- Diet Related
- Exercise Related
- Excess Skin
- Weight Loss and Gain
- Bariatric Surgery Program General FAQ's
- Adjustable Gastric Banding
- Pre Operative Process
- Laparoscopic Surgery
- Risks and Complications
- Medication Related
Diet Related FAQ's
Do I have to do a special diet before surgery?
Yes, our surgeons may require that you lose a percent of your excess body weight (different from your total weight) prior to surgery and we will assist you in this effort by putting you on a specific pre-operative diet. It is called the Bariatric Pre-Operative Diet and may range from 4-8 weeks or longer for some patients. This diet will be discussed in detail at your initial visit.
What Kind of Diet Do You Follow After Surgery?
After Gastric Bypass surgery, your pouch will only hold one to two ounces of food, and after sleeve gastrectomy, it will hold 4-6 oz of food, so you will need to have a healthy diet and consume a variety of foods in order to get the vitamins and minerals you need. To help prevent deficiencies, your doctor will prescribe a multivitamin, protein powder and a calcium supplement. In addition, other supplements may be prescribed. The post-surgery diet progresses from clear liquids, taken immediately after surgery, to soft foods, which include meats, fruits, vegetables and some grains. Intolerance to certain foods varies from person to person.
Will I be able to eat all kinds of foods?
The most common problem-foods include:
- Red meat
- Soft breads
- White rice
Your dietitian and bariatric surgeon will advance you through the following four phases of the post-surgery diet:
- Clear liquid diet
- Pureed diet
- Adaptable, soft diet
- Stabilization/Regular diet
What can I eat after surgery?
Each patient is provided with a detailed post-surgical nutritional manual. Once your surgeon feels you are ready, you will be started on a bariatric clear liquid diet. This includes broth, sugar-free Popsicles, sugar free Jell-O, and other bariatric friendly fluids. After this initial clear liquid diet is tolerated, your surgeon will work with you to decide when you are ready for advancement to the next dietary stage.
What are the diet and lifestyle changes that I will need to make after surgery?
After surgery your stomach will be extremely small and only able to hold a few ounces at a time.
Failure to follow these guidelines not only puts you at risk for regaining the weight, but also for other medical complications resulting from poor nutrition.
- You need to be compliant with the slow dietary progression from liquids, to pureed foods, to soft foods, and eventually to solid foods.
- You need to learn how to eat smaller portions, slowly.
- You must do your part in restricting high calorie foods by avoiding sugar, fatty foods, and strictly following the guidelines set by your surgeon.
- You need to develop an exercise program to maximize weight loss, help prevent muscle wasting, and to avoid regaining the weight.
- You need to take a multi-vitamin, calcium, and potentially other supplements for the rest of your life.
When can I start exercising?
We will strongly encourage you to start walking on the day of your surgery. You will increase your activity level during your hospitalizations and should be able to walk without difficulty at your discharge. Usually by the third or fourth week after surgery, other activities are safe to resume. Most patients can resume a normal workout routine within 1-2 weeks following surgery. We will provide you with physical exercise guidelines.
Excess skin after losing weight — what can I do about it?
If you're concerned about excess skin on your stomach or other areas, plastic surgery is an option. After you're at a stable weight — about 12 to 18 months following surgery — you should meet with a plastic surgeon to discuss your options and insurance coverage.
Will I need plastic surgery?
Exercise can help address the issue of excess skin following bariatric surgery, but depending on how overweight a patient is, exercise alone may not be sufficient. The amount of loose skin a patient will experience after rapid weight loss is dependent upon several factors: genetics, age, sun exposure, history of smoking, size and shape of your body, and length of time at your starting weight before surgery. Many patients find that after surgery, they feel so good that they do not care about a little loose skin. About one third of our patients will want to be referred to a plastic surgeon for a consult to remove some of their loose skin. This procedure is rarely covered by insurance so be prepared to cover it as an out of pocket expense. If you are interested in pursuing plastic surgery, talk with your doctor about whether this option is right for you. He can refer you to a plastic surgeon.
