What are the complications and risks associated with bariatric surgery?
What is the difference between laparoscopic, or minimally invasive, surgery and an open procedure?
What is high blood pressure (hypertension) and how is it affected by bariatric surgery?
What is high cholesterol and how is it affected by bariatric surgery?
What is sleep apnea and how is it affected by bariatric surgery?
What is depression and how is it affected by bariatric surgery?
What is osteoarthritis and how is it affected by bariatric surgery?
What is stress urinary incontinence and how is it affected by bariatric surgery?
What is reproductive health and how is it affected by bariatric surgery?
The causes of morbid obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that, in many cases, significant, underlying causes of morbid obesity are genetic, environmental, and social. Studies have demonstrated that, once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.
Morbid obesity is a Body Mass Index (BMI) of 40 or more, which is roughly equal to 100 pounds or more over ideal body weight. The disease of morbid obesity interferes with basic physical functions such as breathing or walking. Long-term effects of the disease include shorter life expectancy, serious health consequences in the form of weight-related health problems (co-morbid conditions), such as type 2 diabetes and heart disease, and a lower quality of life with fewer economic and social opportunities.
What is a co-morbid condition?
There are two definitions for a co-morbid condition: the presence of one or more disorders or diseases in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient. The primary disease of morbid obesity can lead to several co-morbid conditions.
Bariatric surgery is a surgery designed to give patients a tool to lose weight. It is intended for people who are 100 pounds or more overweight (with a Body Mass Index of 40 or greater) and who have not had success with other weight loss therapies such as diet, exercise, medications, etc. A person with a Body Mass Index (BMI) of 35 or greater and one or more co-morbid condition also may qualify for bariatric surgery.
What is Body Mass Index (BMI)?
BMI is a measure used to index a person’s height and weight. BMI allows healthcare professionals and patients to better understand health issues associated with a specific weight classification (classifications such as obesity and morbid obesity).
The calculation of BMI is based on the following formulas:
Measurement Units Formula and Calculation
Kilograms and meters (or centimeters) Formula: weight (kg) / [height (m)]2
With the metric system, the formula for BMI is weight in kilograms divided by height in meters squared. Since height is commonly measured in centimeters, divide height in centimeters by 100 to obtain height in meters.
Example: Weight = 68 kg, Height = 165 cm (1.65 m)
Calculation: 68 ÷ (1.65)2 = 24.98
Pounds and inches Formula: weight (lb) / [height (in)]2×703
Calculate BMI by dividing weight in pounds (lbs) by height in inches (in) squared and multiplying by a conversion factor of 703.
Example: Weight = 150 lbs, Height = 5’5” (65”)
Calculation: [150 ÷ (65)2] x 703 = 24.96
Click here to have your BMI easily computed for you.
How do I know if I qualify for bariatric surgery?
Patients should have:
– 100 pounds or more of excess weight; or a BMI of 40 or greater
– A BMI of 35 or greater with one or more co-morbid condition
Other common guidelines include:
– Understanding the risks of bariatric surgery
– Committing to dietary and other lifestyle changes as recommended by the surgeon
– Having a history of weight loss treatments having failed the patient
– Undergoing a complete examination including medical tests
Is bariatric surgery right for me?
Talk with your surgeon about the different surgical treatments, as well as the benefits and risks.
Remember:
1. Bariatric surgery is not cosmetic surgery.
2. Bariatric surgery does not involve the removal of adipose tissue (fat) by suction or surgical removal.
3. The patient must commit to long-term lifestyle changes, including diet and exercise. These lifestyle changes are key to the success of bariatric surgery.
4. Problems after surgery are rare, but corrective procedures may be required.
What are the complications and risks associated with bariatric surgery?
As with any surgery, there are immediate and long-term complications and risks. For more information, refer to Associated Risks.
What is the difference between laparoscopic, or minimally invasive, surgery and an open procedure?
Open surgery involves the surgeon creating a long incision to open the abdomen and operating with “traditional” medical instruments. Laparoscopic, or minimally invasive, surgery is an approach that allows the surgeon to perform the same procedure using several small incisions, a fiber-optic camera, video monitor, and long-handled instruments.
Why would I have an open procedure?
The decision to perform minimally invasive or open surgery is made by your surgeon before the operation. For some patients, the laparoscopic, or minimally invasive, technique cannot be used due to dense scar tissue from prior abdominal surgery. Also, the inability to see organs and/or bleeding during the operation can cause your surgeon to switch from minimally invasive to open surgery during your operation.
What is Roux-en-Y gastric bypass surgery?
