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Frequently Asked Questions

Preparation for Surgery

Insurance Issues

Surgery

The Hospital Stay

Life After Surgery

Diet

General

Preparation for Surgery


  • An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels. I take only the most calculated of risks. And, I am known for being ”the safest practice around” for a reason. I will not take risks with your health and safety. Nothing is worth a short-cut in your work-up. RUN from those who guarantee surgery ”ASAP” I am the opposite. It is worth the time to know how to make surgery as safe as possible. My excellent safety record can attest to this fact.

  • I require the following labs: CBC, Chem-13, Lipid Panel, TSH, and UA.

    I require the following consults:

    • For everyone: Pulmonologist evaluation and surgical clearance—with PFT’s with DLCO. This is a comprehensive medical evaluation to determine the state of your medical health and your surgical safety potential. This is done by a doctor who specializes in more advanced medical conditions and has experience and training in critical care.
    • For everyone: Psychiatric professional clearance. This is to get a trained-opinion if you are stable, cooperative, and ready for a life-long commitment. Any psych professional is reasonable and you can use your own, if they are comfortable doing this type of evaluation.
    • If 50 years of age or greater: Cardiologist evaluation and clearance, with some sort of evocative stress test. The risk for notable heart disease in my patient population, if over 50 years of age, is agreed upon by all. This will give us the ultimate surgical, risk-stratification and make everyone feel better about allowing you to go to surgery.
    • If reflux (GERD) for 5 years or more: I require an upper endoscopy (EGD). We are considering operating on your stomach… so if you have reflux issues for 5 or more years, I think we should “take a look at it” before surgery.
    • If you used Fen-Phen for at least 3 months: you need an echocardiogram to make sure you do not have heart valve issues. Very unlikely, but possible.
  • Patients, who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. For example, many patients have symptoms of reflux. Up to 15% of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned. As noted above, if you have reflux (GERD) for 5 years or more: I require an upper endoscopy (EGD). We are considering operating on your stomach… so if you have reflux issues for 5 or more years, I think we should ”take a look at it” before surgery.
  • The sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it. Your pulmonary evaluation will help to clarify this picture. I do not require all of my patients to be screened for this. But, selectively, it may prove to be a useful work-up for you.
  • The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan. I think it is essential for a number of reasons. But, most important is to help you make sure that you are ready for: a life-long commitment, a permanent change in your daily life, and the risks and benefits of bariatric surgery. It is a good thing for you to have the chance to discuss these issues with a professional.
  • Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient’s weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending bariatric surgery if it is otherwise appropriate, but those conditions will make a patient’s risk higher than average. We need to understand your medical issues to make sure we work to minimize their impact on your surgery and recovery. And, personally, I love to know what we are starting with so I can know what we can help to make better!
  • New evaluation appointments are usually booked 4-6 weeks in advance. Once a patient is seen, if the surgeon and patient agree it is appropriate, the operation can usually be scheduled within 6-8 weeks. Why so long? The work-up and insurance approval process is essential and rarely a quick process. AS described above, we take no short-cuts in your work-up. And, in the insurance realm, every insurance has different routes to surgery. We are experts in making it quicker. But the rules are not easily changed. A number of insurances require 3-6 months of medically-supervised weight-loss. Obviously, this takes time. We do have a ”FastTrack” program for those who qualify. (See our home page for details.) And, as an aside, I know of a lot of ”get you in quick and run to the operating room” surgeons. I do not recommend such an approach for obvious reasons.
    1. Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current.
    2. Make a list of all the diets you have tried (a diet history) and bring it to your doctor. 
    3. Bring any pertinent medical data to your appointment with the surgeon — this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
    4. Bring a list of your medications with dose and schedule.
    5. Stop smoking. (Surgical patients who use tobacco products are at a higher surgical risk and I do not operate on smokers. We will help you quit.)
    6. Start working on getting your labs and consults completed prior to your appointment with me. See our home page for details on what to do in preparation for your appointment.

Insurance Issues


  • After your appointment with us, it takes time to get the letter to your insurer. And, they have the right to a number of weeks to get us their evaluation. The time it takes to get an answer can vary from about 3-6 weeks (or longer) if you and we are not persistent in follow-up. We have insurance specialists who will follow up regularly on approval requests. It may be helpful for you to ensure coverage before coming in to see us.
  • Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity." Such an exclusion can sometime be appealed when the surgical treatment is recommended by your surgeon or referring physician as the best therapy to relieve life-threatening obesity-related health conditions, which usually are covered. But, it is not personal when they deny you. The insurance you have was purchased by your employer to cover their employees for a variety of things—and this may not have been included. It is not about you, but rather about the decisions of your employer for the company. Again, it is not personal. Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments—such as dieting, exercise, behavior modification, and some medications—are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as a certain amount of time of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
  • Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery. When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.

