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Frequently Asked Questions (FAQs)

The following are brief answers to some of the most commonly asked questions by those considering weight loss surgery. Unlike the remainder of this website, the answers here have been formulated from a combination of surgical literature as well as the author’s personal experience. If there are any questions that you feel have not been answered completely or that have not been addressed, feel free to contact us. It is our goal that you have a full understanding of bariatric surgery and we will do our best to accommodate you in that regard.

What about the excess skin?
This is far and away one of the most commonly asked questions in reference to weight loss surgery. Additionally, there are many misconceptions concerning this phenomenon. Any adult who loses a massive amount of weight will have some redundant, or excess, skin: this is because the skin of an adult lacks the elastin necessary to stretch back. The amount of redundant skin is a function of two things: the body habitus, or build, of the individual and the amount of weight that is lost. For example, if someone carries most excess weight in the abdomen, there will certainly be redundant skin in that location after massive weight loss. In those whose weight is distributed more evenly, this affect will be less pronounced. However, the more influential factor is the amount of weight lost. In our experience, it is not until about 50% excess weight loss that the excess skin becomes noticeable. It is for this reason that most patients following a laparoscopic banding will have fewer “issues” with their skin than those undergoing procedures that produce more profound weight loss. Moreover, many people believe that exercise “tones up” this excess skin. This is a myth. Although we do believe daily exercise is exceedingly important for success, it does nothing to reduce excess skin. All in all, if you develop areas of excess skin postoperatively, it’s cause to celebrate! This means you have done extremely well and have lost massive amounts of weight. The only true option for correcting this condition is body contouring surgery. It’s amazing what can be done surgically to remove and reshape any excess skin and we have plenty of resources to aid in accommodating this process. Our recommendation would be to make plans for proceeding with a body contouring procedure approximately 18-24 months after surgical weight loss.

Will my insurance pay for plastic surgery?
The short answer to this is probably not. Body contouring surgery is generally considered cosmetic and therefore is not covered by commercial health insurance. The exception to this would be if the procedure were pursued out of “medical necessity”. This classification generally applies to situations where chronic, recurrent skin infections can be documented, therefore justifying skin removal. Even in that case, however, the covered benefit is most commonly a procedure that involves simply cutting off the excess skin (panniculectomy), rather than one that includes contouring of the abdominal wall (an abdominoplasty). Additionally, procedures involving the arms, legs and breasts are all generally considered to be elective and are not covered by insurance carriers. Moreover, many people have the idea that if they have a hernia from their weight loss surgery that needs repaired, then plastic surgery can be included for free as well: this is false. In those situations, while it can be done at the same time, fees are typically prorated so that the patient pays for the plastic surgery portion of the procedure. In addition, many have inquired about the opportunity to “donate” their excess skin in hopes of receiving skin reduction surgery free of charge: this, too, is incorrect. In general, we counsel our patients to be prepared: if you do as well as we hope you do, you will have some redundant skin. If this is something that you will want addressed, start saving early. The opportunity to take care of it will be available 12-18 months after surgery.

What about hair loss?
Some hair loss is very common during periods of rapid weight loss. Oftentimes, patients believe this to be the result of malnutrition or poor protein intake. While it is a possibility, it’s generally not the case. In reality, our hair follicles are always in either a growth phase (anogen) or inactive phase (telogen). All follicles start in anogen and after about 100 days go into telogen, at which time hair naturally falls out. In bariatric patients, this process is accelerated, causing more frequent hair loss. This sort of acceleration can occur for a multitude of reasons, including side effects of certain medications, child birth, fever, thyroid disease, and, of course, rapid weight loss.

Hair loss associated with bariatric weight loss begins approximately three to six months after the surgery and may last for six to 12 months, essentially encompassing the rapid weight loss phase. In general, the follicle suffers no harm and, when weight loss settles down, hair growth returns to normal. Keep in mind that, while nutrient insufficiencies are not usually to blame for the hair loss, they may play a contributing role. We recommend laboratory analysis along with the following supplement guidelines: 80g daily protein, 15ml flax seed oil, 2-5g biotin, 500mcg daily vitamin B12 and 325mg iron. The bottom line: hair loss can be a side effect of bariatric surgery, but it is generally only noticeably to the patients themselves and this process does reverse when the weight loss slows down.

