What is “Bariatrics”?
Bariatrics is the field of medicine offering treatment for people who are overweight. A complete bariatric treatment program includes nutrition, exercise and lifestyle changes. Medications, such as appetite suppressants, and weight loss surgery may also be recommended. The field of bariatric medicine includes research into the causes, prevention and treatment of being overweight.
Do I qualify for weight loss surgery?
Weight loss surgery is reserved for patients who are 100 pound above, or twice, their ideal body weight. Insurance plans including weight loss surgery benefits have a list of requirements for coverage.
For what age range does Healthy Weight Management & Bariatric Surgery offer weight loss surgery?
Bariatric Physician Specialists is currently providing weight loss surgery for qualified individuals between the ages of 18 and 65.
What is BMI?
The BMI, or body mass index, is simply a height to weight ratio for measuring whether or not you have a weight illness. A normal BMI ranges from 20 to 25. Candidates for weight loss surgery have a BMI of 35 or more and medical problems associated with being overweight. If you want to know your BMI, ask a member of our bariatric surgery team.
What is laparoscopic surgery?
Laparoscopic surgery is done through 4 or 5 half inch incisions into the belly. The belly is inflated with a small amount of gas to create space for the surgeon to see. The surgeon sees into the belly cavity using a small video camera and special long instruments to perform the operation.
With an “open” surgery, the surgeon makes a large incision and operates directly on the stomach and bowel. The exact same operation can be done by the surgeon using either the laparoscope or open technique. The advantages of laparoscopic surgery include fewer complications, less pain and a shorter hospital stay.
All of our bariatric surgeons are trained in laparoscopic surgery.
Why aren’t all weight loss surgeries done laparoscopically?
The first laparoscopic Roux en Y gastric bypass was done in 1994. Surgeons must have years of experience in laparoscopic techniques or recent fellowship training to develop the skill needed to perform the surgery safely. Not all bariatric surgeons have the specialized training necessary to perform laparoscopic weight loss surgery.
All bariatric surgeons with Lancaster General Health are trained in laparoscopic techniques.
What are the risks of weight loss surgery?
The risks of weight loss surgery are similar to other surgical procedures. There are also early and late complications specific to each procedure. The risks associated with each procedure will be discussed with you before your surgery.
Will my insurance cover this surgery?
Insurance coverage for weight loss surgery depends on your health insurance policy. You can call your human resources representative at work or your insurance company directly to find out the details of your coverage, including what weight loss procedures are covered. Some insurance plans specifically exclude weight loss surgery.
If I don’t have insurance coverage, can I pay for everything myself? How much do the surgeries cost?
Some patients chose to pay out-of-pocket for their weight loss surgery. Make sure you have exhausted all of your insurance options or consider changing health plans before choosing to pay for the surgery yourself. At Lancaster General Health, an insurance specialist can discuss the costs of surgery with you and help you with your decision.
Are there any activity restrictions after gastric bypass? After sleeve gastrectomy?
The activity restriction is the same for both procedures. You may not lift anything weighing over 30 pounds for two weeks. You may start walking, biking and becoming more active. However, you may not swim for two weeks.
When can I return to work after gastric bypass surgery? After sleeve gastrectomy?
The time to return to work is the same for either procedure. Depending on the requirements of their job, most patients could actually return to work a few days after surgery. We recommend you stay off work for at least 10 to 14 days after surgery. If indicated, we may allow you to remain home for up to 6 weeks after your surgical procedure.
How much weight can I expect to lose after gastric bypass? After sleeve gastrectomy?
A gastric bypass patient typically loses an average of 75% of their excess body weight. A sleeve gastrectomy patient typically loses an average of 65% of their excess body weight. Most patients will achieve this level of weight loss within the first year.
Is it safe to lose weight that quickly after surgery?
The rate of weight loss after gastric bypass or sleeve gastrectomy is safe. There is no evidence to suggest slower weight loss is any gentler or easier on the body.
How will I stop losing weight?