Surgery


  • No. Laparoscopic operations carry the same risk as the procedure performed as an open operation. The benefits of laparoscopy are typically less discomfort, shorter hospital stay, earlier return to work, and reduced scarring. There is a lower risk of significant wound infections. I essentially always use the laparoscopic approach as my initial access.
  • Every attempt is made to control pain after surgery to make it possible for you to move about and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. If you have a Bypass, a Patient Controlled Analgesia Pump (PCA) (which allows you to give yourself a dose of pain medicine on demand) will be used early post-operatively. Various methods of pain control, depending on your type of surgical procedure, are available. For all procedures, we also almost always use a temporary, implantable, pain-pump that drips local anaesthetic into your wounds for 2 to 3 days. It helps minimize narcotic use and its attendant problems.
  • As long as it takes to be self-sufficient. Although it can vary, the hospital stay for Bypass surgery is 2 days on average. For the Band procedures, most people go home the same day. I do not answer to anyone in my decisions on when you can go home… so you leave when you are ready and it is safe. If you need to stay, you stay.
  • After a Bypass or Sleeve procedure, I always leave a JP drain for about 5-7 days. It causes minimal to no discomfort, is easy to remove, and is not a "big deal." I have used them in bariatric surgery for over 1500 major cases and been very pleased with their effectiveness and usefulness. It is a very good, extra, easy-to-use, safety and monitoring system.
  • With the Bypass and Sleeve, I use either a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. In addition, with all bariatric procedures, I use an infusion pump that provides a local anesthetic in the surgical site to control pain without the side effects of narcotics. We make major efforts to control nausea and it is rarely a big problem in my patients.
  • As with any major surgery, you are in danger of death from a blood clot or other surgical side effects. Statistically, the risk of death during these procedures is less than 1 percent. Your doctors will have assessed you for risks and prepared accordingly. All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients. See my informed consent documents on our home page.
    Read about the Safety of Bariatric Surgery Study
  • Almost immediately after surgery we will require you to get up and move about. We want you up and walking within 1.5 to 2 hours after surgery—so get ready to move!! You will be in your own room or the recovery/independence stage of our recovery room by then. On leaving the hospital, you should be able to care for all your personal needs, but will need help with shopping, lifting and with transportation for a few days.
  • For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 3 days after Band surgery and 5-7 days after Bypass and Sleeve surgery.

The Hospital Stay


  • Because a DVT originates on the operating table, therapy begins before a patient goes to the operating room. Generally, patients are treated with sequential leg compression stockings and given a blood thinner prior to surgery. Both of these therapies continue throughout your hospitalization. The third major preventive measure involves getting your moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs. We require 6 (minimum) walks per day. If you have activity limitations, you will be similarly "mobilized" to account for these limits.
  • Basic toiletries (comb, toothbrush, etc.) and clothing may be provided by the hospital, but most people prefer to bring their own. Choose clothes for your stay that are easy to put on and take off. Because of your incision, your clothes may become soiled, so nothing too precious. Other ideas: Reading and writing materials, DVD player, I-Pod, crossword/soduko and other puzzles, personal toiletries, a bathrobe.

Life After Surgery


  • The basic rules are simple and easy to follow. We provide you with no less than 6 classes in your first year. We pay for (free for you!) and encourage you to attend over 10 support groups, both on-line and in the region. And, we give you your own "procedure bible" to help guide you. You will be well instructed. We know you do not know what to do—so we teach you. You will be an expert.

    Even before surgery, we will provide you with special dietary guidelines. You will need to follow these guidelines closely. We teach you how to advance your diet in a very particular way in order to make the transitions easy for you to understand and do successfully. We not only teach you what to eat—we teach you how to eat, how to chew, when to swallow, how to shop for food, etc., etc.! These are all things you thought you already knew. Right? But, we believe in changing it all to give you both success and control. There are variations, dependent on the procedure you have, that will be clearly explained to avoid any confusion.

