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Department of Surgery Referrals Patient Clinician Researcher

Columbia University Center for Metabolic and Weight Loss Surgery

Frequently Asked Questions about Bariatric Surgery

Q. What can I expect when I first visit the office?
A.  Prior to meeting with the surgeon, you will be asked to make an appointment to meet with the nurse practitioner and dietician. You will have a thorough history taken at the time of your visit by the nurse practitioner. Please make sure to bring any pertinent medical information and tests results from other physicians as well as the names and addresses of your primary care physician. Your nurse practitioner may recommend further testing to evaluate any potential obesity-related problems, such as sleep apnea and gastroesophageal reflux disease (GERD). Once you complete your visit with the nurse practitioner, you will then meet with the dietician who will evaluate your dietary habits. For this meeting with the dietician, it is a good idea to being a list of everything you have eaten and their amounts in the two days prior to your appointment. Once the nurse practitioner receives the results of the tests that she has recommended that you do, it is then that our office will schedule an appointment to meet with the surgeon. You are not expected to decide about which surgical procedure you would like on the day you first meet with the nurse practitioner. It may be beneficial to you to contact some past patients to learn about their experiences with the program. This information can be provided during your first seminar.

Q. What can I expect when I first visit the surgeon?
A.  By the time that you meet with the surgeon, you would have already completed any preliminary testing that the nurse practitioner felt you needed to evaluate any potential obesity-related problems. Your tests results, as well as your medical and dietary history, will be reviewed by the surgeon and any potential concerns will be discussed. The surgeon will then review with you the various surgical procedures and potential risks to surgery as they pertain to your individual case. It is then, that most patients decide which weight loss surgery is best for them. If you are still undecided, you do not need to make that decision just then. However, when you do decide which procedure you would like to have after meeting with the surgeon, it is then that your date for surgery will be given. If at any time you feel the need to have further clarification on any step of this journey, please feel free to contact any one of our staff.

Q. When is surgery for weight loss considered successful?
A.  Weight loss surgery is considered successful when 50% of excess weight is lost and the loss is sustained up to five years. For example, a patient who is 100 pounds overweight should lose at least 50 pounds; a patient who is 200 pounds overweight should lose at least 100 pounds. And they should be able to maintain loss successfully for the following five years. Ninety-five percent of patients reach that goal after gastric bypass surgery. Furthermore, 85% of gastric bypass patients go on to lose 2/3 or more of their excess weight. Seventy-five percent of patients attain the goal after vertical banded gastroplasty and the same is likely true for gastric banding.

Q. Are there any restrictions after the surgery like lifting and driving?
A.  Yes. In the post operative period, especially while using any pain medication, we recommend that you do not drive. Depending on how well you are recovering from your surgery, lifting may or may not be restricted. Certainly for the first two weeks most patients are not comfortable enough to do any heavy lifting. After that, if all is going well, you can lift as tolerated.

Q. Do insurance companies cover surgery for obesity?
A.  Most insurance companies will cover this surgery. Some will fight coverage, but we have had great success in getting insurers to realize that this is necessary. We give the insurance providers the information they need to understand why the surgery is necessary and what it involves. These operations are not being done for cosmetic purposes; they are being done to improve overall health and take the morbidity out of morbid obesity. Since bariatric surgery can actually reverse the risk of death, it is medically necessary. After significant weight loss there is often a lot of excess skin. Surgery to remove that skin will often not be covered by insurance. If, however, a hernia should have occurred after surgery and this requires additional surgery, removal of this skin can be done simultaneously and may be partially covered.

Gastric banding is covered by some but not all insurance companies. Since this is relatively new in the U.S., this will likely change over time.

Q. Can I eat whatever I wish, or must I control my intake of fats and sugars?
A.  After gastric banding, almost any type of food is tolerated if chewed well enough. This is part of the reason that this surgery may not have as high a success rate as gastric bypass. 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.

Q. What is "dumping syndrome?"
A.  This term refers to the emptying of concentrated food directly into the small intestine. Gastric bypass surgery empties food from the small stomach pouch directly into the small intestine without first being diluted with fluids in the rest of the stomach. Therefore, whatever you eat empties directly into the small intestine. Sweets and fatty foods irritate the small intestine and causes discomfort. Eating and drinking fluids simultaneously will also cause this dumping syndrome. This is why we recommend waiting half an hour between eating and drinking.

Q. What about exercise after bariatric surgery?
A.  You should get out of bed and start walking as soon as possible after surgery. We recommend that you exercise every day. Whether you have surgery or not, exercise is important to overall health. The more you exercise the healthier you will be and the more weight you will lose. Since walking greatly accelerates weight loss, specifically fat loss, we suggest you walk every day. We recommend walking 30 minutes per day to start, and increasing the amount of time to 45 minutes to one hour to maintain lost weight.

Q. After the surgery how often do I see the doctor?
A.  While you are healing you will be seen on a regular basis, usually once after two weeks, and again six weeks after surgery. You return for a follow-up visit after six months to make sure you are adjusting well, and then once a year after that. It is important for us to follow your vitamin and mineral levels (particularly after gastric bypass) as well as your protein intake.

Q. Can bariatric surgery be reversed?
A.  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.

Q. Is there anyone who should not have bariatric surgery?
A.  This surgery is obviously a very serious step. Patients with psychiatric conditions such as depression, bipolar disease, and/or schizophrenia should be under the care of a psychiatrist before they consider surgery. These conditions can become exaggerated by the body changes that are associated with weight loss. There are some medical conditions which make the surgery too dangerous to perform. These occur rarely but must be taken into account. If patients meet the eligibility guidelines that are outlined above, they are obvious candidates for success with this surgery.

Q. How long will I be in the hospital?
A. Most patients remain the hospital 3 days after surgery unless a complication develops.

Q. When can I return to normal activity?

A.  You can resume normal activity within 4 to 6 weeks after your operation. Any pain related to the surgery should go away after 10 days or so. General fatigue can last from 3 to 4 weeks after surgery.

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