Frequently Asked Questions about Obesity
Surgery
We've complied a list of answers to questions
that we frequently hear from patients that
are considering Obesity Surgery:
Bariatric surgery should be considered
for people who suffer from morbid obesity
who have an obesity-related disease and
have failed non-surgical attempts at weight
loss. Candidates for surgery have:
- A Body Mass Index of 40 or more
- Body Mass Index of 35 with health problems
such as diabetes, sleep apnea, high blood
pressure or severe arthritis and have
failed nonsurgical attempts at weight
loss.
- Obesity-related physical problems that
interfere with employment, walking, or
family function.
- Be between 18-60 years of age.
- Weigh less than 600 pounds.
If you fit the profile for surgery, answers
to the following questions may help you
decide whether weight loss surgery is appropriate
for you. Call Southern Oregon Center for
Obesity Surgery, toll free 1-888-789-5483.
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Any kind of surgery carries a certain amount
of risk, and these procedures are no exception.
However, it is no less safe than many other
surgeries and its risks generally outweigh
the risk of leaving morbid obesity untreated.
You will also undergo extensive testing
to ensure medical eligibility and appropriateness
for the surgery. Your surgeon can more thoroughly
discuss potential risks and/or complications
with you during your consultation.
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The surgeon on our web site is board certified
by the American College of Surgeons and
is a member of the American Society for
Bariatric Surgery. The dietitians are registered
dietitians and are either employees of the
hospital and/or the surgical practice. We
use licensed social workers, who have extensive
knowledge about obesity and eating disorders,
to perform psycho-social evaluations.
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The most common procedures performed are
the Gastric Bypass, which can be done open
or laparoscopically, the Lap Band® procedure,
which is performed laparoscopically and
the Duodenal Switch, which can be performed
open or laparoscopically. Dr. Mirande performs
all of the procedures.
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The first step is to call and register
for an upcoming seminar.
- Attend Seminar
- Complete Packet
- Meetings and Evaluations
- Dietician Meeting
- Psycho-Social Evaluation
- Visit with Primary Care physician
and receive a letter of medical necessity
- Attend a group support meeting
- Insurance Verification
Call Southern Oregon Center for Obesity
Surgery, toll-free 1-888-789-5483, for
more information regarding seminars.
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Call your insurance company to determine
if your benefits will cover the surgery
or if you need to participate in a medically
supervised weight-loss program. Some insurance
companies will not include it in the benefits
and can be appealed if there are other
co-existing co-morbidities.
Some insurance companies may require medical
records showing that a patient has been
involved in a medically supervised weight-loss
program for up to 12 months.
Complete your application packet, which
is available from Southern Oregon Center
for Obesity Surgery via a seminar. Call
toll-free 1-888-789-5483 for help with completing
the application or with questions.
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You should first find out why he/she has
a negative opinion:
- Has the doctor seen patients in his/her
own practice that have had poor results
after Bariatric surgery?
- Could the doctor just not know much
about the operation or, is the doctor
basing their opinion on the old gastric
bypass where patients did have problems?
Bariatric surgery is now more widely accepted
and there are physicians still out there
that do not have much exposure to it.
Maybe providing your doctor with the literature
you have received will give them insight
to the latest procedures available.
- Is the doctor prejudiced against obese
people? This is could be a situation where
it would probably be appropriate to select
another doctor.
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The surgeries are designed to reduce the
amount of food you consume at one sitting.
Because the stomach pouch is smaller, you
eat less and feel satisfied more quickly.
Your appetite is also reduced. Since you
will be eating less, you will lose weight.
Choosing the procedure that is right for
you will be discussed in detail with you
at your appointment.
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As with any surgery, there are operative
and long term complications and risks associated
with weight loss surgery procedures that
should be discussed with your surgeon at
the time of your consultation.
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Your hospital stay will vary depending
upon the procedure you undergo and how quickly
you recover:
- Gastric Bypass (open) - typically 5-7 days
- Laparoscopic Gastric Bypass - typically
2-3 days
- Laparoscopic Lap-Band - typically 24-72
hours
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It depends on the procedure being done
and every case is different, but generally,
open bypass, 2-2.5 hours; laparoscopic bypass,
1.5-2 hours; gastric band, 1-1.5 hours.
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You should bring basic toiletries (comb,
toothbrush, etc). The hospitals all provide
large hospital gowns but you can bring your
own along with a robe and slippers. Choose
clothes for the hospital which are easy
to take off and on. You will also need to
bring your bariatric care manual.
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With weight loss, some patients experience
improvement in their medical problems and
may require a smaller dose of medication.
Sometimes, their medical problems may resolve
and the patient can stop their medications.
Check with your surgeon and your primary-care
physician for specific information about
your medications and how those medications
should be monitored.
Liquid medications are ideal after your
surgery. Long-acting or extended-release
medications should be changed to immediate-release
mediations.
Pills that are larger than a pencil eraser
will need to be cut up or crushed (if appropriate)
before taking them.
