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I. General Surgical Weight Loss
II. Insurance and Morbid Obesity
III. Preparation for Surgical Weight Loss
IV. Bariatric Surgery and Your Hospital Stay
V. Life After Bariatric Surgery
VI. Diet After Bariatric Surgery
Patients over 60 require very strong indications for surgery and must also meet stringent Medicare criteria. The risk of surgery in this age group is increased due to other medical problems and the expected weight loss benefits is less.
Yes. There is good, scientific evidence that weight loss surgery – and the corresponding lifestyle changes – can significantly prolong your life.
If you have serious obesity-related health conditions, are at least 100 lbs. over ideal weight, and are able to comply with lifestyle changes (daily exercise and low-fat diet), your chances of lengthening your life improve greatly.
For instance, a female smoker with a BMI of greater than 40 could lengthen her life expectancy by more than 15 years if she loses weight and quits smoking.
Generally accepted guidelines from the American Society for Metabolic 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 in their teens. There is a real 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 changes necessary for success.
At one year after successful bariatric surgery, 96% of obesity related medical conditions are either completely resolved or significantly improved. This does depend on the patient’s compliance to the recommended diet and exercise.
The easiest way to find out if your insurance company covers bariatric surgery is to call or go online to see if weight loss surgery is covered for the treatment of morbid obesity.
Surgeries fall under these CPT, or Current Procedural Terminology, codes:
Lap Band 43770
Open Gastric Bypass 43846, 43847
Laparoscopic Gastric Bypass 43644, 43645
If your insurance doesn’t cover bariatric surgery, we work with local and national banks that may be able to assist you.
Bariatric surgery is a life-altering decision. Every candidate goes through multiple levels of review before surgery is fully approved.
After completing your initial consultation and your insurance requirements(such as sleep study and psychological exam), we will send a letter to your insurance company to start the approval process.
In the meantime, we’ll work together to complete your “work-up,” the additional medical tests and consultations necessary to confirm that you are a candidate for surgery. Once complete, insurance approval usually takes between one and six weeks – we’ll notify you as soon as possible. If you don’t hear from us, we encourage you to call the claims office at your insurance company for an update.
Most insurance denials are a result of specific exclusions for obesity surgery or “treatment of obesity” in your insurance policy. You can appeal these exclusions when surgery is recommended by your surgeon or referring physician as the best treatment for life-threatening conditions.
Another common reason for denial is due to a lack of “medical necessity.” That necessity is based on the need to treat a serious or life-threatening condition. For bariatric surgery, most insurance request documentation of previous attempts at losing weight with alternative treatments, including diet, exercise, behavior modification and certain medications.
Gather all the information (diet records, medical records and medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
When the letter is submitted, call your insurance company regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.
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While patients vary in age, most are between 30 and 50 years old.
Generally accepted guidelines from the ASMBS and NIH encourage surgery only for adults over the age of 18.
Surgery has been performed on teens in the past, but there is concern that younger patients may not have the emotional or developmental maturity to make these life-long decisions.
Patients 60 and older must meet strict Medicare criteria and have medical indicators that the benefits of surgery will outweigh the risks.
Certain basic tests are done prior to surgery:
Complete Blood Count (CBC)
Comprehensive Chemistry Panel
Thyroid Function Test
Additional common tests:
Pulmonary Function Test
Sleep Lab Studies
Gastrointestinal (GI) Evaluation
Arterial Blood Gas
Before surgery, we want to get an accurate and comprehensive assessment of your health. All of these tests help up get a clear picture of your health and ensure the best possible results. Our goal goes beyond helping you lose weight, we want to help you lead a healthier life.
Sleep studies help us detect conditions that may lead to further complications after surgery. Conditions like sleep apnea – in which relaxed muscles cause abnormal interruptions to breathing – are found in nearly 70% of obese patients. Post-surgery narcotics can exaggerate these existing breathing abnormalities. It’s vital to us that we have an accurate understanding of what to expect and how to handle it.
A psychiatric evaluation will help prepare you for the necessary lifestyle changes that come with bariatric surgery. You’re getting ready to make a life-long commitment to health – and we’re ready to help. Our psychiatrists and psychologists will also help clear up any surgery concerns and make sure you’re ready for the next steps of your life.
Medical problems, such as serious heart or lung issues, can increase the risk of any surgery. Often times, these problems are related to weight, and also increase the need for surgery. Severe medical problems can increase the risk of having surgery, but the final decision will be made between you and our team of experts.
If you don’t already have a primary care physician, choose one and begin developing a trusting relationship with him or her. Then, work to complete your routine health testing, including the appropriate tests for your age and gender. It’s important to always keep track of your medical records, but they’re vital for your bariatric surgeon to get an accurate picture of your long-term health. You’re about to make a life-long commitment to health, so deciding to stop smoking can never happen too soon.
Additional items to bring to your appointment:
Medical records and test results
Hospital discharge summary for any recent hospital visits
Medications (dosage and schedule)
No. Laparoscopic operations carry the same risk as the procedure performed as an open operation. However, laparoscopic surgery does typically reduce the amount of discomfort, time at the hospital, hernia and infection rates, scarring and downtime.
A hospital gown will be provided by the hospital, but most people prefer to bring their own clothing and toiletries. Choose loose-fitting clothes for your stay that are easy to put on and take off. Because of your incision, your clothes may become stained by blood or other body fluids.
