How to Talk to Your Doctor About Weight-Loss Surgery
For many obese people, losing large amounts of weight is more than just a simple equation of eating less and exercising. Whether you have struggled with obesity as an adult or for most of your life, weight-loss surgery (bariatric surgery) can help restore your quality of life and improve your health.
Weight-loss surgery is the only option that effectively treats obesity in people for whom medically supervised weight-loss measures, such as diet, exercise and medication, have been unsuccessful. In addition, surgical weight loss can dramatically reverse type 2 diabetes and high cholesterol, which ultimately reduces the risk of heart disease. Experts define successful weight-loss surgery as a loss of 50% of your excess weight five years after surgery.
If weight-loss surgery is on your mind, one of the first steps you need to take is talking about it with your doctor. Starting a discussion allows you to gather all the facts, learn the pros and cons, and understand how weight-loss surgery will affect your life. Here are some questions to get you started in the right direction.
- Am I a good candidate for weight-loss surgery?
- How will weight-loss surgery help me?
- Who performs weight-loss surgery?
- Where do I have weight-loss surgery?
- What type of weight-loss surgery should I have?
- What are the advantages and disadvantages of different weight-loss surgery techniques?
- What can go wrong during and after weight-loss surgery?
- What happens after surgery? What type of follow-up care will I need?
- Can I speak with other patients who have had weight-loss surgery?
- How much does weight-loss surgery cost?
Am I a good candidate for weight-loss surgery?
Whether or not weight-loss surgery is right for you depends on:
- your body mass index (BMI)
- your general health and weight-related health conditions
- your personal motivation
- your age
- your history of weight loss
Your BMI is a measurement of your body fat that uses both your weight and height. A normal BMI is between 18.5 and 24.9. You are overweight if your BMI is greater than 25, and you are obese if your BMI is 30 or greater. Severe obesity (also called morbid obesity) is defined as a BMI of greater than 40.
You may be a candidate for weight-loss surgery if you have a BMI greater than 40. This means being approximately 100 pounds overweight for men and 80 pounds overweight for women.
If you have a BMI greater than 35 and you have serious weight-related health problems, you may also be a candidate for weight-loss surgery. Weight-related health problems include high blood pressure, high cholesterol, severe sleep apnea, type 2 diabetes, heart disease, and liver disease.
Your doctor will also ask you about other weight-loss programs you have tried, such as long-term dieting, exercise, and medications. This is part of establishing your eligibility for bariatric surgery. Most programs won’t accept you until you have tried these nonsurgical measures.
How will weight-loss surgery help me?
Carrying excess fat on your body is a serious health risk. Obesity shortens your lifespan. It is a risk factor for type 2 diabetes, cardiovascular disease, high blood pressure, sleep apnea, and other conditions. It also makes it harder to breathe and walk.
Weight-loss surgery will not only help you lose weight, it can significantly improve many different health conditions. In fact, many people with type 2 diabetes are able to stop taking their diabetes medications after weight-loss surgery. Ultimately, long-term weight loss will prolong your life.
Who performs weight-loss surgery?
General surgeons, gastroenterologic surgeons, and bariatric surgeons perform weight-loss surgery. Make sure that your surgeon has the necessary qualifications and experience. Because most weight-loss surgeries are performed laparoscopically, the surgeon should have documented training in laparoscopy and specifically in laparoscopic weight-loss surgery.
Highly qualified surgeons should be members of a professional bariatric association, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), and be board certified in general surgery.
Your primary care doctor can most likely refer you to a weight-loss surgeon. Take the time to research several different surgeons. There are a variety of surgical approaches, and you want to find a surgeon who has performed at least 100 of the specific type of surgery you need, because research shows that operating time and complications decrease after about 100 surgical cases.
In addition, you should look for a provider that offers a complete treatment program that includes education about what to expect before, during and after surgery; diet and exercise support and therapy; patient support groups; and surgical follow-up care. Many bariatric surgery programs also require a psychological evaluation to address behavioral and environmental factors that may have contributed to your obesity and to determine if you are ready to embrace the lifestyle changes necessary for long-term weight loss. Weight-loss surgery is part of a lifelong commitment to lifestyle change. Look for a treatment program approved by the American College of Surgeons or other healthcare organization that can support you throughout your journey.
You can research and compare doctors at www.healthgrades.com. You may also need to ask the surgeon directly how many times he or she has performed the surgery.
Where do I have weight-loss surgery?
Ideally, you want to have your weight-loss surgery at a hospital with a dedicated team of bariatric medicine specialists, surgeons, nurses, and support staff. The American College of Surgeons recognizes hospitals for bariatric surgery excellence. Designation as a Bariatric Surgery Center of Excellence indicates that the hospital provides exceptional medical care to patients undergoing weight-loss surgery.