     

    Here are some essentials:

    • We like you to eat 5-6 small meals per day to avoid every really getting hungry. And, in this way, you “trick” your body into giving up its fat stores.
    • Protein in the form of lean meats (chicken, turkey, and fish) and other low-fat sources should be eaten first. These should comprise at least 70% of the volume of the meal eaten.
    • Foods should be cooked without fat and seasoned to taste.
    • Avoid sauces, gravies, butter, margarine, mayonnaise and junk foods.
    • Never eat between meals.
    • Do not drink flavored beverages, even diet soda, between meals. Drink 60 ounces or more of water each day.
    • Water must be consumed slowly, 1-2 mouthfuls at a time, due to the restrictive effect of the operations.
  • When you have a weight loss surgery procedure, you lose weight because the amount of food energy (calories) you are able to eat is much less than your body needs to function. It has to make up the difference by burning reserves or unused tissues. Your body will tend to burn any unused muscle before it begins to burn the fat it has saved up. If you do not exercise daily, your body will consume your unused muscle, and you will lose muscle mass and strength. And, lost muscle will decrease your basal metabolic rate—the rate at which you burn calories just by existing. Obviously, we want to avoid this. Daily aerobic exercise for 30 minutes at least will communicate to your body that you want to use your muscles and force it to burn the fat instead. Also, weight resistance workouts will similarly help to increase this lean body mass. We give a lot of exercise instructions. But, we realize that many of you are new to (or "hate!") exercise. We will help you to change that. We start easy and ritualistically. Then, we increase to get you to a good performance state. We want you to live a health, active life—unencumbered by activity limitations and deconditioning. We want you to participate—not observe. Life is to be lived. Not to be watched. This requires a certain amount of conditioning. We can help make this "do-able" and fun.
  • Many patients are hesitant about exercising after surgery, but exercise is an essential component of success after surgery. Exercise actually begins on the afternoon of surgery — you must be out of bed and walking. The goal is to walk further on the next day, and progressively further every day after that, including the first few weeks at home. 6 activity sessions per day is the absolute minimum. It is not negotiable. We remind you constantly. Patients are often released from medical restrictions and encouraged to begin exercising about two weeks after surgery, limited only by the level of discomfort. The type of exercise is dictated by the patient's overall condition. Some patients who have severe knee problems can't walk well, but may be able to swim or bicycle. Many patients begin with low stress forms of exercise and are encouraged to progress to more vigorous activity when they are able.

  • It is strongly recommended that women wait at least one year after the surgery before a pregnancy. Approximately one year post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. Also, we want the first year to be all about you. And, if you are pregnant, the baby comes first. We want you to experience the control and success to ensure that you know your true potential before getting pregnant. Only then should pregnancy be an option. Invariably, this takes at least one year. You should consult us as you plan for pregnancy.

    Often, women become more fertile after bariatric surgery. We get many referrals from infertility doctors in this regard. So, be careful! Even if you "have trouble getting pregnant." I know many stories of this surprisingly becoming untrue after a notable weight-loss.

  • Contact your original surgeon — he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body. Revisions are a difficult undertaking. We consider them selectively. However, often the procedure is intact and the patient's use of it is not. We do a lot of re-teaching those who have failed their procedure from other doctors. Often, education is the answer to success. Ask us about specifics.
  • The remnant stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy. But, for the most part, it remains unchanged. The remnant stomach still contributes to the function of the intestines even though it does not receive or process food — it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known. It still functions in many of the parts of digestion that do not involve food passing through it. In the Sleeve procedure, a large portion of the stomach is completely removed.

  • This can vary based on your individual anatomy and surgical considerations. But, in general, in the gastric bypass the stomach pouch is created is 1-2 ounces in size. We say it is roughly the size of an egg. In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 4-8 ounces.

    In the Band procedures, the pouch above the Band is made about the same size as in the bypass. Over time, the ideal meal volume tolerated for satiety is 4 ounces of protein.

    In the Sleeve, the actual volume of the stomach created is about 10-20% of your present stomach volume (the tube made is about 150ml in volume). But, it is created from the relatively less "stretchable," left side of your stomach—so it does not expand as much as your present stomach. A great ultimate meal volume after the Sleeve is about 6-8 ounces.