After weight loss surgery, weight loss slows down for a variety of reasons. How well you stick with the recommended lifestyle changes is a big factor in how quickly you stop losing weight. Also, your body will adapt to the decreased food intake by becoming more efficient and adjusting its energy needs.
Can my stomach pouch get bigger after sleeve gastrectomy surgery?
Yes, it is possible. The stomach pouch can stretch after surgery. Stretching occurs when meal sizes are larger than recommended.
Do people regain weight after weight loss surgery? All of their weight?
Most patients will experience a rebound weight gain of 5 to 10% after weight loss surgery. This usually occurs when patients do not stick with the recommended lifestyle changes.
Patients can regain all of the weight they lost after surgery if they do not change their lifestyle. In addition, all of the medical problems related to being overweight can return.
I was told I can’t take anti-inflammatory medicine after weight loss surgery. I have severe arthritis and need medicine to get around. What will I take if I can’t take my medication?
After surgery, anti-inflammatory medicine increases the chance of developing an ulcer in your new pouch. For gastric bypass patients with severe arthritis, Tylenol-based products are recommended. Mild narcotic pain relievers may also be prescribed. Evan a modest weight loss may reduce or eliminate the need for medication to treat joint pain.
I hate to exercise. Will that affect my weight loss after surgery?
Most definitely! In order to lose weight you have to burn more calories than you eat. Becoming more active will widen the gap between energy eaten and energy burned. The wider the gap, the greater the weight loss. As you lose weight, physical activity becomes easier and the results become more apparent.
I have terrible joint problems that keep me from exercising. How will I be able to exercise after surgery?
At Lancaster General Health, we have a state-of-the-art aquatic therapy facility at Suburban Pavilion building, which next to the Healthy Weight Management office on Harrisburg Pike. Even people in wheelchairs can get in and out of the specially designed pool with ease. Aquatic therapy takes the weight of gravity off of the joints, relieving the pain you have with exercise. You will eventually reach a point in your therapy when your weight loss and re-conditioning combined make it possible for you to do exercises on land.
What is sleep apnea? How do I know if I have it?
About 70% of patients who qualify for weight loss surgery have some form of sleep apnea. People who have sleep apnea stop breathing during sleep. One or more breaths are missed before the person starts to breath again. This cycle repeats itself many times during sleep. Sleep apnea is a serious medical condition, and many patients do not realize they have it. Excessive daytime sleepiness can be a symptom. Testing is performed before surgery to determine if you have sleep apnea and how severe it is. If you have sleep apnea, treatment is started before surgery.
Can a gastric bypass be reversed? Adjustable gastric band? Sleeve gastrectomy?
Removal of the adjustable gastric band would take about an hour. Reversal of a gastric bypass would take several hours. The sleeve gastrectomy cannot be reversed.
What weight loss surgery procedures does Healthy Weight Management & Bariatric Surgery offer?
We primarily perform Roux en Y gastric bypass and sleeve gastrectomy surgeries. We also provide weight loss surgery revisions using a laparoscopic approach. Your options for weight loss surgery will be discussed during an individual consultation with the surgeon.
How do I decide which surgery is best for me?
Choosing which weight loss surgery is best for you is a personal decision. Your eating habits, and overall health, are important factors to consider when making your decision.
How soon can my surgery be done?
After your consultation with the surgeon, it usually takes 8 – 12 weeks to get ready for the surgery. Meeting the insurance company’s requirements for approval often takes the most time. Check with your insurance company as early as possible to find out what you need to receive coverage for your surgery.
How long is the surgery?
The length of the surgery depends on several factors. On average, a laparoscopic gastric bypass surgery or sleeve gastrectomy take about 75 to 90 minutes.
Will I need to receive blood with this surgery?
Less than 5% of patients have bleeding problems with weight loss surgery. Most of the bleeding associated with surgery stops on its own and does not require a blood transfusion. Less than 1% of weight loss surgery patients receive a blood transfusion.