How Much Weight Do Most Patients Lose?
Weight loss depends on many factors, including, but not limited to, a patients starting weight, age, body metabolism, ability to exercise and type of operation. The average weight loss for a bariatric patient is approximately one third of his/her starting weight. Typical and satisfactory weight loss with the gastric bypass may result in the weight loss of 15-20 pounds per month, with this amount lessening over time.
Is it possible to regain the weight that I lost?
Absolutely! Bariatric surgery isn't a magic bullet. You can regain the weight you lost, as well as all of the other problems associated with it.
To be successful, you must adopt a lifelong commitment to maintaining a healthy weight through good nutrition and exercise.
Can I get pregnant after weight loss surgery?
You can get pregnant after weight loss surgery and in fact many women who had trouble getting pregnant prior to surgery will find it much easier after they lose weight. Pregnancy is not advised during the period of rapid weight loss following surgery and therefore you will need to have a VERY reliable form of birth control in place. After you are finished losing the majority of your excess body weight (one to two years post-op), you can work with your surgeon and your obstetrician to have a safe and healthy pregnancy.
Is Bariatric Surgery The Right Choice For Me?
The decision whether or not to have bariatric surgery should not be taken lightly. Although the health benefits are undeniable, it is important to understand that surgery is not necessarily the right choice for everyone. Patients must be able to make permanent lifestyle and eating behavior changes in order to achieve and maintain successful weight loss. These changes start immediately after surgery, with the patients consuming extremely small amounts and severely restricted types of food due to smaller stomach size and surgical wound healing. If patients do not comply with the strict dietary restrictions, wound healing could be disrupted with potential serious complications.
Patients must learn how to eat healthier, monitor fats, carbohydrates, and sugars, and exercise to achieve lifelong results. If patients are unable to incorporate these lifestyle changes, there is a high risk of regaining weight. Before choosing weight loss surgery, it is important to understand the different surgical procedures and research the lifestyle impact, and the risks and the benefits of each surgical option.
Benefits of Surgery (see your Surgeon for a complete list)
- Improved health
- Improved quality of life
- Improved self image and self esteem
Risks of Surgery (see your Surgeon for a complete list)
- Staple Line Leakage
- Blood clots
- Loss of too much weight
- Loss of too little weight
Is bariatric surgery considered cosmetic surgery?
No. Although patients feel much better about their appearance after weight loss, the purpose of surgery is to become healthier. Weight loss surgery may alleviate or help the patient avoid weight related diseases. From an insurance standpoint, the surgery is definitely not cosmetic.
How long does the operation take?
Most of the laparoscopic gastric bypass and sleeve gastrectomy procedures can be performed in approximately 2 hour. It may take longer if you have had previous surgery or there is anatomic difficulty accessing your stomach such as an enlarged liver.
Why do I need to stop smoking before having weight loss surgery?
There are multiple reasons to stop smoking. Patients overall will have fewer complications if they no longer smoke. Smoking damages the lungs and this can lead to higher anesthetic risks and pneumonias following surgery. It takes about a month for the lungs to recover – so stop now! In addition, weight loss surgery is about improving your health. Smoking directly contradicts this goal. Southern Illinois Healthcare offers free smoking cessation programs.
Does your program offer support groups following surgery?
We offer several support group meeting options every month. We encourage you to attend the meetings both before and after surgery. We require the attendance of three support group meetings pre-operatively. The meetings allow the opportunity to discuss various health topics, get information from guest speakers, and talk with individuals going through the same experience.
Do you have a dedicated registered dietician as part of your program?
Yes. Part of our comprehensive weight-loss program includes scheduled visits with our dietician(s). They will meet with you in our office and help you develop proper eating habits before and after surgery and work with you to achieve your nutritional goals.
Does insurance cover the surgery?
Most insurance plans now understand the medical necessity of weight-loss surgery and will give approval. However, each insurance carrier has its own guidelines for approval. Our staff can help guide you through the insurance maze. For those patients for whom insurance does not cover obesity surgery, our office can provide you with information on other payment methods.