Healthgrades also recognizes hospitals that have low bariatric surgery complication rates with the Bariatric Surgery Excellence Award. Healthgrades found hospitals that performed 375 surgeries or more during a three year period had the lowest in-hospital complication rates.
You can use this information and other information provided on the Healthgrades website to find hospitals in your area that provide the best care for weight-loss surgery.
What type of weight-loss surgery should I have?
Weight-loss surgery reduces the amount of calories your body can consume by using restrictive devices to reduce the size of the stomach and changing the way the body absorbs nutrients from the food you eat. There are two main categories of weight-loss surgery: restrictive and combination restrictive/malabsorptive procedures.
- Restrictive procedures can help you lose weight by reducing the size of the stomach, which limits the amount of food you can eat. Restrictive procedures include adjustable gastric banding, stomach stapling, and combination banding/stapling.
- Malabsorptive/restrictive procedures (gastric bypass) can help you lose weight by altering the normal process of digestion. These procedures involve attaching the stomach directly to the middle of the small intestine, diverting food past most or all of the first section of the small intestine (the duodenum) where most calories are absorbed by the body. The malabsorptive part of the procedure includes the Roux-en-Y gastric bypass (abbreviated RGB or RYGB) and the biliopancreatic diversion with duodenal switch (BPD-DS). The BPD-DS procedure is less common than the RYGB due to a greater potential for long-term health risks.
Learn all that you can about the different types of weight-loss surgery. With this information, you and your surgeon can decide which type of surgery is best for you based on your specific circumstances, such as your general health, other health conditions, age, and possibly your personal preference.
What are the advantages and disadvantages of different weight-loss surgery techniques?
In general, restrictive procedures are simpler to perform than the combination procedures. However, patients typically do not lose as much weight with a purely restrictive procedure compared to procedures that include a bypass.
While combination procedures result in greater long-term weight loss and reversal of obesity-related health conditions, they are also associated with more long-term side effects due to the bypass procedure. Since the bypass procedure alters your normal digestive pattern, you may experience vitamin and nutritional deficiencies which will require that you take vitamin and mineral supplements.
What can go wrong during and after weight-loss surgery?
As with any surgery, complications can develop during the procedure or throughout your recovery. General risks of surgery include problems related to the anesthesia, bleeding, blood clots, infection, and death. However, the death rate for bariatric surgery is low, with one death per 1,740 surgical cases. Healthgrades finds that patients experience fewer complications at hospitals rated highly in bariatric surgery.
Complications more specific to weight-loss surgery include leaks from the staples or bypass stitches; slippage, deflation or erosion of the restrictive device (band or mesh); obstruction of the smaller stomach opening; and malnutrition. Left untreated, malnutrition can lead to long-term complications, such as osteoporosis, anemia, and permanent nervous system damage. Because of this, you will need regular doctor visits and you will have to take ongoing vitamin and mineral supplements.
Unfortunately, weight-loss surgery does not always lead to long-term weight loss. There is a possibility that over the years you will regain some of the weight you lost. Remember that your primary care doctor and healthcare providers at the bariatric surgery program are available to support you if or when this occurs.
What happens after surgery? What type of follow-up care will I need?
- Hospital stay: The length of time you stay in the hospital depends on your individual circumstances and the type of surgery you have. A total hospital stay of up to five days may be required, but you may have to stay in the hospital longer if you develop complications. Ask your doctor about your risk of complications and what measures he or she will take to prevent or minimize complications.
- Diet and exercise: Your diet will change drastically after bariatric surgery. You will start out on small amounts of liquids, then soft foods, and probably transition to solid foods about 10 to 12 weeks after your surgery. Your diet, combined with your vitamin and mineral supplements, should meet your nutritional needs. You will need to be very careful about what and how much you eat. Your surgeon and dietician will give you specific instructions about your diet. Getting back to a full solid food diet can take up to a year.
- Medications: The changes to your digestive system will also affect which medications are safe for you. In general, most bariatric centers recommend indefinitely avoiding nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin) and naproxen (Aleve). In addition, extended-release forms of medications are not absorbed properly after bariatric surgery. For this reason, your medications need to be immediate-release or liquid preparations.
- Physical activity: Becoming and remaining physically active is very important after bariatric surgery. The best long-term weight-loss outcomes occur in people who reach at least 60 minutes of daily moderate physical activity, such as walking. A good bariatric surgery program will have physical fitness experts who can coach you on the type and level of exercise that is right for you.
