Weight Loss Surgery Questions
Do I have to change my lifestyle?
Yes. You cannot live your current lifestyle and get anywhere but where you are right now. By the way, this is true of almost all things in life. If we do not change our lifestyle, no surgical or non-surgical treatment can be durable.
Are there any ways to lose weight other than surgery?
Yes. However, statistically speaking, once you get to be over the BMI of 35, there is no treatment that has any long-term success. In fact, there is no documented success of any treatment greater than a period of three years other than surgical treatment.
Is weight loss surgery dangerous?
No. In the last five years, dramatic advancement in techniques and technologies have improved the operations. With the dramatic progress in pre-, intra-, and postoperative care of the morbidly obese patient, your chance of dying from one of these weight loss operations is approximately the same as having your gallbladder removed. The minor and major complication rates have dramatically diminished as well.
How common is it to regain significant amounts of weight in the years following weight loss surgery?
This isn’t nearly as common today as in the past. Multiple factors exist: A. Older operations were technically less durable. B. We believe the operation is just a tool to help you change your lifestyle. ‘An indispensable tool’ but nevertheless, a tool. Without significant support and education over the long haul, the tool has an increased risk of failure. C. You cannot live your current lifestyle and get anywhere but where you are right now. By the way, this is true of almost all things in life. If we do not change our lifestyle, no surgical or non-surgical treatment can be durable.
How can I afford to get the operation done?
More and more insurance companies will cover the cost of the operations. We also have several financing plans available. In the big scheme of things, the question really is not, “How can I afford it” but really from a health and longevity standpoint, the question is “How can I afford not to get the operation done”.
What operation is best for me?
Potentially any one of the three operations. Any one of the three operations is infinitely better than any nonoperative treatment available at this time (once you become morbidly obese). Each operation has characteristics that are better for some than they are for others. We hesitate to say that it is like splitting hairs because we think there are some significant differences, but we think that any of the three operations is better than doing no operation.
How many adjustments are necessary before I start losing weight?
Because of the special diet we place the patients on after the operation, some lose weight before any adjustments are made. Six weeks after surgery, the patient will have their first fill of the band. The decision to do a fill is related to how hungry the patient is feeling, how much weight he or she is losing, and what he or she is eating.
How are the adjustments performed?
The adjustments are typically performed in the office and take only a few minutes. On rare occasion, we are not able to do a fill in the office, and it must be done under flouroscopy for guidance in locating the port.
When do I know that I need an adjustment?
Are you losing weight? We expect you to lose weight at the rate of one to two pounds per week. Do you have hunger between meals? You may need a fill. Do you experience reflux or vomiting? Your band maybe too tight, and you should see your doctor. Band adjustments are usually done on a monthly basis.
How much weight can I be expected to lose with the band?
Average weight loss ranges from 45 to 55 percent excess body weight. That is 45 to 55 pounds for every 100 pounds that a patient is overweight.
What are some of the potential complications with the band?
The band generally has more overall complications than other bariatric operations, but the overwhelming majority of the complications are very minor. The band can “slip” in about two percent of patients, meaning that it can slip out of position and cause reflux, vomiting, or pain. This is usually diagnosed with an X-ray and requires an operation to correct. The band can also erode into the stomach, requiring an operation to correct. This occurs in about one percent of Lap-Band procedures. At Transforming Lives, we have never had a band erode in one of our patients. Finally, patients may experience difficulty swallowing, have large bites of food stuck at the opening of the band, or dialation of their swallowing tube that could require the removal of the fluid in the band or an operation to remove the band.
What does the name of the operation mean?
The name was first used by Cesar Roux (1857-1943) to describe an operation to bypass a blocked stomach caused from scar tissue after severe ulcer disease. The “Y” comes from the similarity of the stick figure representation of the procedure to the letter “Y” itself. It has been modified and used in many other surgical procedures. Today a Roux-En-Y gastric bypass can sometimes be referred to as a “Roux”.
Will I be able to eat normally after surgery?
NO! Your “normal” eating is one thing that has contributed to your weight gain. You will be able to eat some normal foods but in a very different manner. Most patient experience a lack of hunger after surgery. This is most noticeable immediately after your operation and can lessen with time for some patients. Patients become full after eating small amounts of food, which is the reason this operation works while diets in general do not work. You are expected to eat “regular” food and follow a high protein, and low carb eating plan. You must never eat sweets as this can cause severe abdominal cramps called “dumping”.
What is "dumping"?
“Dumping” consists of severe abdominal cramping, sweating, nausea, vomiting, lightheadedness, shakes, and diarrhea. It usually occurs when concentrated sugar or carbohydrates enter the upper GI tract without mixing with the normal digestive juices from the liver and pancreas. These undiluted carbs are exposed to a part of the GI tract that never interacts with these undiluted sugars. Most patients will try sweets once but feel so terrible that it makes a second try very unlikely. Dumping can be considered a good side effect of your operation to help control your sweet eating.
How much weight can I expect to lose?
Average weight loss is 65-75 percent of your excess body weight, meaning you should lose 65 to 75 pounds for every 100 pounds you are overweight. Weight loss is very rapid in the first six months and can continue at a slower rate for the next 18 months. As with all weight loss operations a small percent of weight regain is common in the first two to five years after the operation.
Before & After Surgery
Will I have a lot of tubes and hoses in me after surgery?
No. With the new techniques we utilize, 98% of people have no tubes or hoses in any body parts when they come out of surgery (other than an IV).