Roux-en-Y gastric bypass surgery is both a restrictive and malabsorbative procdedure. In this surgical weight loss procedure, the surgeon creates a small stomach pouch and then constructs a “bypass” of some of the small intestine. The smaller stomach pouch restricts the amount of food the patient can comfortably eat, and the bypass produces malabsorption as it decreases the number of nutrients and calories absorbed.
Click here to view our video on Roux-en-Y gastric bypass surgery.
What is a gastric banding procedure?
Gastric banding is a purely restrictive surgical procedure, generally performed laparoscopically, in which a silicone band is placed around the uppermost part of the stomach. The band is adjustable and can be periodically tightened or loosened depending on the patient’s needs.
Click here to view our video on Gastric Banding Surgery.
Sleeve gastrectomy is a restrictive weight loss procedure that also creates important changes in hormones that regulate hunger. The surgeon creates a small, sleeve-shaped stomach, about the size and shape of a banana. This procedure originally was performed on super obese or high risk patients with the intention of performing another surgery at a later time. The second procedure in our clinic would be a gastric bypass procedure. However, now the Sleeve is being performed as the primary and only procedure planned. Most patients do not require a second surgery in order to lose the desired weight.
Click here to view our video on Sleeve Gastrectomy.
How successful is bariatric surgery?
Studies show that bariatric surgery can effectively improve and resolve many co-morbid conditions. A review of more that 22,000 bariatric surgery patients showed:
– 61.2% reduction of excess weight over time
– Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea in the range of 70 – 90%
Do I qualify for insurance coverage for the surgery?
Because every insurance policy is unique, it’s important that you thoroughly understand your Coverage to know exactly what is and isn’t covered through your plan. Most insurance companies that cover weight loss surgery have specific criteria that must be met in order for a patient to qualify. By providing our office with specifics about your policy, we can assist you in finding out if your policy covers weight loss surgery and the policy’s required criteria. We will need all of the insurance information from your insurance card. In order to serve you better, you will want to have this card with you when you contact our office. Once it is established that your insurance policy covers weight loss surgery and their criteria is met, a letter of medical necessity to your insurance company may be necessary in order to obtain prior approval for surgery. As a service to you, we will be glad to write the letter to your insurance company.
Once I am approved for surgery, what is the next step?
A consultation for weight loss surgery will be scheduled with Dr. King at OXFORD BARIATRIC once you receive insurance approval for surgery. If you are paying cash for your surgery, your appointment will be made when you contact our office. It is not necessary for you to have prior approval. At the consultation, you will meet with our bariatric nurses as they provide you with valuable information about our program and you will have a detailed consultation with Dr. King. He encourages you to bring at least one member of your support team with you on this consultation so that they will also be informed. Once it is determined that you are a good candidate for surgery, several tests and/or consultations may be scheduled to get you ready for surgery. This work up is individualized by Dr. King toward the needs of the patient. If no additional tests or consults are necessary, you are started on a pre-op diet for at least 2 weeks and a surgery date is scheduled.
What are the routine tests before bariatric surgery?
Certain basic tests typically are performed:
– Complete Blood Count (CBC)
– Urinalysis
– Chemistry screen
– Electrocardiogram
- Chest xray
– Psychological evaluation
- Pregnancy test if applicable
Other tests that may be requested include:
– Hemoglobin A1C
– Pulmonary function testing and pulmonary medicine evaluation
– Sleep study
– Upper endoscopy
– Cardiology evaluation
What can I do to prepare for surgery?
Bariatric surgery is like other major abdominal surgery. You can best prepare by knowing the benefits and risks of surgery, and by closely following your doctor’s instructions.
- Visit your local medical doctor and have your weight loss attempts documented at every visit. Most insurance companies require this to be documented for at least 6 months before they will approve coverage for weight loss surgery.
– Understand the surgical process and what to expect afterward.
– Keep in mind that you’ll never be able to eat the way you did before. You will have to watch what and how you eat for the rest of your life.
– Talk to people who have had bariatric surgery.
– Write down your reasons for having bariatric surgery and outline your plans to maintain your weight loss after surgery.
– Start a journal. Record how you feel now, the challenges you face, and the things you hope to be able to do after bariatric surgery.
– Ask your family and friends for their support. Talk to them about why you want to have bariatric surgery. It helps to have people behind you, waiting to help.
- Understand that it is imperative to have lifetime follow with Dr.King after surgery. Make a commitment to the recommended follow up in order to achieve and maintain successful weight loss. Commitment to follow up promotes better health and accountability. It helps detect any possible problems and helps you stay on track.