- Follow-up visits: You will need to see your surgeon and a dietitian at regular follow-up visits. These visits occur a few weeks after surgery, and then every few months up to the first year for gastric bypass procedures. If you have a gastric band, you will go to the surgeon monthly to adjust the band until you reach a point where your hunger level stabilizes. In most cases, you will see your surgeon, dietitian, and nurse practitioner on a yearly basis (or more frequently) thereafter.
- Other considerations: If you are severely obese and you lose a significant amount of weight, you will probably have loose skin. This may lead to trouble with daily activities, such as bathing and getting dressed. Loose folds of skin are also susceptible to friction, irritation and infection. The bariatric surgery program at your hospital will have a specialist you can talk to you about managing this unwanted side effect of significant weight loss.
Can I speak with patients who have had weight-loss surgery?
Sometimes it helps to talk with someone else who has gone through weight-loss surgery. Many bariatric surgery programs have patient ambassadors who are former bariatric surgery patients themselves. They can be invaluable resources for you as you navigate the bariatric surgery process. If your center does not have patient ambassadors, ask your surgeon for references to patients who are willing to discuss their experience. Ideally, get a list of people who had their surgery months and years before.
How much does weight-loss surgery cost?
If you decide to have weight-loss surgery, your first concern should be getting the best possible care. But you also need to understand what your medical insurance covers and doesn’t cover. The average hospital charge for bariatric surgery is about $42,000. While you are likely to have some out-of-pocket costs, there are choices you can make now to prevent unnecessary costs.
Call your insurance company, ask the following questions, and where possible, get the answers in writing. Take careful notes and record the date, the name of the person you speak with, and his or her direct phone number.
- Which doctors and hospitals are in my plan’s network? Keep in mind that even if a hospital participates in your plan, the doctors at the hospital may not.
- What is the difference between in-network and out-of-network costs including my deductible costs and co-pays?
- Do I need permission—pre-authorization—for the procedure?
Many bariatric surgery centers have coordinators, often called patient advocates, who can help you get your insurance coverage in order.
Weight-loss surgery is a life-changing experience. However, it is just one part of a complete obesity treatment plan, which includes a strong, lifelong commitment to healthy dietary and exercise habits, vitamin supplementation, and regular follow-up care.
Your surgeon will determine if you are a good candidate for bariatric surgery, and advise you on which procedures and approach are best for you based on your specific circumstances.
Bariatric surgery may be an option for you if:
- Your body mass index (BMI) is 40 or higher.
- Your BMI is 35 or higher and you have a serious weight-related health problem, such as diabetes, heart disease, or sleep apnea.
- You are motivated to complete all pre-surgical and post-surgical activities including self-care, doctor appointments, nutritional and psychological counseling, and patient support group meetings.
- You are committed to lifelong lifestyle and behavioral changes including healthy exercise and dietary habits and possible vitamin supplementation.
Take the time to research bariatric surgeons and bariatric surgery centers carefully. You’ll want to ask specific questions about their level of experience and your care before, during and after surgery.
One important aspect of care is a hospital’s complication rate. Some states require their hospitals to report in-hospital complications. You can find this information at www.healthgrades.com.
You should also visit the hospital’s bariatric surgery program in person. Make sure you feel comfortable with the program personnel and the surgeon(s). Ask the surgeon about your individual surgical risks and what the clinical team will be doing to minimize potential complications so that you can experience the best results from your surgery.
- Poirier P, et al. Bariatric Surgery and Cardiovascular Risk Factors: A Scientific Statement from the American Heart Association. Circulation. 2011; 123:1683-1701.
- Fontaine KR, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187-193.
- Reis CE, et al. Role of bariatric-metabolic surgery in the treatment of obese type 2 diabetes with body mass index <35 kg/m2: a literature review. Diabetes Technol Ther. 2012. Apr;14(4):365-372. http://www.ncbi.nlm.nih.gov/pubmed/22176155
- Kligman, M. Training Considerations for Laparoscopic Bariatric Surgery. In: Minimally Invasive Surgery Training: Theories, Models, Outcomes. A National Institutes of Health and National Library of Medicine-Sponsored Online Book, 2010. http://mastri.umm.edu/NIH-Book/training_bariatric.html
- Rahim, A. Choosing Bariatric Surgery to Improve Overall Health: 2012 Healthgrades Trend Report. http://insight.healthgrades.com/rs/healthgrades/images/HealthGradesBariatricSurgeryTrendsReport2012.pdf
- Miller AD, Smith KM. Medication and nutrient administration considerations after bariatric surgery. Am J Health Syst Pharm. 2006;63(19):1852-1857.
Medical Reviewer: Arshad Rahim, MD
Last Annual Review Date: Jul 30, 2012
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