to one of our educational seminars, please ask about this procedure for more information.
A: Pain is very subjective.  The same exact stimulus will lead to very different levels of "feeling" pain among different patients.  Bariatric surgery is not an exceptionally painful operation. All in all, it is average.  Laparoscopic surgery tends to be less painful than conventional open ones.  Also, open surgery through a relatively small incision tends to cause much less pain than surgery through conventional longer incisions.
A:

Some health insurance plans do, and some do not.  Some make it an absolute "exclusion".  Some put certain restrictions and conditions, even if your weight and BMI qualify you from the medical stand-point.  For example, some plans mandate a certain period of supervised or medically-supervised weight loss before approving bariatric surgery.  It may be a good idea to discuss your weight problem every time you see your Primary Care Provider so that it may be documented on the chart that your weight was recorded, and that a discussion was made to help you lose weight by non-surgical means.  This will help you, in case you need weight loss surgery later on, to demonstrate what attempts were made and documented.

Before you attempt to get authorization, here are some helpful hints to assist you with the authorization process:

  • Read and understand your insurance provider’s "certificate of coverage." 
  • Keep accurate, detailed records of visits to healthcare providers. Of particular importance are visits that included weight wellness recommendations or actual supervised weight loss instructions or program.  Also, save receipts for any exercise equipment, fitness programs, diet centers, weight loss drugs and anything else that can assist in the authorization process.

With so many different insurance policies and types of plans among insurance providers, it is important that you understand the authorization requirements for your individual policy.

Please notice that every insurance company has more than one plan, with different details.  The fact that an insurance company, as a matter of principle, covers weight loss (bariatric) surgery does not mean that such a benefit is covered in the particular plan that you or your employer has purchased.  Also, please notice that the rules of coverage may change.

If your insurance does not cover, or if you will incur high out of pocket costs, you may want to consider financing options.  Our office can help guide you as to the available resources.  Also, remember that out of pocket healthcare expenses may provide some tax cuts.  You may want to ask a tax advisor about those benefits.
A: Well, well-meaning people can give the wrong advice.  For the right patients (see the question "am I a candidate"), the risk of surgery is actually less than the risk of morbid obesity itself, particularly in the presence of a metabolic syndrome or significant limitations on physical activity.  Of course, it is important to try to lose weight by non-surgical means.  By dieting and behavior modifications, and without surgery, patients can consistently lose weight.  This is not the problem.  The problem is that, using those means on the long term, only 5-10% of patients will maintain effective weight loss after 5 years.  This means that 90-95% will have their co-morbidities not improving or getting worse, and a percentage will continue to have shortened life span. In comparison, bariatric surgery produced effective weight loss in 70-90% over 5 years.  Some studies are even 10 years or more.  So, we certainly encourage you, and advise you, to try to lose weight without surgery, and keep it down on the long term.  But, if you have tried that already and could not maintain the weight loss, or if the weight loss could not help you with your comorbidities, then surgery may very well be your best option.