How does bariatric surgery help you lose weight?
In the digestive process, juices in the stomach break down food. Nutrients are absorbed as food moves through the small intestine. Your body gets calories from absorbed nutrients. Bariatric surgery changes the structure of the digestive system by either limiting the size of the stomach (restrictive) or by reducing the nutrients absorbed by the stomach (malabsorptive). The most common type of bariatric surgery is both restrictive and malabsorptive. It is called Roux-en-Y gastric bypass.
How overweight do I have to be to qualify for weight loss surgery?
In 1991, the National Institute of Health defined morbid obesity as a BMI (body mass index) of 35 or greater with obesity-related medical conditions (such as diabetes, high blood pressure, sleep apnea) or a BMI of 40 or greater in the absence of obesity-related medical conditions. Insurance companies ultimately dictate whether they will pay for your operation based on your BMI, your weight loss attempt history and your demonstration of commitment to a post-surgical weight loss program. The criteria that each insurance company uses are subject to change at any moment.
Will my insurance pay for bariatric surgery?
To answer this question, you need to know if bariatric surgery is a covered benefit of your policy. Contact your insurance as you begin the process of deciding whether you are a candidate for bariatric surgery. Ask your insurance representative the following questions:
- Are there limits or exclusions for bariatric coverage in my policy?
- What specific bariatric surgical procedures are covered?
- Will my presurgical evaluation, including any required tests, be covered?
- Will my post-surgical follow-up appointments be covered?
- Are related services, like nutrition counseling, covered?
- Are surgical procedures to remove excess skin after weight loss covered?
- Will I have any co-insurance, deductibles or co-pays?
- What is the pre-authorization process for bariatric surgery? Your insurance company may have requirements that must be met before you are approved for bariatric surgery.
Because the process of being evaluated and preparing for bariatric surgery may take from four months to six months, you should check your policy again before surgery to make sure it hasn’t changed. If your insurance policy coverage for bariatric surgery is limited, we can provide estimates of your out-of-pocket expenses.
How much weight will I lose after surgery?
Surgery is a tool to help you lose weight. You will need to make changes to your eating and exercise patterns in order to achieve weight loss results. Assuming that you make these changes and stick to them, most people lose two-thirds of their excess weight in the first year. This depends on the operation performed, as well as your food choices and following a consistent exercise program. Excess weight loss with the laparoscopic sleeve gastrectomy is lower than that with the Roux-En-Y gastric bypass.
How long will I be out of work after the surgery?
After bariatric surgery, you can expect to stay in the hospital from two to three days. Longer hospitalization may be necessary if you develop complications. Many people return to work within two weeks after surgery. Some may have an additional length of time off due to other health concerns or if their job requires heavy lifting.
What about activity after surgery?
After bariatric surgery, you will be able to do most of your normal daily activities. You will be asked not to lift, push or pull more than 20 pounds for the first month. This is more to protect the work done on the intestine than for the small incisions that are made.
What are the potential risks and complications of bariatric surgery?
A variety of complications can occur with weight loss surgery. The risks of surgery depend upon which surgery you have and any medical problems you had before surgery, as well as your age at the time of surgery. Some of the more common surgical complications include bleeding, infection, leakage from the intestine and blood clots in the legs or lungs.
How will my eating change after surgery?
Bariatric surgery is designed to give you a tool to be able to change your eating habits permanently. Weight loss surgery is not "magic." You still need to consume fewer calories than your body needs in order to lose weight. Surgery does not make these changes for you. Instead, it gives you a way to help you make better food choices by inducing negative consequences.
Each operation has its own way of reminding you about what good and bad food choices are. In restrictive operations, such as the Roux-en-Y gastric bypass, as you eat, your little stomach pouch gets stretched. This sends a signal to your brain, telling you to stop eating. If you do not heed this signal, the next bite may bring a sense of pain or severe pressure. If you still do not listen to this signal, the next bite may exceed the capacity of the small pouch, and cause vomiting of the food. It is important to eat slowly, taking at least 30 to 45 seconds for each small bite of food. This gives the pouch time to send the signal to the brain, and for you to pay attention to the cues your body is giving you. The sleeve gastrectomy is less restriction, but still may limit the amount of food that is eaten at one time. In addition, if you eat high-carbohydrate or high-fat foods, these can lead to loose stools and foul smelling gas.
After any weight loss surgery you will need to stay on blended foods for several weeks. You will work closely with the dietitian to tailor your diet to soft foods you like. We want you to emphasize protein as the most important nutrient. After a gastric bypass, we want you to get at least 60 grams of protein each day. Some people may need to take protein supplements in the early post-operative period in order to meet these requirements. By three months after surgery, you will be back to eating many of the healthy foods that you enjoyed before surgery.
Why would my surgeon ask me to stop smoking before surgery?
Your surgeon will require you to stop all tobacco use before surgery and will expect you to remain tobacco free. The purpose of weight loss surgery is to improve your health and to extend your life. People who use tobacco have an increased risk of health problems and have a decreased life expectancy, so it may not be worth the risk of weight loss surgery since tobacco users will not have optimal benefit from the surgery. In addition, people who use tobacco products, especially smoking, have a higher risk of complications from anesthesia and have a higher risk of developing stomach ulcers after surgery.
Can I get pregnant after surgery? Will the baby be healthy?
Yes, you can, but it is recommended that you wait at least 18 to 24 months after your surgery to become pregnant due to the possibility of nutrient deficiencies during the weight loss period. You also will need time to adjust physically and emotionally to your weight loss before becoming pregnant. It is important to practice effective contraception other than birth control pills during the weight loss period to avoid getting pregnant. With appropriate nutrition and vitamin/mineral supplementation, weight loss surgery does not cause growth or developmental problems for the fetus. In fact, studies find that women who have had weight loss surgery have improved pregnancy and infant outcomes compared to women who have severe obesity and have not had weight loss surgery.
Is surgery reversible?
If you are considering bariatric surgery, you should consider this an irreversible procedure.
Will I need cosmetic surgery?
Many patients, after losing a large amount of weight, will have some excess skin. Patients are encouraged to exercise, which increases muscle tone and may minimize the need for cosmetic surgery. However, should you choose this type of surgery, we can help refer you to a skilled plastic surgeon for assistance. Most insurance companies do not pay for cosmetic surgery unless it is medically necessary.