What is a co-morbid condition?
There are two definitions for a co-morbid condition: the presence of one or more disorders or diseases in addition to a primary disorder or disease; or, the presence of a disorder or disease that is caused by or otherwise related to another condition in the same patient.
What is type 2 diabetes and how is it affected by bariatric surgery?
Type 2 diabetes is a long-term metabolic disorder where the body produces insulin, but resists it. Insulin is necessary for the body to utilize sugar.
– 83.8% of patients who had gastric bypass surgery experienced complete resolution of type 2 diabetes.
– 47.8% of patients who had gastric banding surgery experienced complete resolution of type 2 diabetes.
– Patients who had bariatric surgery had lower insulin resistance, and their risk for metabolic syndrome, high blood pressure, and high amount of fats in the blood also decreased.
What is high blood pressure (hypertension) and how is it affected by bariatric surgery?
High blood pressure generates more work from your heart to profuse your body’s organs.
Excess body weight is associated with an increased risk of heart disease, elevated cholesterol, and high blood pressure. These conditions can lead to heart attacks, strokes, and heart and kidney damage. Bariatric surgery reduces excess body weight over time, which decreases strain on the heart.
– 75.4% of patients who had gastric bypass surgery experienced complete resolution of high blood pressure.
– 38.4% of patients who had gastric banding surgery experienced complete resolution of high blood pressure.
– Changes in diet and exercise after surgery can lead to significant improvement of cardiovascular problems.
What is high cholesterol and how is it affected by bariatric surgery?
High cholesterol is a disorder of lipids—the fat-like substances in the blood. A common form of dyslipidemia is hyperlipidemia (or high cholesterol), the condition that exists when someone has too much of certain lipids in the blood. As these lipids build up inside the artery walls, harmful scar tissue and other debris begin thickening and hardening the walls. Long-term, this can lead to heart disease and high blood pressure.
– 95% of patients who had gastric bypass surgery experienced improved cholesterol health.
– 78.3% of patients who had gastric banding surgery experienced improved cholesterol health.
What is sleep apnea and how is it affected by bariatric surgery?
Obstructive sleep apnea is when breathing suddenly stops because soft tissue in the back of the throat collapses and closes during sleep.
Morbid obesity can cause sleep apnea and other respiratory problems that may result in chronic fatigue.
– 86.6% of patients who had gastric bypass surgery experienced complete resolution of sleep apnea.
– 94.6% of patients who had gastric banding surgery experienced complete resolution of sleep apnea.
Acid reflux, also known as gastroesophageal reflux disease, is injury to the esophagus caused by chronic exposure to stomach acid. It is a serious disease that can cause esophagitis, Barrett’s esophagus, and esophageal cancer (adenocarcinoma).
– 98% of patients who had gastric bypass surgery experienced complete resolution of acid reflux/GERD.
– 32.3% of patients who had gastric banding surgery experienced complete resolution of acid reflux/GERD.
What is the relationship between morbid obesity and cancer?
Morbid obesity may put you at a higher risk for several types of cancer, such as colon, breast, and kidney cancer. In 2003, an article in the New England Journal of Medicine estimated that obesity could account for:
– 14% of all deaths from cancer in men
– 20% of all deaths from cancer in women
What is depression and how is it affected by bariatric surgery?
Depression is an illness that involves the body, mood, and thoughts. It affects the way a person eats, sleeps, thinks, and feels. There are many reasons people with morbid obesity experience depression. Emotional health goes hand in hand with physical health. Lifestyle improvements and renewed health can help resolve depression. Weight loss, combined with counseling, can be very helpful in improving mental health.
– 47% of patients who had gastric bypass surgery experienced improvement of depression symptoms.
What is osteoarthritis and how is it affected by bariatric surgery?
Osteoarthritis is one of the most common forms of arthritis. Known as the wear-and-tear kind of arthritis, osteoarthritis is a chronic condition in which there is a breakdown of joint cartilage. For anyone who is living with morbid obesity, the excess body weight placed on joints, particularly knees and hips, results in rapid wear and tear and pain caused by inflammation.
Bariatric surgery can reduce much of this weight over a long period of time and can be very effective in treating osteoarthritis.
– 41% of patients who had gastric bypass surgery experienced complete resolution of osteoarthritis pain and stabilized the disease.
What is stress urinary incontinence and how is it affected by bariatric surgery?