Managing pain is one of our largest concerns. The faster you can move about and become active, the less likely you are to experience complications. While you’re in the hospital, you’ll have appropriate pain medications to keep you comfortable. As you leave to start recovering at home, we’ll prescribe medications to help you manage any remaining pain.
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
Almost immediately after surgery. We’ll ask you to walk or stand at the bedside on the night of your surgery. Over the next few days, you’ll take several walks up an down the halls and around your room. Walking is one of the initial pieces of recovery, and it effectively reduces your risk of having severe lung issues, like a pulmonary embolism.
Usually 7-14 days after surgery. For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly maintain control of your vehicle.
The stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.
Because DVT originates on the operating table, therapy begins well before you head to the operating room. Generally, patients are treated with sequential leg compression stockings and given a blood thinner prior to reduce the risk of DVT/PE – and both are continued during your hospital stay.
When you have a weight loss surgery procedure, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to operate. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you don’t exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. Consult with your bariatric specialists to determine what amount of exercise is appropriate for you.
Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.
In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-20cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-7 ounces. Drinking fizzy drinks like soda and overeating can stretch the size of the pouch out and make the operation less effective.
The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.
Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems.
A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20% of patients develop a hernia after an open procedure, but only about 1% of patients that have laparoscopic surgery will develop a hernia. Most of these patients do require a repair of the herniated tissue.
Your primary care doctor will determine whether you should stop taking certain medications for blood pressure, diabetes, etc. as your health improves. Most pills or capsules, including oral contraceptives, are small enough to pass through the new stomach pouch.
The largest concern regarding medications involve two classes of medications that should be used only in consultation with your surgeon: diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines).
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.
It is strongly recommended that women wait at least 1.5 to 2 years after the surgery before becoming pregnant. Approximately 1.5 years post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. You should consult your surgeon as you plan for pregnancy obstetrician familiar with the needs of patients who have had weight loss surgery.You will also have to be under the care of an obstetrician familiar with the needs of patients who have had weight loss surgery.
Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection and interferes with blood supply to the healing tissues. In addition, nicotine use is the main cause of ulcers following weight loss surgery.
Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. It is generally not recommended to have surgery for skin removal until at least two years post-operatively, at which time your weight loss has begun to stabilize.
Infrequently: If needed, it is usually given after surgery to promote healing.
Undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including: Early ambulation, blood thinners and special wraps around the lower legs.
Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc and biotin supplement, and a good daily volume of fluid intake. Most patients experience natural hair re-growth after the initial period of loss.
We recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by pureed foods, will be recommended for at least four weeks until adequate healing has occurred. We will provide you with specific dietary guidelines for the best post-surgical outcome.
Eggs, low-fat cheese, low-fat cottage cheese, tofu, fish, other seafood, chicken (dark meat), turkey (dark meat).
When you are losing weight, there are many waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight loss. Water also fills your stomach and helps to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it may be because you did not drink enough water in the hour before.
Eating sugars or other foods containing many small particles when you have an empty stomach can cause dumping syndrome in patients who have had a gastric bypass where the stomach pylorus is removed. Your body handles these small particles by diluting them with water, which reduces blood volume and causes a shock-like state. Sugar may also induce insulin shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling: you break out in a cold, clammy sweat, turn pale, feel "butterflies" in your stomach, and have a pounding pulse. Cramps and diarrhea may follow. This state can last for 30-60 minutes and can be quite uncomfortable - you may have to lie down until it goes away. This syndrome can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be well tolerated at the end of a meal.
Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake, defeating the restrictive effect of your operation. Snacking will slow down your weight loss and can lead to regain of weight.
Most patients experience a drop in appetite for the first four to six weeks. Over the next several months the appetite returns, but it tends not to be an intense hunger. Most spikes in hunger are caused by eating starch-heavy meals.
Patients may begin to wonder about this early after the surgery when they are losing 10-40 pounds per month, or maybe when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition. That being said, all patients do need to take vitamins to replenish their mineral supplies.
You can, but you will need to be very careful, and we recommend that you avoid it for the first several months. Red meats contain a high level of meat fibers (gristle) which hold the piece of meat together, preventing you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.
Consume foods high in protein with a goal of 60-70 grams per day are generally sufficient. Check with your dietitian to determine the right amount for your type of surgery and the best ways to increase your protein intake.
No, your salt intake will be unchanged unless otherwise instructed by your primary care physician.
Most patients are able to enjoy heavily spiced food following the initial 6 months after surgery.
You will find that even small amounts of alcohol will affect you quickly. It is suggested that you drink no alcohol for the first year. Thereafter, with your physician's approval, you may have a glass of wine or a small cocktail. Remember, however, these drinks are empty calories.
Yes, you will be required to take supplements following your surgery. Common daily supplements include a bariatric-specific multivitamin. Your dietitian will advise you of any additional supplements needed.
You will need to take a daily multivitamin for the rest of your life, as well as calcium. Some patients may require iron B12 or other supplements as well.
Women are more susceptible to iron and calcium deficiency especially if they are still menstruating. Therefore, women are likely to be placed on iron and calcium supplements in addition to their multivitamin. B12 injections are sometimes suggested if your B12 levels run low. B12 may also be taken orally or sublingually (under the tongue) by many patients.
We require patients to consult with a nutritionist before surgery. Counseling after surgery is also required to assure successful outcomes.
We provide patients with materials that clearly outline their expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure.
If you're considering bariatric surgery, the path to improved health begins with two simple steps.
Watch our online seminar and complete a form.