How long is the hospital stay?
The typical stay in the hospital is two nights after the gastric bypass and one night for the sleeve gastrectomy. These stays may need to be extended depending on each individual's medical situation. The bottom line is that each patient stays until the surgeon feels that it is safe for the patient to go home.
If I've had prior stomach surgery, will I be able to have gastric bypass?
Prior stomach surgery will not necessarily eliminate you from candidacy for weight loss surgery and for most patients is not a problem. It is rare that patients would have to be converted to an open procedure because of complications from prior stomach surgery, but this is something that you will discuss one on one with your surgeon during your consultation and pre-operative process.
What if I'm just under the criteria for the BMI and medical necessity?
Most insurance plans are VERY strict on the requirements that need to be met in order to be approved for weight loss surgery. They will require you to at least have a BMI of 35 or higher with 1-2 co-morbid conditions that you can document or a BMI of 40 of higher. Unfortunately, they do not make exceptions for patients that are being treated for co-morbid conditions but do not meet the 35 BMI requirement. For more information, please attend one of our free informational seminars.
How long will it take me to go through the pre-operative process and get a surgery date?
Most patients find that they will be able to complete the pre-operative process quickly and that the time from seminar to a surgery date is about 2 to 3 months. This time frame depends heavily on the patient's motivation and schedule to get the checklist items completed and the requirements of their specific insurance company. Some insurance companies may add 6 to 9 additional months to this time frame based upon their pre-authorization requirements.
How often do I come in for appointments after surgery?
New Life Weight Loss Center wants to partner with you for the rest of your life on your weight loss goals. After Sleeve or Bypass surgery we will want to see you at 1 week, 4 weeks, 6 weeks, 3 months, 6 months, 1 year and then at least annually for life.
How long will I be out of work after surgery?
Most patients will only need to take 1-2 weeks off of work after surgery. Many of our patients even return to work in a few days. You will work closely with your surgeon to discuss you particular needs.
Do you perform laparoscopic gastric banding (adjustable band, Realize band, Lap-Band)?
We no longer perform adjustable gastric banding as a primary weight Loss procedure. We do however, maintain care of our previous band patients by offering band maintenance and band adjustments.
How is the Lap-Band® or Realize® band adjusted?
The band is adjusted in a very simple and quick procedure right here in our office during a regularly scheduled follow up appointment. A special needle is used to access a port that is sutured into the inner abdominal wall and connected to your band by some thin tubing. The practitioner will access your port with the special needle and inject saline fluid to fill your band.
Your surgeon will determine and explain what you need to do before having obesity surgery, but these are answers to some of the more common questions regarding tests and procedures you may be asked to do in preparation for your surgery.
What are the routine tests before weight loss surgery?
Certain basic tests, such as a full blood examination are performed as part of your initial assessment. Tests such as pulmonary function testing, chest x-ray, echocardiogram, sleep studies, gastrointestinal evaluation, cardiology evaluation, or assessment by a psychologist may be requested when indicated. The New Life Weight Loss Center pre operative process is patient specific.
What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery to minimize the chance of complications and this will be determined by your surgeon.
Why do I have to have a Gastrointestinal Evaluation?
Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a Hiatal hernia, gastro esophageal reflux or gastric ulcer.
What can I do before the appointment to speed up the process of getting ready for obesity surgery?
- Select a general practitioner if you don't already have one, and establish a relationship with him or her. Work with your doctor to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
- Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
- Bring any pertinent medical data to your appointment with the bariatric (weight loss) surgeon - this would include reports of special tests or hospital discharge summary if you have been in the hospital.
- Bring a list of your medications with dose and schedule.
What should I bring with me to the hospital?
Personal toiletries and clothing for your stay that is easy to put on and take off.
What does laparoscopic surgery mean?