Among women, morbid obesity is a risk factor for stress urinary incontinence, or uncontrollable urine loss. A large, heavy abdomen and relaxation of the pelvic muscles due to morbid obesity may cause the valve on the urinary bladder to weaken, leading to leakage of urine with coughing, sneezing, or laughing. Bariatric surgery has been found to improve stress urinary incontinence. Less weight is placed on the bladder and other physical changes take place to improve this condition.
– 44% of patients who had gastric bypass surgery experienced complete resolution of stress urinary incontinence.
What is reproductive health and how is it affected by bariatric surgery?
Reproductive health can be a concern for women struggling with morbid obesity. Issues such as infertility (the inability or reduced ability to produce children) and menstrual irregularities may occur due to morbid obesity. Fertility issues include possible miscarriage, reduced success with fertility treatments, and polycystic ovarian syndrome (PCOS). Additionally, women living with morbid obesity are more likely to have children with certain birth defects. A recent study of women following gastric bypass surgery showed improvement of multiple clinical problems related to infertility and PCOS.
– 100% of patients who had gastric bypass surgery experienced complete resolution of menstrual dysfunction due to PCOS.
– 79% of patients who had gastric bypass surgery experienced complete resolution of excess hair due to PCOS.
– Patients who had gastric bypass surgery experienced restored ovulation and fertility.
How can I deal with my fear of surgery?
The fear of surgery is not irrational or abnormal; in fact, it’s very common. Consultation with Dr. King will include a frank discussion of the risks and possible complications of bariatric surgery. Our clinic welcomes any or all questions or concerns. We will do our best to alleviate your fears with knowledge. We encourage you to consider the following:
– Share your concerns and fears with your surgeon.
– Attend a support group and speak with patients who likely share the same fears.
- Attend a free informational seminar presented by Dr. King, as he reviews surgery options, risks and benefits. You will also have an opportunity to meet a patient that will share their experiences with you.
– With all surgical procedures, there are risks and possible complications. Although it is necessary to understand the complication and mortality rates of surgery, serious complications are uncommon.
Remember that without weight loss surgery, the odds are that essentially 100% of morbid obese patients will have increased problems each year. Remember…you will have a team of healthcare professionals dedicated to your best possible care.
How does bariatric surgery change my body?
For people who have spent years living with morbid obesity, bariatric surgery can transform their lives. Successful weight loss surgery will change a patient so that they will become healthier physically and mentally.
To learn more about the different types of bariatric procedures, click here.
What is the cost of bariatric surgery?
For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Even without insurance, many people feel that the surgery is worth the investment in their health and seek out alternative financing options.
- Our cash price for the Gastric Band and Gastric Sleeve is $14,500. This includes the surgeon’s fee for surgery, the first 90 days of routine post-operative care and the first adjustment (fill), as well as the hospital costs up to 30 days after surgery. This also includes the anesthesiologist’s surgery fee.
– The cash price for the Roux-en-Y Gastric Bypass begins at $19,000. This includes the surgeon’s fee for surgery and the first 90 days of post-operative care, as well as the hospital costs up to 30 days after surgery. This also includes the anesthesiologist’s surgery fee.
Since our clinic is not able to carry loans for surgery, cash prices are payable two (2) weeks prior to surgery. Subsequent office visits and lap band adjustments must be paid at the time of service.
We encourage you to contact our office and talk to our insurance coordinator for specific information about cash prices.
How will I pay for bariatric surgery?
There are several ways to pay for surgery, including:
- Cash
– Health insurance coverage for bariatric surgery
- We accept VISA, Mastercard and CareCredit
– Alternative financing options such as medical loans or home equity loans
Click here for the affordability calculator.
What are alternative financing options?
If you do not have health insurance coverage for bariatric surgery, and the cash payment is not an option there are alternative financing options available, such as CareCredit. Some patients have found that their credit union or bank will provide financing. Second home mortgages have also been an option for some patients. Please contact our insurance coordinator to further discuss payment options.
How long do I have to stay in the hospital?
It varies from person to person. Generally, the hospital stay (including the day of surgery) can be one day or less than 24 hours (as an outpatient) for a gastric band; two to three days for a laparoscopic gastric bypass or laparoscopic gastric sleeve; and four to five days for an open gastric bypass.
After the surgery, what support will I receive in adjusting to new daily habits?
At OXFORD BARIATRIC, Dr. King and his well trained staff of bariatric nurses are ready to provide support for the bariatric patient before and after surgery. Leslie Kennedy, an experienced Registered Dietitian, is available on a consultant basis to work directly with individuals who are considering weight loss surgery, both pre-operatively and post-operatively. Leslie has worked in health and fitness for over 21 years. Her expertise as a consultant in health, nutrition and exercise will prove invaluable to your success. Also, a monthly Support Group is held the first Tuesday of every month. We strongly urge all of our patients to participate and enjoy the support and encouragement of each other as they share their experiences. Please contact our office for details.
