Patients must meet specific criteria before they will be considered for an evaluation with the Bariatric & Metabolic Surgery program.
- Have a Body Mass Index (BMI) of greater than 40 or a BMI of >35 accompanied by other issues related to health (co-morbidities). These include diabetes, high blood pressure, coronary artery disease, obstructive sleep apnea, osteoarthritis, hyperlipidemia (high cholesterol, triglycerides, etc), metabolic syndrome, polycystic ovarian disease, pseudotumor cerebri, etc.
- Be medically stable, and have an actively involved and supportive primary care physician.
- Have a stable psychological status with an adequate social support system to help them through the course of surgery and the postoperative period.
Weight loss surgery, no matter which type, is only a tool to help you lose weight and keep it off if used effectively. After weight loss surgery, almost any type of food is tolerated if chewed well enough, and eaten slowly. There are many exceptions to this:
- The Gastric Band can provide a constant restriction on your stomach; however, it can affect your eating habits. Weight loss is dependent on the quality of the food you eat. Eating soft sweets, such as chocolates, ice creams, or drinks/liquids high in calories can cause poor weight loss or weight gain.
- The Gastric Bypass provides significant weight loss for one to two years, then plateaus. Gastric bypass requires that you greatly reduce your intake of sweets and fats. You will experience physical symptoms such as abdominal cramping, sweating and general weakness when you consume too much fatty food or too many sweets.
- The Sleeve Gastrectomy results in a banana-shaped, or sleeve-like stomach. Similar to the Gastric Band, eating, soft foods, sweets and drinks/ liquid high in calories will cause weight to regain, or poor weight loss.
After surgery, most patients return to work after two to four weeks. Some may be able to work from home as early as one week after surgery. Because of the significantly reduced calorie intake, many patients have low energy for 1-2 weeks after surgery. However, most patients gain their energy back once they start to have soft food.
The average surgical time for gastric bypass is about 2 hours and sleeve gastrectomy is about 1-2 hours. The laparoscopy totally changed bariatric surgery. Almost all our patients can walk a few hours after surgery. They start to have liquids the day after surgery. The majority (more than 95%) of patients only stay in the hospital for one night or two nights.
Most patients have some pain after surgery. However, the pain is usually just a little bit more than laparoscopic gallbladder surgery. Most patients just need to take oral pain medications for a few days after surgery. The majority of our patients felt that pain was not a major issue during their recovery.
As soon as patients totally wake up from anesthesia, we encourage patients to walk. The key is to start slow and listen to your body. If you lift weights or do sports, stay “low impact” for the first month (avoid competition, think participation). If you experience pain or discomfort, stop and relax. Avoid lifting heavy objects for the first 6 weeks. If you swim, your wounds need to be healed over before you get back in the water and always swim slowly at the beginning.
Women generally have significantly increased fertility after weight loss surgery. Birth control pills do NOT work as well in heavy patients and during the time of rapid weight loss. We strongly recommend all child bearing age women to use other ways of contraception after bariatric surgery.
Most surgeons recommend waiting 12-18 months after weight loss surgery before getting pregnant. After losing most of the excess weight, there is much less risk of having problems during pregnancy (gestational diabetes, eclampsia, macrosomia) and during childbirth. There is also decreased risk of having miscarriages and stillbirths. The kids born after mon’s bariatric surgery are less prone to being obese later in their life. Bariatric surgery also reduces the chance of needing a C-section.
Many patients (up to 50%) may regain a small amount of weight (approximately 5 percent) two years or more following their surgery. However, longitudinal studies find that most bariatric surgery patients maintain successful weight-loss long-term.
One study summarizing the results from 22 reports with a total of 4206 patient cases reported good long-term durability of gastric bypass surgery. The average excess weight loss was 66.5%, and there was no significant association between excess weight loss and length of follow-up. Now we have data to support the durability of gastric bypass surgery up to 15 years. Studies also have shown that sleeve gastrectomy patients were able to maintain its well-documented weight loss outcome at 5 or more years after surgery, with the overall mean excess weight loss at 5 or more years still remaining 50%.
Such significant and sustained weight loss after surgery is in sharp contrast to medical management
After losing most of the excess weight, most patients may have some loose or sagging skin. For many patients, this might be just temporary. The degree of loose or sagging skin depends upon several things, including how much weight you lose, your age, your genetics and whether or not you exercise or smoke. Generally, many patients can hide loose skin by clothing or compression garments.
We generally recommend wait for at least 18 months before having plastic surgery. Plastic surgery to remove excess abdominal and breast skin is often covered by insurance because it may cause rash. You may have to pay yourself for the areas such as arms because it is considered cosmetic by your insurer.
For the reasons we still don’t fully understand, hair loss after bariatric surgery is common between 3 and 6 months following surgery. However, hair loss is almost always temporary. Adequate intake of protein, vitamins, biotin and minerals will help to ensure hair re-growth, and avoid longer term thinning.
You will need to take a multivitamin for life. You may need higher doses of certain vitamins or minerals, especially Iron, Calcium, and Vitamin D and also need to have at least yearly lab checks.
Surgery for weight loss can be reversed, but reversal procedures are usually more dangerous than the original ones. We would only consider reversing these operations in patients who have significant long term problems from the surgery. It is important to note that anyone who has the operation reversed will regain the weight they lost after the first surgery.