WLS Questions & Answers
- How will weight loss surgery help me lose weight?
- What are my weight loss surgery options?
- How do I know which weight loss procedure is the best option for me?
- What are patient qualifications for weight loss surgery?
- How much weight will I lose with weight loss surgery?
- Are there any age restrictions for weight loss surgery?
- How much does weight loss surgery cost?
- Will insurance pay for weight loss surgery?
- Is weight loss surgery covered by Medicare?
- What is a Letter of Medical Necessity?
- What qualifications should I look for when choosing a surgeon?
- Why can't I drink soda after weight loss surgery?
- Why do I have to stop smoking before weight loss surgery?
- What about pregnancy after weight loss surgery?
- Why do I have to exercise after weight loss surgery?
Weight loss surgery (bariatric surgery) uses two basic approaches to help you lose weight - restrictive procedures and malabsorptive procedures. Some operations use a combined restrictive and malabsorptive approach. Restrictive procedures create a smaller opening to the stomach and a smaller stomach area which limits food intake and reduces hunger. Malabsorptive procedures alter the digestion process by rerouting the intestines so fewer calories and nutrients are absorbed by the body.
The two most popular procedures are the Roux-en-Y gastric bypass surgery and adjustable gastric banding (lap band surgery). The Roux-en-Y gastric bypass procedure, a combined restrictive-malabsorptive procedure, has been performed for over 30 years and is the most frequently performed weight loss surgery. Adjustable gastric banding (lap band surgery) is a newer and safer restrictive procedure that is quickly growing in use. Other surgical procedures include vertical banded gastroplasty (older stomach stapling procedure that has fallen out of favor), biliopancreatic diversion, biliopancreatic diversion with duodenal switch, and extended distal gastric bypass.
Your doctor will make a recommendation based on your medical history and weight, but the final decision is up to you. Thoroughly research the various procedures, talk to other patients of weight loss surgery, and educate yourself so that you completely understand the process and what changes you can expect after each type of surgery. Make sure you discuss the surgical options with your doctor, including the possible risks and complications, advantages and disadvantages, and lifestyle changes associated with each procedure. When you are properly informed you will be better able to make a confident decision and choose the procedure that is the best option for you.
Weight loss surgery is a last resort treatment for morbid obesity. Before weight loss surgery is considered, patients must have made sincere efforts to lose weight through non-surgical methods including dieting, exercise, nutritional counseling, commercial diet programs, or medically-supervised weight loss programs. To qualify, a patient must have a body mass index (BMI) of 40 or higher, which is about 100 pounds overweight for men and 80 pounds overweight for women, or a BMI of 35 or higher with obesity related medical problems such as high blood pressure, diabetes, heart disease or severe sleep apnea.
Your overall weight loss will depend on the procedure and whether or not you follow the guidelines relating to diet and exercise. Some patients reach a normal weight and others lose a substantial amount of weight but are still overweight. On average, gastric bypass patients lose 100-200 pounds or up to 70 percent of their excess body weight within the first one to two years. At that point weight loss levels off but it is common for patients to have a weight regain of about 10 percent. For lap band patients, weight loss is not as quick in the beginning but progresses steadily over a two to three year period before it stabilizes with minimal weight regain. After five years from surgery, studies show that the total amount of weight loss is comparable between patients of gastric bypass and lap band surgery.
Age itself will not necessarily preclude a patient from weight loss surgery if it is a life and death situation and no other effective treatment options are available. However, general age guidelines for weight loss surgery state that qualified patients should be between the ages of 18 and 60.
The cost of weight loss surgery can range from $15,000 to $35,000, depending on the surgical procedure, surgeon experience, medical team, medical setting, and level of post-op aftercare and support.
For the most part insurance companies are finally accepting the medical benefits of obesity surgery and covering the weight loss procedures, but medical insurance coverage for weight loss surgery will vary between states, insurance providers, and health plans. Even with coverage, there will still be requirements for eligibility such as documentation of previous weight loss attempts, weight and BMI standards, obesity related health conditions, and a Letter of Medical Necessity from your primary care doctor and/or bariatric surgeon.
In February 2006, Medicare began covering laparoscopic adjustable gastric banding (lap band surgery) and Roux-en-Y gastric bypass (open or laparoscopic). In addition to meeting standard patient criteria, coverage only applies when the procedure is performed in a hospital or by a medical practice that is rated a Center of Excellence by the American Society for Bariatric Surgery or the American College of Surgeons.
A Letter of Medical Necessity is a statement written by your doctor for the insurance company which typically lists 1) your weight and body mass index (BMI), 2) health conditions associated with obesity 3) how long you have been overweight 4) details of your weight loss attempts over the years 5) a recommendation for weight loss surgery in your situation.
Look for a surgeon with plenty of experience - not just years of practice but how many times they have performed the specific procedure you are considering. Find out years of experience in the weight loss field, the number of operations they have performed, how many times they have performed a specific procedure, if they are board-certified, and if they are members of the American Society for Metabolic and Bariatric Surgery (ASMBS). A skilled and experienced surgeon will have less surgical complications.
Carbonated beverages, whether regular or diet, should be avoided after weight loss surgery because the carbonation can cause bloating and pain. For lap band patients, carbonation may lead to swelling and stretching of the stomach pouch and band area. Sugary drinks of all types should be avoided because of the high calorie content.
If you smoke, your doctor will ask you to quit smoking 6-8 weeks before surgery. It takes at least a month for lungs to recover from the damages caused by smoking. Patients who do not smoke have fewer surgery complications, less anesthesia complications, and are less likely to develop pneumonia after surgery. Smoking also contradicts the purpose of weight loss surgery, which is about improving your health.
Although pregnancy after weight loss surgery has many risks to both the patient and baby, the most common nutritional problems complicating pregnancy in the United States is obesity even without weight loss surgery.
Weight loss surgery patients are advised to take all necessary precautions and avoid getting pregnant during the first two years after surgery. This is the period of rapid weight loss and the associated nutritional deficiencies are dangerous to the developing fetus.
If you are planning a pregnancy after weight loss surgery, pre-conception and early prenatal nutritional counseling is very important. Nutritional supplementation of vitamins and iron is important in all pregnancies, but even more so after weight loss surgery.
Exercise serves two basic purposes - it burn calories and protects muscle tissue. With rapid weight loss, you will lose both muscle and fat unless you exercise. When the body loses muscle tissue, it also gains weight due to the fact that muscle tissue burns energy. If you don't exercise, you will have to eat less and less over the years. The recommended amount of exercise is thirty minutes of walking a day and thirty minutes of strength/resistance training a week. Exercise is a very important part of successful weight loss after weight loss surgery.