What if I want to get pregnant?
This is, understandably, a common concern for many young women who look forward to starting a family. The common belief is that weight loss surgery will cause difficulty with pregnancy, especially in terms of adequate nutrition. Contrary to popular belief, all studies have shown that weight loss surgery is beneficial in relation to pregnancy and childbirth. This becomes even more evident when one considers the following:
o There are improved chances of getting pregnant after weight loss surgery.
o There is less weight gain during pregnancy.
o It will be easier to achieve a normal post-pregnancy weight.
o The possibility of having to undergo C-section is less likely.
o If a C-section is needed, complications will be less likely.
o There is a decreased chance of complications during childbirth or shortly after (peripartum) for the mother and the baby.
o The baby will most likely be healthier than if born to a mother who is morbidly obese.
o Neither the child nor the mother will suffer malnutrition.
The above data are based primarily on studies concerning gastric bypass and pregnancy, but would certainly hold true in relation to laparoscopic banding or sleeve gastrectomy. The only difference is that, with gastric banding, we often recommend removing fluid from the balloon for the first trimester. This is a precaution in case the mother develops excessive nausea and vomiting (hyperemesis gravidarum) during pregnancy. “Loosening” the band decreases the likelihood of a “slip” occurring: an event that would require an urgent surgery during the early portion of the pregnancy. Women commonly do not know they are pregnant until at least four weeks into the first trimester, so fluid removal is only performed for about a month.

Again, one very common misconception is that banding is “safer” if one is considering pregnancy. This is untrue and has no basis in clinical data. Overall, when looking at weight loss surgery in relation to pregnancy and childbirth, all options can be considered “good” options.

What is the recovery time?
As with all surgeries, postoperative recovery is different for everybody. A typical hospital stay is 24 hours for laparoscopic banding and 48 hours for gastric bypass and sleeve gastrectomy procedures. Although it varies, most patients return to work within two to three weeks on average. Again, this timeframe is different for every individual and we have seen some patients return to work earlier (as soon as one week) and others return later (up to twelve weeks post-surgery). In our experience, most employers will allow four weeks off for recovery.

If the procedure is performed laparoscopically (banding), unrestricted activity can be resumed as soon as the patient feels comfortable, usually within a of couple weeks. If the procedure is performed in an open manner (gastric bypass and sleeve gastrectomy), lifting will need to be restricted to less than ten pounds for six weeks. This decreases the chance of developing an incisional hernia. These restrictions may delay the return to work for those who have rigorous occupations or perform manual labor. Essentially, there is no hard and fast guideline for when a patient will return to full activity: the timeline is made up of individual factors.

How long after consultation until I get my surgery?
The length of time between the initial consultation to having surgery is quite variable and could fall anywhere between three and twelve months. This time period is dependent upon multiple variables, mostly having to do with the amount of time it takes to accomplish the pre-surgery workup that may be required by the program or by your insurance carrier. The most common reason for delay is the persistent requirement for a “supervised diet” before surgery: most major insurance carriers require some sort of documentation that an individual has undergone a medical weight loss plan prior to them approving bariatric surgery. This medical weight loss plan will need to be supervised by one’s primary physician for three to six (sometimes up to 12) consecutive months, depending on the insurance company’s requirements. Unfortunately, there is really no way around this requirement and many patients find it very discouraging. We understand. Our advice is to fully review your insurance carrier’s requirements as it relates to bariatric surgery and to get started on completing them even prior to your initial consultation.

Can you work with my insurance carrier to get me approved?
We have experts on staff to guide you through the process of getting approved for weight loss surgery. We will submit all the required paperwork and help you accomplish the prerequisite steps necessary for getting surgery okayed and underway. And, if issues should arise, we will assist you in the appeals process. With that said, bariatric surgery coverage is completely dependent on each patient’s specific plan. Your policy should clearly state whether or not it covers weight loss surgery (and the requirements to do so) in your description of benefits. Unfortunately, it is possible for an insurance company to offer surgical weight loss coverage while your individually selected plan does not include the option. If this is the case, no amount of appeals or negotiation will convince a carrier to approve the process.

Isn’t bariatric surgery dangerous?
Bariatric surgery, especially gastric bypass, has the reputation of being “high risk”. It is, of course, a major gastrointestinal surgery and – as with any surgery – risks are unavoidable. However, the risk of succumbing to a complication of morbid obesity far outweighs the risk of surgery. Current studies show that the thirty-day mortality for any bariatric procedure is around .1-.3% (1-3 in 1,000). This statistic is equivalent to that of many procedures done every day, such as gallbladder surgeries, hysterectomies, and hip repairs. In fact, weight loss surgery is up to ten-fold safer than procedures like colon resection, esophageal surgery and cardiac surgery. And keep in mind: no other procedure can come close to providing the multitude of benefits that can be offered from successful weight loss surgery, like a 90% resolution of multiple comorbidities and a significantly increased likelihood (40-90%) of being alive in five years (compared to life expectancy if morbid obesity is not addressed.) Yes, it is important to understand the risks of surgery and, yes, it is important to weigh the risks against the benefits. We would like to reiterate, however, that the risks of surgery are far less than those associated with continuing to suffer the disease of morbid obesity.