Generally, you should avoid regular use
of non-steroidal anti-inflammatory drugs
(NSAIDs) and aspirin.
You will need to take a daily multivitamin
and vitamin B12 after surgery.
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Within two to six weeks generally, depending
on type of work you do. You should not be
lifting heavy items for at least four weeks
after a Lap Band procedure, and at least
eight weeks following an open procedure. Your
surgeon will help you determine when you
are ready to return to work.
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Most patients do not get hungry. In fact,
for the first 3-5 weeks, patients indicate
that they have no appetite. Your appetite
will return but it will not be "eat everything
in sight" type of hunger. What if I'm really
hungry? This is usually caused by the types
of food you are eating, especially starches
(pasta, potatoes). Also, make sure you are
not drinking liquids with food (liquids
wash the food out of the pouch). To avoid
dehydration, drink small amounts of water
frequently. Avoid all drinks sweetened with
sugar and carbonated beverages. You may
be having a psychological problem with the
lack of food in your life. Speak with your
surgeon and/or your weight loss surgery
support group therapist.
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Not necessarily. Most people can and will
eat most foods, but there needs to be
moderation, control and good food choices.
Some people may not tolerate some foods.
It is important to choose foods that are
healthy - fruits, vegetables, whole grains
and lean protein - to ensure your body
gets the nutrients you need. Southern
Oregon Center for Obesity Surgery provides
a comprehensive nutrition manual that offers
guidance at the various stages.
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Initially, about two ounces per meal. This
will increase to four to six ounces over
time. You will eat approximately three to
five meals per day.
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Patients who take the opportunity to begin
making changes after surgery have the best
results. The most successful patients do
the following:
- Comply with the diet which means that
you're eating 3 meals per day, are eating
healthy foods, drinking lots of water
(not during meals though) and taking at
least 20 minutes or so per meal.
- Exercise regularly!
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Yes, but most surgeons recommend that you
wait twelve to eighteen months after the
surgery. At one year your body will be more
stable from a weight and nutrition standpoint
and you should be able to go through a normal
pregnancy. You should be in contact with
your surgeon as you plan for pregnancy as
well as using multiple forms of birth
control for the first year after surgery.
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In general, weight loss surgery success
is defined as achieving loss of 50% or more
of excess body weight and maintaining that
level for at least five years. Clinical
data will vary for each of the different
procedures mentioned on this site. Results
may also vary by surgeon. Ask your doctor
for the clinical data stating their results
of the procedure they are recommending.
Clinical studies show that, following RNYGB,
most patients lose weight rapidly and continue
to do so until 18 to 24 months after the
procedure. Patients may lose 30 to 50% of
their excess weight in the first six months
and 70% of excess weight as early as 12
months after surgery. Another study showed
that patients can maintain a 50-60% loss
of excess weight 10-14 years after surgery.
Patients with higher initial Body Mass Index's
tend to lose more total weight. Patients
with lower initial Body Mass Index's will
lose a greater percentage of their excess
weight and will more likely come closer
to their ideal body weight.
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Weight loss surgery is major surgery. Its'
growing use to treat morbid obesity is the
result of three factors:
- Our current knowledge of the significant
health risks of morbid obesity
- The relatively low risk and complications
of the procedures versus not having the
surgery
- The ineffectiveness of current non-surgical
approaches to produce sustained weight
loss
Surgery should be viewed as a method for
alleviating debilitating disease. In most
cases, the minimum qualification as a candidate
for the procedure is 100 Ibs above ideal
body weight or those with a Body Mass Index
(BMI) of 35 or higher and obesity related
health conditions.
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Yes. The surgery is a "tool" which gives
you the mechanical means to help you manage
your food intake. But it also requires a
personal commitment from you. The weight
loss surgery support programs provide the
tools to help you become an independent
person, free from a constant reliance on
food. Online support such as Obesityhelp.com may also be a good resource for networking
with other patients on tips to manage food
intake. Surgery is a tool to help you lose
weight. You will be most successful if you
make healthy food choices, exercise regularly
and regularly attend support groups.
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Vomiting often occurs if too much food
is eaten. Long-term effects of overeating
may result in dilation of pouch or
the pouch-infective connections. THe LAP
BAND could "slip" with N/V associated
to overeating.
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Not necessarily. Careful adherence to the
post-operative instructions will often minimize
or avoid this problem. For instance, immediately
eating solid foods before you should, can
create problems. Experience shows that initial
compliance is important to increase the
likelihood of long-term success.
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You can begin by calling your insurance
company and asking if "gastric bypass" and/or
"adjustable lap band" for morbid obesity
is covered. You may get confusing information.
That's why it's important to let the Southern
Oregon Center for Obesity Surgery representative
assist you. Be aware that it does take
some time for the approval process.
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The options vary from surgeon to surgeon
but most offer a cash package which usually
includes all physician and hospital charges.
The other option is looking into financing
options.
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