I have Type 2 Diabetes. Which operation is best for me?
Gastric bypass is the recommended procedure for patients with diabetes. With gastric bypass, the first part of the small intestine is bypassed which changes how the body makes and responds to insulin. Some gastric bypass patients who have diabetes are able to leave the hospital medication-free. How gastric bypass effects insulin is currently under research.
Why do I need to stop smoking before this surgery?
Smoking is a destructive personal habit. Smokers who have general anesthesia have a higher rate of lung-related complications after surgery. Also, your risk of developing stomach ulcers is ten times higher if you smoke after surgery. Weight loss surgery is an elective procedure offered to improve your health. All unhealthy habits must be avoided after surgery.
It is our policy for smokers to stop smoking completely six weeks before surgery. Lancaster General Health has different options to help you quit smoking before your surgery and for maintenance therapy after surgery.
I was told I couldn’t have laparoscopic surgery, and I would have to have an “open” procedure. Is that true?
For an experienced laparoscopic surgeon, there is no weight limit for laparoscopic surgery. Over 99% of patients are able to have their surgery performed laparoscopically.
My religious beliefs do not allow me to receive any blood products. Will you still be able to operate on me?
We respect the religious beliefs of all our patients. We often use alternatives to blood transfusion therapy. Any anemia, or low blood count, is corrected before your surgery.
My primary care doctor doesn’t believe in weight loss surgery and will not give me a referral letter. What can I do?
Some doctors are fearful of weight loss surgery and how it was done 20 to 40 years ago. Your doctor may have cared for a patient who had a bad experience with weight loss surgery. Patients now have access to experienced weight loss surgery teams that provide the support they need to be successful. These teams, which include experts in nutrition, exercise, and lifestyle change, have worked together to bring weight loss surgery out of the “Dark Ages”.
Urge your doctor to contact us for information about our program. If your doctor is still not willing to refer you for surgery, you may need to obtain a second opinion or consider changing physicians.
Will I need to have my gallbladder removed at surgery? Or later?
About 7% of patients who have gastric bypass will eventually develop problems with their gallbladder and need to have it removed. The gallbladder can be removed laparoscopically. Removing the gallbladder at the time of gastric bypass surgery is not recommended. Please feel free to discuss this with your surgeon at your appointment.
What happens to the bypassed stomach after a Roux en Y gastric bypass?
No part of the stomach is removed during gastric bypass surgery. The portion of the stomach separated from the pouch still works normally, but it no longer receives food. As a result, stomach acid production declines. The bypassed portion of the stomach does not “shrivel up” or “die off” because the blood supply is unchanged. The stomach stays in the same position and drains digestive juices into the small intestine as it did before surgery.
Can my family stay with me after the surgery?
Yes. We typically limit each patient to one family member or close friend.
How long will I need to be in the hospital for gastric bypass surgery? For sleeve gastrectomy?
Barring any complications, patients who have either laparoscopic surgery are in the hospital for two days.
Will someone need to take care of me after my surgery?
After surgery, you will be able to take care of yourself completely.
How often do I need to follow-up after surgery?
Patients are seen 2 weeks and 6 weeks after surgery. They will also follow-up at 3, 6, 9 and 12 months. After the first year, patients are seen yearly for follow-up. Sticking to the follow-up plan is important to maintaining your weight.
Who will be adjusting my medications after surgery?
When you are discharged from the hospital, we provide you with a list of medications you are to take after surgery. We will send your medication list to your primary care doctor. Your primary care doctor will manage your medications while you lose weight. Do not stop or “self-adjust” medications without discussing your thoughts and concerns with your doctor first.
What do I tell other healthcare providers if I need emergency care or surgery in the future?
Because weight loss surgery has become more common, most emergency care providers are familiar with caring for post-operative weight loss surgery patients. It is always best for you to let your healthcare providers know about your weight loss surgery. Some patients choose to wear a medical alert bracelet after surgery.
