Frequently Asked Questions about Bariatric Surgery

How much weight will I lose and how fast?

The expectation for most patients is that they will lose up to 50% of their excess weight in the first year. That means that if you are 100 pounds over your ideal weight, you will lose 50 pounds within a year of the surgery. If you are 200 pounds overweight, we expect you will lose 100 pounds the first year. You will continue to lose weight but at a slower rate after the first year.

Which surgery is better?

Each surgery has its own risks and benefits. Your doctor will discuss your individual circumstance with you and together you will decide which is best for you based on how much you need to lose and any other health issues you have.

Vertical Sleeve Gastrectomy is increasing in popularity because it doesn't directly affect the digestive tract and has a slightly lower complication risk than the Roux-en-Y Gastric Bypass.

The Bypass surgery has the extra benefit of bypassing a small portion of the small intestines which further limits calorie absorption and speeds weight loss. It has slightly more potential risk than the Sleeve surgery and is often recommended for patients with type 2 Diabetes because it has been shown to improve diabetes even without significant weight loss.

How long will it be before I can schedule the surgery?

The average time from initial consultation to actual surgery is about six months. This is because you need to undergo a thorough evaluation of your health and a supervised weight loss program before we can even schedule the surgery. Not everyone who starts the process will actually go through with it because they may not qualify or they may be so successful on the supervised weight loss program that they no longer need the surgery.

Will my insurance cover bariatric surgery?

In most cases, yes. We go through a rigorous review and evaluation process to be sure that you meet all the criteria the insurance companies demand prior to surgery, including a medically supervised weight loss program as well as health and psychological evaluations.

When can I eat normally again?

That depends on what you consider normal. If "normal" means sitting down and devouring a plate of spaghetti or a 10 oz. juicy steak, the answer is never. If you resume those types of normal eating, you will at a minimum be uncomfortable and possibly feel quite ill and in the worst case, you will re-stretch your stomach and gain the weight back.

With any bariatric procedure, it is important that you make significant lifestyle changes that include limiting portion sizes, calorie consumption and exercise. Permanent weight loss requires a permanent lifestyle change. If you cannot commit to making that lifestyle change you might want to consider more traditional weight loss methods rather than surgery.

I've tried to lose weight for years and haven't. Why do I have to lose weight before I can get the surgery?

We want you to lose weight before the surgery for a number of reasons. First, we want you to survive the surgery and being overweight for a long time has already compromised your health. Losing weight before the surgery will help your body withstand the surgery. It will also reduce the size of your liver, which is important for the surgeon to have a clear field of vision when performing the surgery. And finally, by following the restricted diet before the surgery, you will be more acclimated to the new diet and lifestyle you will have to follow after the surgery to be successful.

We will support you in your pre-surgery weight loss by having you work with a dietician who will give a specific diet and exercise regimen as well as track your progress.

How long will I be off of work after the surgery?

Most people are able to go back to work within 10 days. Work situations can sometimes create stress that may make you overeat, so we want you to be fully in your new diet and exercise regimen before returning to work.

When can I stop taking my blood pressure pills and diabetes medication?

Many patients can begin to reduce the amount of medication they take for things like high blood pressure and diabetes as they lose weight. Some are able to go off them altogether, but it is important to work with your primary care provider or endocrinologist regularly to monitor your bloodwork.

I really want to have a baby but my OB says I can't because I am obese. Will bariatric surgery let me try to get pregnant? And how soon after the surgery can I try?

Getting pregnant when you are obese is often very hard and can be dangerous for both the mother and baby. Bariatric surgery can help you lose enough weight to minimize the risks of being pregnant. We recommend you wait at least 12 months after the surgery to begin trying to get pregnant so that you can lose enough weight to fully mitigate the potential risks. It is important to note, however, that the surgery also immediately impacts your hormones, meaning that many women become very fertile as soon as they have bariatric surgery. Because of the increased fertility, you should take precautions so that you do NOT become pregnant too quickly; your fertility may be higher, but your risks are still high until you lose a significant amount of weight.

Can I still eat pizza?