  • The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.
  • It's normal not to have an appetite for the first month or two after Band and Sleeve surgery, and for up to 6b months after Bypass. Eating to us is like taking your medicine. It just has to be done. You plan you meal content, volume, and times always. But, especially during these non-hunger intervals post-operatively, eating becomes a way of just "feeding the machine." It will make you do better, feel better, and lose weight better. This is not the time to diet. (And, dieting never worked for you in the long run anyway. Why continue to do it?)
  • Most pills or capsules are small enough to pass through the new stomach to bowel connection or through the Band. Initially, we may suggest that medications be taken in liquid form or crushed. We will discuss this in detail and in specific with you as you get closer to surgery.
  • Most patients have no difficulty in swallowing these pills. We like you to be off of them for 4 weeks pre- and 6 weeks post-operatively. This decreases blood clots. Use another, non-hormonal, birth control regimen during this interval. Getting pregnant will seriously delay your surgery for at least 9 months!
  • Patients can return to normal sexual intimacy when they feel like it—when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks. That is normal.
  • Both men and women generally respond well to bariatric surgery. In general, men lose weight slightly faster than women do. We believe that this has a lot to do with their generally higher lean body mass, and therefore their basal metabolic rate. Women DO catch up.
  • Patients must stop smoking at least one month before surgery. This is non-negotiable. Smoking more than doubles all major complications. And, it is an addiction and an unhealthy activity that will undermine the health and control you will be gaining after surgery. To continue to smoke would be to actively work against all that you and we are doing to improve your life and health. We will help you stop.
  • Patients may begin to wonder about this early after the surgery when they are losing significant weight. Many see a loss of 20-40 pounds per month, some worry when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. With the Bypass, the stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. With the Band, we orchestrate your increased intake too. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition. In fact, the last 10% or so of your target weight loss usually requires a little more focus and commitment on your part. That is built into the procedures and is a good thing. Working for it makes it all the more yours.
  • Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure. We work closely with a number of plastic surgeons who are experts and belong in this process, if you are interested. For the vast majority of patients, it is either not a problem or not a big enough deal to do anything about.
  • The cornerstones of minimizing excess skin are: good (high protein) nutrition, hydration, exercise, vitamin supplementation, sun block, and good genetics!
  • Most patients say no. In fact, for the first 4-6 weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger. If you eat as we recommend—5 to 6 small, high protein, meals per day—then when do you have time to get hungry? Impulse and starvation fade. You are in control.
  • This is often caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes) that cause insulin surges. Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch or through the Band. And, we want you to eat often. Just to be careful with what your diet consists of. We teach this again and again. It will not be a mystery.
  • Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the bypass pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are sometimes not able to take in enough potassium from food to compensate. When potassium levels get too low, it can be a problem.
  • A hernia is a weakness in the muscle wall through which bowel can pass and possibly get caught. With the laparoscopic approach, it is relatively rare. But, it does happen. It is usually relatively easy to diagnose and fix.
  • Patients rarely need a transfusion after Bypass. It is almost always a delayed issue to need blood—which is usually caused by a delayed bleed from a staple line. Almost never does this require an operation. Usually, in the rare instances blood is given, a simple transfusion is all that is needed. In the Band and Sleeve procedures, transfusions are almost unheard of.
  • Undesired blood clotting in veins, especially of the calf and pelvis is a big deal and very dangerous. It can break off, go to your lungs, and cause death. It is not completely preventable, but preventive measures will be taken, including: early and frequent ambulation, blood thinners, pulsatile "squeeze" stockings (SCD's), short OR times, and close vigilance. Fortunately, our DVT rate is very low. We take all precautions.
  • Many patients experience some hair loss or thinning after Bypass surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily multivitamin supplement and a good daily volume of fluid intake. Some people recommend biotin supplementation. It almost always returns to just about normal at the one year anniversary. In very few patients is this a "deal breaker." And, in most, it is not evident to anyone but the patient and their shower drain. When seen, it is usually with the Bypass. Rarely is this seen with the Band.
  • Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems. And, they are notably less significant after laparoscopic surgery than with the old-fashioned, open procedures.
  • It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after surgery. In most patients, there is a complete resolution of symptoms by six months following surgery.