Laparoscopic surgery means that instead of making one large incision in your abdomen, we make several small incisions in the abdomen. These smaller incisions allow you to recover faster. You'll also experience less pain, leave the hospital sooner and will be back to your normal activity sooner. In general, we start all of our cases laparoscopically unless the patient has had previous surgery on their stomach.
Will I have a lot of pain?
Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain.
How soon will I be able to walk?
Almost immediately after surgery doctors will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.
How soon can I drive?
For your own safety, you should not drive until you have stopped taking narcotic medications. Consult your doctor as to when you are able to drive.
What are The Risks Associated with Bariatric Surgery?
As with any operation, there are risks and side-effects associated with bariatric surgery. Potential complications include bleeding, blood clots and breathing problems, and side-effects include increased risk of developing anemia and bone disease, such as osteoporosis. The risk of death associated with bariatric surgery is low - less than .5%.
Bariatric surgery will change the way you eat and how your body digests and absorbs food. Adherence to recommended nutritional and exercise guidelines are paramount to ensuring optimal results.
Following discharge from the hospital, patients should contact their physician if they develop any of the following symptoms:
- Persistent fever (over 100.5 F)
- Bloody bowel movement
- Increased abdominal swelling or pain
- Persistent nausea or vomiting
- Persistent cough and shortness of breath
- Difficulty swallowing
- Generalized weakness
Will I lose my hair?
Hair loss can accompany the rapid and significant weight loss seen after surgery. This more commonly occurs after gastric bypass or sleeve gastrectomy surgery, as the weight loss with these procedures is faster. Some patients notice this around 3-5 months post-operatively, particularly while brushing their hair. Hair loss can occur with any significant stress to the body and is usually similar to that seen in pregnancy or trauma. The hair follicles return to normal after the weight loss subsides with virtually everyone.
What is done to minimize the risk of deep vein thrombosis (DVT)/pulmonary embolism (PE)?
Because a Deep Vein Thrombosis originates on the operating table, therapy begins before a patient goes to the operating room. Generally, patients are treated with sequential compression devices that massage your lower legs to keep the blood flowing, leg compression stockings and given a blood thinner prior to surgery. All of these therapies continue throughout your hospitalization. The fourth major preventive measure involves getting the patient moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs.
What are the risks of the operation?
Weight loss surgery is major abdominal surgery with significant risks. However, we know experience counts and high-volume centers like Stanford Hospital & Clinics have an extremely low complications rate. The following potential complications include, but are not limited to:
- Risk from general anesthesia
- Blood clot in the legs or lungs
- Hernias (internally or externally)
- Blockage or obstruction
- Narrowing where surgeons suture the pouch to the intestine, which can require another endoscopy and dilation
- Leakage from the stomach or the intestines
- Injury to liver and/or spleen
- pulmonary and/or cardiac and/or renal failure
With the adjustable gastric band (lap-band), there's a risk that the band can either slip or erode. There's a risk that you will not lose weight if you don't follow the diet and exercise program. There's a risk of needing another operation or conversion to an open operation with a long incision.
How do I know which operation is for me?
Deciding which procedure is best for you is largely a personal one best achieved in discussion with your surgeon.
Is there anything else I need to know?
It's very important that you understand this surgery won't always remove your sense of hunger. It won't cause you to lose your desire to eat and it won't remove any of the psychological cravings that you may have for food. If you eat when you're stressed, you'll still feel like eating when you're stressed. Therefore, it'll be very important that you understand the stresses that make you feel like eating and identify other ways of resolving these issues. Part of your Bariatric Surgery team can include a psychologist to help you understand your eating triggers and how to cope with them.
What about medication? Can I still take pills or do they have to be liquid or chewable?
Most of your medication following surgery will need to either be chewable, crushable, or in liquid form. You will need to work closely with your primary care physician and your pharmacist to find forms that work for you. The good news is that most patients find that they take much less medication after surgery once they start losing weight.
Can I take ibuprofen or similar medications after surgery?
Non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen (Advil, Motrin), Naprosyn, Aleve, Iindomethacin, Celebrex or other similar medications should not be taken after surgery. It is okay to take Tylenol.