Frequently Asked Questions
This is a decision only you can make but if you have failed diet attempts, have more than 75 pounds to lose and have started developing weight related medical conditions, the answer is yes. A great way to start is to attend a Support group and learn more details.
You end up with a smaller stomach that restricts your portion size and helps you control your cravings and total daily calorie intake. You will consume only 600 calories per day for several months and eventually consume on average 1300 calories per day to maintain your new weight. Generally, patients feel full with one scrambled egg from about one month after surgery until after 3 months. The pouch size will increase some but patients usually report feeling full on up to 4 ounces(deck of cards) of lean protein at one year after surgery. Everyone is at risk for gaining some weight back due to the increase in the stomach pouch size, bad dietary choices and inadequate exercise. The surgery is great at helping you lose the weight but the correct dietary choices and vigorous exercise are critical for maintaining weight loss. The stomach pouch size never returns to the original size of the stomach. Most patients attribute weigh gain to snacking on junk food and lack of exercise.
Weight loss surgery has become safer than gallbladder surgery in the last decade so complications are usually minor or rare. The most common problem is dehydration in the first month after surgery and this may result in a trip to the ER for IV fluids. Please be aware that some patients are very low risk for surgery(young, no medical problems, lower body weight) and some patients are very high risk for surgery(older, several medical problems, higher body weight). Proper planning before surgery will reduce everyone’s risk(lose weight, increase mobility, control medical problems, stop smoking). Following the postoperative instructions closely will also minimize risk.
Weight loss surgery is great for about 75-125 pounds. It is hard to lose more than 125 pounds but many patients do lose more than 125 pounds. It may be hard to accept, but the sooner you come in for weight loss surgery(only 75 pounds overweight) the better the result will be.
The reason insurance companies authorize surgery is because of the high rate of cure or improvement of diabetes, high blood pressure, sleep apnea, high cholesterol and orthopedic problems. Most patients are able to discontinue many of their prescription medications!
This is a complex question but generally patients are on 600 calories per day until they lose all of their excess weight. This is usually about 6-12 months. The long term diet averages about 1300 calories per day(range 1,000-2,000 per day). The diet is generally lean proteins and fruits and vegetables. Daily exercise is also important. Exercise must be vigorous! Usually 10,000 steps per day and/or several days per week of cardio and weight lifting. The goal is to preserve muscle mass(lean body mass) and metabolize body fat. If you have 100 pounds to lose, that is 350,000 calories to metabolize(3500 calories = 1 pound). Do the math! If surgery reduces your diet from 2000 calories per day to 600 per day and you exercise daily, that’s a deficit of at least 1400 calories per day. It would take two days to metabolize one pound of fat. If you eat carbs instead of protein, you will breakdown muscle and not fat.
Will Insurance Cover It? Most insurance companies do cover weight loss surgery in 2017 and it is rare for someone to have to pay for it. If one does have to pay, the cost is about $17,000 plus some additional expenses related to testing and travel. Many insurance companies do require some amount of preoperative weight management that is supervised such as Weight Watchers, MD supervised programs or several months through our surgery clinic. The period of time is often 3 months(Aetna, Cigna, Sutter Select) and may be 6 months(some Blue Cross plans). It’s a great idea to enroll in a program and keep records so you don’t have to struggle to get your insurance to authorize you for surgery
In 2014, the sleeve gastrectomy became the most common operation in the United States. It’s long term safety profile and weight loss results have made it a favorite of patients.
That has to be discussed one on one during an office consultation/appointment.
- Lose weight. Losing weight before surgery helps to reduce your liver size and the amount of fat in your abdomen and on your stomach. This makes the surgery easier for the surgeon and safer for you. Most patients only need to lose 10-20 pounds. This can be done with a low calorie diet, medically supervised weight management and even the use of medications if necessary.
- Start dieting! Now that you know you will need to lose weight do the following: Minimize starch(bread, rice, pasta, potatoes), eliminate liquid calories(sodas, juice, alcohol), consume lean proteins(seafood, chicken) and minimally cooked vegetables and fruit. You can use calorie counter websites and apps like My Fitness Pal or Lose it!
- Mobilize! Start exercising more. If you can’t walk the length of a football field(100 yards) your risk for blood clots during surgery is much higher.
- Improve medical conditions! Make sure your blood pressure, diabetes and sleep apnea are well treated prior to surgery. Surgery will be cancelled for uncontrolled blood pressure and diabetes. Always bring your CPAP to the hospital with you.
- Testing. We give you orders for the tests you will need. They should be done within 30 days of surgery and probably more than a week before so if there is an abnormality, additional testing can be ordered. Everyone needs blood tests and an EKG(12 lead ECG). Patients over age 50, usually need more tests.
1 night for sure; about half of patients requires 2 nights.
You should always try to take one week off of work. If you have a really physical job then at least 2 weeks and maybe 4 weeks. There is no bed rest after this surgery. We expect you up and walking and light duty the first week.
You would have to call your insurance company and ask them if you have the benefit of bariatric surgery. Most insurance companies do cover bariatric surgery as of 2015.
The more weight you lose, the more skin you will have that you may want removed. A plastic surgery consult about one year after surgery is a good way to help decide if you want to proceed with any type of excess skin removal.
It can be difficult but all of the operations can be revised, reversed or corrected in some way.
No the operations are all done laparoscopically(about 5 small incisions) and pain is mild enough that you only need a day or two in the hospital and a week off of work. Rarely, an open operation may be required.
Generally, heartburn is more common with increasing weight. The operations can be done in a way to improve or correct heartburn. Rarely, heartburn can become worse.
A patient has usually lost 100 pounds by the end of one year; feels 10-20 years younger; is no longer taking prescription medications for the weight related medical co-morbidities; and is often able to hike and run places they never dreamed!