How long will I need to be off work, and when can I return to normal activity after the operation?
Immediately. If we complete your operation laparoscopically (with the small holes), which we do approximately 99% of the time, we require no physical activity restrictions whatsoever. You can do whatever you want..other than eat. (We have a very strict food program for the first two weeks.) Complications may occur, but the only way the operation can be injured is by eating or drinking too much at one time. The operations are not magic; there still may be some discomfort. However, compared to a regular open (old fashion incision) operation, the discomfort is minimal.
Will I lose my hair after weight loss surgery?
Potentially. People may lose their hair when they experience rapid weight loss. However, the hair always returns once weight loss levels off. No vitamins, protein, free fatty acids, or other concoctions help keep your hair from thinning. Once your weight levels off for several months, your hair will grow back.
Will I have loose skin after the operation?
Potentially. The elasticity of the skin is genetically programmed. If you stretch your skin past that predetermined limit of elasticity, it will not snap back. It is not a function of losing weight slower or faster. It is not a function of exercising more or less. We want you to exercise, and we want you to lose weight as fast as possible. These factors have nothing to do with the amount of excess skin you may have. In fact, even rubbing lotions or other concoctions on your skin will make no difference.
We have identified plastic surgeons who are very interested in helping people with loose skin, and we can send you to these surgeons to help your situation. We are not concerned about the fact that you may have excess skin or not when you are thinking about having the operation. In the future, we are happy to help you feel comfortable in a bikini or a Speedo if that is your goal from a cosmetic standpoint. However, our goal first and foremost is to improve your health and increase your longevity and the quality of your life.
After a Roux en Y Gastric Bypass, does the remaining stomach shrivel up and die or just lose its blood supply?
No. Actually, the stomach has a very redundant blood supply (this allows us to do radical operations on it with impunity). The stomach shrinks to some degree, but if recruited back into use, it would function normally.
What is the youngest age for which weight loss surgery is recommended?
Generally accepted guidelines from the American Society for Bariatric Surgery and the National Institutes of Health indicate surgery only for those 18 years of age and older. Surgery has been performed on patients 16 and younger. There is a genuine concern that young patients may not have reached full developmental or emotional maturity to make this type of decision. It is important that young weight loss surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle behaviors necessary for success.
Can weight loss surgery prolong my life?
Yes. Three landmark articles published in the last three years show between 25% to 89% survival advantage (25-89% less deaths) for those undergoing operation versus those who are treated without weight loss surgery. The bulk of the reductions are from two main areas: cardiovascular events (heart attacks, heart failure, strokes) and cancer deaths. In one study, diabetics enjoyed a 92% survival advantage over an eight year period.
Can weight loss surgery help other physical conditions?
Yes. According to current research, weight loss surgery can improve or resolve associated health conditions. Below is a partial list of disease that can be cured or greatly improved by losing weight. Type II Diabetes Mellitus, Hypertension, Hypercholesterolemia, Elevated triglycerides, Metabolic Syndrome, Obstructive Sleep Apnea, Stress Urinary Incontinence, Infertility, NASH (fattly liver dz), GERD (reflux), Osteoarthritis – back, hips, knees, feet, Leg Swelling, Pseudotumor Cerebri, decrease risk of many cancers, decrease death from these cancers: breast, uterine, prostate, colon, stomach, esophagus, kidney, some lung cancers
Will I be asked to stop smoking?
Yes. Smoking increases the risk of lung problems after surgery, can reduce healing, increases the rates of infection, and interferes with blood supply to the healing tissues. This can result in immediate (life threatening) complications as well as long term (ulcers and strictures) complications.
What if I have had a previous weight loss surgical procedure and I'm now having problems?
Ideally, your original surgeon is the best resource, he or she would be the most intimately familiar with your operation and course. If your original surgeon is not available or you are seeking a second opinion, we will be happy to see you in our office.
What can I do to help the process?
Attend the seminar first. Several things are important before your first visit. Completely fill out your paperwork before you attend the first appointment and if you have insurance, obtain a copy of your plan from your HR department and bring it with you. These two things will help expedite your first visit. After that, communicate regularly with your patient advocate regarding your track to surgery. Your patient advocate can recommend resources that will aid you in submitting a successful request.
Why does it take so long to get insurance approval?
Bariatric surgery, unlike any other medical care, undergoes intense scrutiny at each level of the whole approval process. Each major insurance company may have many different plans. Each employer may choose a different plan – some of those plans may have a bariatric benefit, some may not. If the plan has a bariatric surgery benefit, each insurance company may have a different criteria requirement to approve the operation. Some of these criteria may be historical (5 years of documented morbid obesity, for instance) and some may be proactive (must complete a 6 month program of diet, exercise and behavior modification, for instance). Because of the complex intricacies of each plans’ criteria, we employ “patient advocates” – they help you navigate the tortuous voyage through the approval process.
How can they deny insurance payment for a life-threatening disease?
Remember that your insurance company is not your health plan. Their marketing may have suggested so, but in most states (all but 7 at this time) insurance companies may categorically exclude certain treatments or operations (like bariatric operations). They may exclude coverage despite the extent of your disease. Philosophically, they get away with this, because of society’s prejudice against obesity and obese patients. Discrimination is the real answer to this question – but a well accepted discrimination. Please feel free to write to your congressmen, employers, city leadership etc regarding the inequities.