The National Institutes of Health have studied morbid obesity and determined that
bariatric surgery is considered medically necessary in patients who have a body
mass index (BMI) of 40 kg/m2. This is the equivalent of being about 100 pounds above
your ideal body weight. Patients are also considered a candidate if they have
a BMI between 35 and 40 kg/m2 if they suffer from a serious medical condition such
as Type 2 diabetes, hypertension or sleep apnea.
If you are considering bariatric surgery you should also be aware of and willing
to make the necessary lifestyle changes.
At this time patients with a BMI of less than 35 kg/m2 are generally not considered
candidates for bariatric surgery. There is ongoing research looking at offering
bariatric surgery to patients with a BMI of between 35 and 40 kg/m2.
There may be certain medical conditions that may prevent you from having bariatric
surgery. Our surgeons evaluate each patient to determine if bariatric surgery is
Bariatric surgery serves as a tool to assist you in weight loss. Many of the benefits
of bariatric surgery are related to improvement in other medical conditions as a
result of the weight loss. Conditions such as diabetes, hypertension, sleep apnea,
and high cholesterol may be resolved or improved after surgery.
Our patients also describe to us an improved quality of life and the ability to
participate in activities that were too difficult prior to their weight loss.
There are risks and potential complications, including death, associated with all
surgical procedures. Morbid obesity may increase your surgical risks. It is important
that your surgeon have as much information as possible about your medical and surgical
history so that he can discuss your risks, benefits and alternative treatments with
you, and thus allow you to make an informed decision about bariatric surgery.
Risks include but are not limited to bleeding, infection, blood clots in the legs
or lungs (for gastric bypass), band slippage (for adjustable gastric banding), and
injury to surrounding organs.
The surgeon will discuss the benefits and risks of surgery at the educational seminars
and again at your office consultation.
It is important that you are as healthy as possible prior to surgery. Please discuss
your plans for bariatric surgery with your primary care physician to determine if
you are medically stable. Having optimal control of conditions such as diabetes
and hypertension may decrease your risk.
You will be asked to begin a diet prior to surgery. Your surgeon and our registered
dietitian will discuss the length and type of diet with you. The rationale for this
diet is to shrink the liver, which lies in close proximity to the stomach. The liver
stores fat so pre-operative weight loss and shrinkage of the liver may make it easier
for the surgeon to perform the surgery.
Stop smoking! Cigarette smoking or other tobacco usage increases your immediate
post-operative risks for blood clots, bleeding, poor healing, and respiratory complications.
It can also increase your long–term risk for ulcers.
Begin an exercise program prior to surgery. Exercise may improve your cardiopulmonary
status. Be sure to discuss an exercise program with your doctor before you begin
to determine if the program is appropriate for your medical situation.
Surgery done by an experienced bariatric surgeon in a facility that is experienced
in the care of the bariatric surgery patient may decrease your risks. Our team of
surgeons have done hundreds of bariatric surgical procedures. Hahnemann University
Hospital has an experienced team of nurses, medical consultants and ancillary staff
to care for you before, during and after your hospital stay.
Many insurance plans do cover bariatric surgery. We will verify your specific benefits.
If it is determined that you do have benefits, we still must generally submit a
pre-determination letter and documentation to prove medical necessity. Once we submit
the letter it may take anywhere from a few days to a few weeks to receive a response.
Generally, patients who have the laparoscopic adjustable gastric banding will spend
the night in the hospital and be discharged the next day. Patients who have the
Roux-en-Y Gastric Bypass will generally spend two nights in the hospital.
Most patients who have the Laparoscopic Adjustable Gastric Banding can return to
work after 1 week. For patients who have the Roux-en-Y Gastric Bypass, the average
return to work is 2 weeks. Time off from work may vary depending on the type of
work you do. Your bariatric surgeon will discuss your individual situation with
A multivitamin is recommended for all patients who have had bariatric surgery. Additional
supplementation of Vitamins B-12, D-3, calcium, and iron may be necessary depending
on the surgical procedure. Your surgeon and the dietitian will discuss this with
you prior to surgery.
Your surgeon will see you back approximately 2 weeks after surgery. For patients
who have had LAGB, your first adjustment will generally be 4-6 weeks after surgery.
You will need to be seen frequently to determine the need for further adjustments.
Patients who have the Roux-en-Y Gastric Bypass are usually seen 2 weeks, 4 weeks,
8 weeks, 3 months, 6 months, 9 months, and one-year post-operatively, and then annually.
It is imperative that you continue to follow-up with your bariatric surgeon and/or
the support staff including the nurses and dietitian. Bariatric surgery requires
a long-term commitment between the patient, the surgeon and the program!
Weight loss will vary from patient to patient. There are a number of factors that
can influence your weight loss including age, pre-operative weight, gender, and
compliance with follow-up, dietary guidelines and lifestyle changes (such as exercise).
Generally, patients who have laparoscopic adjustable gastric banding will lose about
50% of their excess body weight. The majority of the weight is lost in the first
year but continues over a period of 2-3 years. Patients must have regularly scheduled
follow-up with the surgeon for adjustments in order to achieve maximum success.
Patients who have the Roux-en-Y Gastric Bypass average a weight loss of 60- 80%
of excess body weight. Most patients will lose most of their weight in the first
year. Some patients may experience about a 20% weight regain but will generally
maintain a 60-70% loss of excess body weight.
Please keep in mind that bariatric surgery is only a tool. Patients must learn to
utilize that tool effectively. We are here to help you by providing ongoing educational
classes with our registered dietitian and support groups to assist you with making
the necessary lifestyle changes.
Significant weight loss may lead to excessive skin in areas such as the neck, abdomen,
arms, and thighs. For some patients the excessive skin may cause problems with skin
irritation and rashes. For others it may be bothersome from a cosmetic perspective.
A plastic surgeon will be able to determine the type of procedure that is needed
and if there is medical necessity. It is recommended that you wait until you have
lost most of your weight before considering plastic surgery.
Morbidly obese women may often have problems with fertility and the ability to become
pregnant. Obesity may also increase the risk of complications during pregnancy.
Pregnancy is not advised during the first 2 years when the most rapid weight loss
is occurring as it may deprive the fetus of essential nutrients that it needs to
grow. Because weight loss may improve fertility, it is imperative that a reliable
form of birth control be used following surgery. Women who are contemplating bariatric
surgery and future pregnancy should discuss this with their obstetrician/gynecologist.