The best diet to lose weight and maintain that weight loss is a high protein, low simple complex carbohydrate diet. Does that mean you can never have a treat ever again? Of course not, but high carb foods such as pizza, pasta and cake should only be consumed in very small quantities and only occasionally. Your diet will be more focused on proteins and vegetables with minimal grains. Your dietitian will help you learn about exactly what you should and should not eat to lose the weight and keep it off. The good news is that, once you stop eating carbs and sugar, your body will stop craving them and you will naturally come to prefer proteins and vegetables and not feel deprived.

Can I drink alcohol after the surgery?

We recommend that you not drink alcohol after the surgery for 2 reasons:

1. Alcohol is empty calories that offer you no nutritional benefit, and losing weight means limiting calorie consumption; it is better to get your calories from nutritious food.
2. Your stomach is significantly smaller after the surgery with much less surface area to digest the alcohol; that means that any alcohol you drink will enter your blood system much faster and at a much higher concentration, resulting in you becoming intoxicated very quickly – even after just a few sips.

I'm a smoker and I think I can handle not smoking for the 6 months before the surgery, but why do I have to commit to not starting again?

By making a commitment to bariatric surgery, you are taking the first step toward a healthier lifestyle. Smoking is the leading cause of a number of life-threatening diseases, including heart disease and a large number of cancers. If you continue to smoke after your surgery, you are continuing to put your health at risk.

I can barely walk now. How am I supposed to exercise?

We don't expect you to run a marathon before your surgery or even after! We do need you to become more active and mobile. That may mean just walking to mailbox every day to start with. As you lose weight and start to move more, moving will become easier. Most exercise programs start with easy walking and increase the distance and amount of time you can walk. Adding exercise bands and light hand weights begins to add muscle mass which will help you burn more calories and increase muscle tone. Do some patient eventually run marathons? Yes, and that's an admirable goal, but even a marathon starts with a single step.

If bariatric surgery is just making my stomach smaller so I can't eat as much and am forced to restrict calories, isn't that the same as the calorie restricting diets that haven't worked? What's makes surgery different?

A number of things happen as part of weight loss surgery. Yes, your stomach is physically reduced in size so you will feel fuller faster. With the removal of a portion of your stomach, we also remove some of the parts that produce the hormones that affect hunger, satiety and metabolism. The diet will also focus on protein and 'good' carbs like vegetables which helps to reduce (or eliminate!) cravings for high carbohydrate/high calorie foods like breads and pastas. Your diet will also include protein shakes and small snacks throughout the day which also helps prevent hunger. With a smaller stomach and fewer hormones in your system, you won't feel as hungry, will feel full faster and will be satisfied with smaller amounts of food.

What happens if I regain the weight?

Weight regain is a concern for any patient undergoing bariatric surgery if they find the lifestyle changes to their diet and exercise regimen difficult to maintain. We also see some patients who have a harder time being disciplined about what they eat once they begin to socialize more, especially when that socializing involves food. We will work with you to help keep you on track and motivated to maintain your newfound health and diet. You will see your doctor at least once a year. The dietitian is available to you as you need and we offer support groups where you can talk with people who are going through the exact things – feelings, emotions, challenges – as you are, providing a safe space to share experiences and success tips.

How long will I be in the hospital?

You should plan to be in the hospital at least 1 night, possibly 2, depending on the procedure and your overall health. We perform our procedures using minimally invasive laparoscopic techniques which generally means faster recovery and less scarring. In some rare cases, we may have to convert to an 'open' procedure that requires larger incisions; if that is the case, you may be in the hospital longer.

I hear stories about people having the surgery then gaining back all the weight. How is that possible if you're taking out most of my stomach?

Committing to the lifestyle changes to your diet and activity level is key to not regaining the weight. Some people go back to their old way of eating after they hit their weight loss target, falsely thinking that they are done. Others think that they are adhering to the new diet if they drink smoothies or other high calorie 'health drinks' rather than eat healthy food. Unfortunately, that just doesn't work. This is a lifestyle change, not a quick fix. If you resume your old eating habits you can stretch your stomach over time, negating the benefits of the surgery. If you replace solid food calories with high calorie smoothies and liquid meal replacements, you are getting more calories than your body needs, which also results in weight gain.

Successful, long term weight loss requires a lifelong commitment to changes to how you eat, what you eat and why you eat.