Since I live far away from the hospital, what should I do if I need emergency care?
What to do in case of emergency is something you should consider before coming here for surgery. If you live several hours away from our main hospital, it may be wise for you to stay in the area until after your two week follow-up appointment. After the early post-operative period, emergencies can usually be handled or stabilized by a hospital close to your home.
Will I have more bowel movements after gastric bypass surgery?
Once on regular food, 90% of gastric bypass surgery patients have no change in bowel movements. Some patients notice an improvement in bowel habits after surgery.
What is dumping?
Dumping only occurs after gastric bypass surgery. It is the body’s reaction to eating foods with a high fat or sugar content. Dumping usually occurs 30 to 60 minutes after eating and can cause nausea, vomiting, abdominal pain, heart pounding, headache, dizziness and diarrhea. A dumping episode can last 4 to 24 hours and rarely requires emergency care. Dumping can be a good tool for teaching patients to avoid unhealthy foods
Will I lose all of my hair? What can I do to prevent hair loss?
People rarely lose all of their hair. Hair thinning can occur, but can be minimized by reaching your protein goal each and every day. The hair thinning process usually starts around 3 months after surgery and stops by 7th month. After 7 months, the hair starts to regrow.
Hormonal factors also influence hair loss. If you had hair loss with pregnancy, you will probably have hair loss after weight loss surgery. Having weight loss surgery during menopause may also impact the amount of hair a woman loses. Taking daily multivitamin and adding zinc and biotin supplements is recommended.
Will my weight loss surgery affect future pregnancies?
Weight loss surgery does not increase the chance of birth defects with future pregnancies. In fact, fertility increases for women after successful weight loss surgery. We recommend women who have had gastric bypass surgery wait two years before becoming pregnant.
Proper diet and nutritional supplements are necessary after weight loss surgery and when planning any pregnancy. It is best to plan any future pregnancies with your gynecologist and bariatric surgeon
How will this surgery affect me when I am older?
Neither surgery has any negative impact on your body’s natural aging process. In fact, losing weight at an earlier age helps improve your quality of life as you age.
Will I need skin reduction surgery?
About 15% of patients choose to have skin reduction surgery after weight loss has stopped. We recommend waiting two years after your original surgery before considering this option.
Will I ever be able to eat anything sweet after gastric bypass surgery?
An “all or nothing” attitude towards sweets is not necessary after surgery. It is certainly possible to eat a bite or two of a sweet treat after surgery. However, “testing the waters” to find your sugar limit is not recommended. The fear of dumping is a powerful motivator and should not be tested.
Am I allowed to drink soda after surgery?
Only diet drinks are recommended after weight loss surgery. Carbonation can cause discomfort after weight loss surgery and can contribute to nausea and vomiting. It is best to avoid carbonated beverages after surgery.
Can I drink alcohol after weight loss surgery?
You should wait at least 6 months after surgery to begin consuming alcohol. Some studies suggest there is a lower tolerance to alcohol after gastric bypass surgery. Alcohol can also have a high calorie count. After surgery, you need to be careful of soft or liquid calories that can easily add up to slow weight loss or cause weight gain. Another concern about alcohol after weight loss surgery is the possibility of changing an addiction to food into an addiction to alcohol.
Do I have to give up caffeinated beverages forever?
Caffeine can be an appetite stimulant and a diuretic. Until you can consume at least 64 ounces of fluid a day, it is best not to consume products with caffeine.
Will I ever be able to take capsules?
We recommend you avoid taking capsules after surgery. The stomach needs to be intact to breakdown most capsules. Also, the size of the opening leaving the pouch with either operation may block the passage of an intact capsule. Check with your doctor or pharmacist to see if another form of the medication is available or if the contents of a capsule can be mixed with food.
Will I need vitamin supplements for the rest of my life?
Yes, nutritional supplements are required after weight loss surgery. You are eating less food and supplements help prevent nutritional deficiencies. Routine blood work is also necessary to monitor your nutritional status.