Diet


  • For the Band, bypass, and Sleeve, we provide you with detailed dietary instructions. All involve a progression from liquids with protein supplementation, to soft/pureed foods, to "regular" food. The timing is different with the different procedures. We will provide you with specific dietary guidelines for the best post-surgical outcome.
  • Eggs, red meat, chicken, fish, tofu, soy, cottage cheese, yogurt, and many others that are more subtle. We also teach this.
  • When you are losing weight, there are many waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight-loss. Water also fills your stomach and helps to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it may be because you did not drink enough water in the hour before.
  • Eating sugars or other carbohydrate-rich foods can cause dumping syndrome in patients who have had a Bypass. Your body handles these small particles by diluting them with water, which reduces blood volume and causes a "shock-like" state. The result is a very unpleasant feeling: you break out in a cold clammy sweat, turn pale, feel "butterflies" in your stomach, and have a pounding pulse. Cramps and diarrhea may follow. This state can last for 30-60 minutes and can be quite uncomfortable — you may have to lie down until it goes away. This syndrome can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be well tolerated at the end of a meal. You will learn your limits. It is not a feeling you will court more than a time or two. Not everyone has dumping and it can also fade away. Many patients "want" to have these intolerances to limit them.
  • Milk contains lactose (milk sugar), which is sometimes not well digested in bypass patients. This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas. Whether you have this intolerance or not often it depends on the form of the milk product, the volume eaten, and your particular constitution and tolerances.
  • Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake, defeating the restrictive effect of your operation. Snacking will slow down your weight loss and can lead to regain of weight. And, with 6 meals per day, when are you going to find the time to snack. We like meals—what you plan to eat. Not snacks—what you "happen to grab."
  • You can, but you will need to be very careful, and we recommend that you avoid it for the first 6 weeks. Red meats contain a high level of meat fibers which hold the piece of meat together, preventing you from separating it into small parts when you chew. The fibers can plug the outlet of your stomach pouch or your Band and prevent anything from passing through. This is a condition that is very uncomfortable. We teach you how to cut up and eat meat properly to minimize this potential problem.
  • In general, 60 grams per day is your goal. We will help you decide what the right amount is for you.
  • Your salt intake will be unchanged unless otherwise instructed by your primary care physician. We still want your food to taste good to you. Season away! The only limitation is to make sure that your condiments are not "over-carbing" you.
  • You will find that even small amounts of alcohol will affect you quickly. This is especially true with the Bypass. It is suggested that you drink no alcohol for the first 6-8 weeks. Thereafter, with your physician's approval, you may have a glass of wine or a small cocktail. Be careful—the carbohydrates in many drinks can add up quickly.
  • Bypass patients need B-12 1000 mcg vitamins in sublingual form, daily for life. All bariatric patients need multivitamins for life to make up for the smaller amount of food you are eating. To make sure that you are on track, we will track your B-12, B-1, and foliate levels, as well as any other micronutrients that may need to be evaluated.
  • Some insurances require this type of evaluation. We provide extensive teaching at all of our classes as well, as in your many consultations with us. We have an in-house dietician. Counseling after surgery is available on an individual basis, as needed or required.
  • We provide patients with materials that clearly outline our expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure. After surgery, health and weight loss are highly dependent on your compliance with these guidelines. You must do your part by restricting high-calorie foods, by avoiding sugar, snacks and fats, and by following the guidelines set.

General


  • Generally accepted guidelines from the American Society for Bariatric Surgery and the National Institutes of Health indicate surgery only for those 18 years of age and older. Surgery has been performed on patients 16 and younger. There is a real concern that young patients may not have reached full developmental or emotional maturity to make this type of decision. It is important that young weight loss surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success. My lower limit, in select cases, is 16 years of age.
  • I judge people by health age—not chronological age. I have turned down 30 year-olds and done procedures on 75 year-olds. It is all about understanding and managing risk/benefit rations. The risk of surgery in the elderly age group is increased, and the benefits, in terms of reduced risk of mortality, are reduced. But, quality of life in them is paramount. And, they are some of my star patients!
  • A very important study was published in 2007 which definitively answered this question. It was al over the news. You probably saw it. The answer: YES!
  • According to current research and our database, weight loss surgery can improve or resolve associated health conditions. We are happy to share with you our amazing results in terms of: depression, diabetes, GERD, hypertension, lipid disorders, menstrual irregularities, urinary stress incontinence, joint pain, and sleep apnea… among others!

  • Yes, it is different. Everyone in the world who has not had a stomach reduction procedure or Band placed achieves satiety by meeting his or her need for calories. The mechanism of your morbid obesity is that your appetite center may not be "set" properly to recognize satiety from calorie input until you have taken too many calories. You then store those extra calories as fat.

    Following the Band, sleeve, and Bypass procedures, you now achieve satiety by stretching your pouch or sleeve stomach walls. If you do not stretch them (by missing meals), if they are not stretched sufficiently (by snacking), and/or if the stretch does not last long enough (by taking liquids with meals or by eating liquid foods), then the satiety does not last long enough to reach to the next meal. It is helpful if you always remember that your satiety comes from stretching the pouch walls, from the actual volume and type of food that you eat. The next logical step is to realize the importance of the caloric density of foods you eat, as I mentioned earlier. (For example, think of the difference between half a cube of butter and a large bowl of salad with light dressing—each may have the same calories, but their effect on your pouch and your appetite will be dramatically different).


TOOLS FOR SUCCESS

Our patients are our number one priority. We offer meetings to accommodate every schedule and encourage you to join us. [click for more]

ABOUT OBESITY

Obesity is a medical condition affecting every aspect of our life, from our general health to our mood and behavior. [click for more]

VIDEO SUITE

We have put together a video suite to include our informational seminar, interviews with our patients, and introductions from the staff and surgeon. [click for more]