Can I get pregnant after bariatric surgery?
Most doctors recommend that women wait at least one year after the surgery before a pregnancy. Approximately one year postoperatively, your body should be fairly stable (from a weight and nutrition standpoint). Consult your surgeon as you plan for pregnancy.
What about postoperative pain and discomfort?
Many people think bariatric surgery will be followed by a long and painful recovery period. However, most patients report experiencing only discomfort and soreness rather than pain. Recovery does, however, vary from patient to patient. You will be given pain medication to help ease immediate post-operative pain.
What is the long-term success of bariatric surgery?
For people suffering from morbid obesity, bariatric surgery can be a powerful tool for weight loss. Multiple clinical studies have demonstrated the long term success and longevity of bariatric surgery. Commitment to lifestyle changes and compliance with our recommendations for diet and exercise will ensure your success!
What will my life be like after the surgery?
Bariatric surgery is not a quick fix. It’s an ongoing journey toward transforming your health through lifestyle changes. After surgery, you will feel more full and more satisfied with less food. Positive changes in your body, your weight, and your health will occur, if you maintain the diet and exercise routines recommended by our bariatric team. Remember, surgery is not the easy way out.
How often will I be able to eat?
After the initial recovery period, most patients are instructed to eat 1/4 cup, or 2 ounces, of food per meal. As time goes on, you can eat more (as instructed by Dr. King and staff). A year or more post surgery, most people can eat about 1/2 to 1 cup of food per meal.
When can I go back to my normal activity level?
As with any major surgery, there will be a recovery period. Your ability to resume pre-surgery levels of activity depends on your physical condition, the nature of the activity, and the type of bariatric surgery you had. Many patients return to normal levels of activity within 1-3 weeks following laparoscopic surgery. However, if you require “open” surgery, recovery could take up to 6 weeks.
How much exercise is needed after bariatric surgery?
Exercise is an important part of success after surgery. You will be encouraged to begin walking the day of your operation. Over time, we would like for you to build up to one hour a day of walking or similar exercise. Exercise is necessary to maintain weight loss long term.
Is there any difficulty in taking medications?
Most pills or capsules are small enough to pass through the new stomach pouch eventually. At first, however, Dr. King will insist that medications be taken in crushed or liquid form. Remember that with certain procedures, some medicines should never be used. For example, after adjustable gastric band surgery and the gastric bypass, NSAIDS (non-steroidal anti-inflammatory drugs) should not be used. If there are any concerns about medications after surgery, please discuss with our clinical staff.
Eating simple sugars (such as sugar, honey, and corn syrup) or high-fat foods can cause dumping syndrome in patients who have had gastric bypass surgery. This occurs when these products, which have a small particle size, are “dumped” from the stomach into the intestine at a rapid rate. Water is pulled into the intestine from the bloodstream to dilute the sugar load. This flush of water causes symptoms that can include diarrhea, rapid heart rate, hot flashes or sweating and clammy skin, and dizziness.
What is the long-term follow-up schedule?
At OXFORD BARIATRIC, we feel as though lifetime follow up is imperative to the success of weight loss and management. The frequency of follow up depends on the type surgery. With any surgery, during the immediate post-operative period your follow up will be more frequent. Routine Band appointments depend on the need for adjustments and the progression of the weight loss. After the Gastric Bypass or Gastric Sleeve, appointments will be approximately every 6 months – after the first year. With all weight loss surgeries, lifetime commitment to follow up is necessary.
How can I find a support group?
Support groups give patients an excellent opportunity to talk about personal issues. Most patients learn, for example, that bariatric surgery will not resolve personal relationship issues. Ongoing support after surgery helps to achieve the greatest level of success for patients. Patients help keep each other motivated, celebrate small victories together, and provide perspective on the everyday successes and challenges that they experience. Contact our office for information about monthly support groups that meet the first Tuesday of every month.
What are the long-term benefits of bariatric surgery?
Studies show that bariatric surgery can effectively improve and resolve many weight-related health conditions. A review of more that 22,000 bariatric surgery patients showed:
– 61.2% reduction of excess weight over time
– Improvement in or complete resolution of conditions including type 2 diabetes, hypertension, and sleep apnea in the range of 70 – 90%.
At Oxford Bariatric we are here to support you in your weight loss journey. Call us today to register for a free informational seminar!