How does your body know to stop losing weight after weight loss surgery?
This is a good question, and the answer is not entirely clear. However, we believe it has to do with the way that weight loss surgery changes the body’s structure and function, as well as the minor changes that occur over the first two years after weight loss surgery. The mechanisms for initial weight loss are explained elsewhere in this site (see “Why Choose Surgery”). After several months, the pouch and bypassed intestine adjust so that a little more food can be taken in at a time and calories are absorbed more efficiently. As a result, weight loss stabilizes.

Next, the “set point theory” of obesity may come into play (see “Metabolism” under “Causes of Obesity”). Essentially, research suggests that everyone’s body is “programmed” or “set” to be within a certain weight range. (Think of it as a thermostat: you’d like your home to be 72 degrees but if the thermostat is set to 84 degrees, that’s where the temperature will stay.) Many believe that weight loss surgery actually reduces a given “set point” to near normal levels. Once that set point is achieved, weight loss stabilizes. (If you set the thermostat to 72 degrees, the house will cool down and remain 72 degrees.) This is important: the new set point is subject to the same environmental and lifestyle factors as the one prior to surgery. Thus, it has been shown that maintaining a new weight will require continued effort. (Just as the air conditioner must run constantly to keep the house cool on a summer day.) Studies have shown that if a gastric bypass patient starts consuming more than 1,000 calories a day, weight gain may follow.

It is very rare to see patients lose “too much” weight after surgery. The true challenge is not stopping the weight loss, it’s the opposite: keeping it off. A life of continued dietary discipline and healthy choices will keep you at your goal weight once you get there.

How can people regain their weight after weight loss surgery (and how can I not be one of them)?
Overall, weight loss surgery is successful in about 80% of patients. (Success is defined as maintaining 50% excess weight loss.) This is, of course, compared to medical therapy, which carries a 95% failure rate (or 5% success rate). It is true that it’s not uncommon for patients to gain 10 to 20 pounds back from their lowest weight. Unfortunately, however, 10-20% of patients will gain most, if not all, of their weight back. Why? This is best answered by examining those who have not. For years, the National Weight Control Registry has been tracking the habits of those who have lost large amounts of weight and kept it off. Several habits are consistently seen in this group: they generally eat several small meals, they stay away from sweets and fried foods, they weigh themselves 1-2 times per weeks, they drink a lot of water, and they exercise up to one hour daily (yes, daily). Over the years, we have found that those who do follow these habits rarely see significant weight regain. Conversely, for those who do not adopt these habits, there is a consistent trend: the weight comes back. In the end, the key to success if found in a life of daily healthy choices and discipline. Weight loss surgery is only the first step of the rest of your life and it is up to you to take charge from there.

Are there any detrimental effects long-term with the Gastric Bypass or Band?
For gastric bypass, there are none that we know of as long as patients take the recommended vitamin supplements. For laparoscopic band, we don’t think so: at this point in time, there are no reports of the band “wearing out” with almost 20 years of accumulated experience world-wide.

Don’t you have to take vitamins?
Gastric Bypass – yes
Laparoscopic Band – no
Sleeve Gastrectomy – no

Doesn’t Gastric Bypass make you malnourished?
No. Not as long as the procedure is performed properly without bypassing too much intestine. However, there are several vitamin deficiencies that will likely occur if one does not take a multi-vitamin, Vitamin B12 supplement, and calcium. A daily iron supplement may be required as well if its identified as being deficient. As for protein malnutrition, this is exceedingly rare after gastric bypass and is only seen in about 1% of patients.

Do I really need to exercise?
Yes! It has been shown that the vast majority of those who lose massive amounts of weight and keep it off long-term exercise up to one hour daily. The process of daily rigorous exercise is completely out of the question for many people before weight loss surgery. Three to six months after surgery, however, with thirty to fifty pounds of weight loss, this goal becomes much more achievable. The recommendation is this: start slow, be persistent, never give up and you will be amazed at what you can accomplish.

Isn’t bariatric surgery the easy way out?
No. In fact, for many, it’s the only way out. Bariatric surgery certainly is not a venture for the faint of heart or for those who are looking for a short cut to success. We’ll be the first to tell you: we believe that success is critically dependent on a life of daily discipline, including healthy dietary habits and regular exercise. Currently, these are the habits of less than 5% of the U.S. population. The vast majority of those who are successful after weight loss surgery move forward knowing the life they lead is profoundly more disciplined than those around them, but the quality and fullness of life achieved in return is worth every effort.